One of the biggest challenges in cancer care delivery is getting harder to ignore, according to leaders who spoke at Becker’s Oncology Executive Summit in April. The geographic distribution of National Cancer Institute-designated cancer centers — the most research-intensive cancer care facilities in the U.S. — does not reflect where the nation’s cancer burden is highest. The consequences of that misalignment are playing out in real time.
There are 73 NCI-designated cancer centers across 37 states and the District of Columbia. Nearly 40% of the states with higher-than-average cancer incidence have no NCI-designated cancer center. Meanwhile, almost one-fourth of U.S. cancer centers can be found in two states.
“New York has 10% of the NCI designated cancer centers in the country. California has another 12%,” Richard Barakat, MD, physician-in-chief and executive director of the Northwell Health Cancer Institute in Lake Success, N.Y., said at the summit.
The dynamic is unfolding in the Boston area ahead of the impending split in 2028 between Dana-Farber Cancer Institute and Mass General Brigham. Dana-Farber is constructing a $1.68 billion freestanding inpatient cancer hospital with Beth Israel Deaconess Medical Center, while Mass General Brigham has established the Mass General Brigham Cancer Institute and unveiled plans to invest $400 million to expand oncology services.
The combined investment of more than $2 billion for NCI-designated cancer care in Boston will sit a few hours’ drive from Maine and Vermont — two states with no NCI-designated cancer centers and cancer mortality rates well above the national average.
Sachin Apte, MD, chief clinical officer at Salt Lake City-based Huntsman Cancer Institute, detailed the geographic challenge during the Oncology Executive Summit. Huntsman serves patients across Wyoming, Montana, Idaho, Nevada, Utah and western Colorado — covering 17% of the continental U.S. State lines, he said, function like an iron curtain: A hospital seven miles from a border may be clinically equipped to serve patients on the other side, but licensing, credentialing and Medicaid coverage restrictions make crossing that line effectively impossible.
As the level of NCI-designated cancer care available in Boston doubles, it may be inaccessible for Medicaid patients in Maine and Vermont.
For patients outside the orbit of an NCI-designated center, clinical trials are largely out of reach.
A 2024 study found that only 7.1% of all U.S. cancer patients participate in clinical trials. At NCI-designated cancer centers, trial enrollment jumps to 21.6%.
Health systems that opt to integrate clinical trials as a core component of oncology care are faced with the challenge of not only identifying eligible patients but also enrolling and supporting them throughout the trial journey.
Miguel Gonzalez-Velez, MD, a medical oncologist at Edison, N.J.-based Hackensack Meridian Health, told Becker’s that real-time trials require the ability to continuously submit clean data — a capability most community and midsize academic centers do not currently have.
“If we don’t invest in lifting that floor, real-time trials risk deepening the geographic and demographic disparities in phase 1 access that already exist,” he said.
In response to this divide, health systems and regulators are pursuing strategies aimed at expanding clinical trial enrollment and reducing the administrative hurdles associated with research.
Charlotte, N.C.-based Advocate Health partnered with AI platform Lind to automatically screen patients for trial eligibility through the system’s EHR. Chicago-based Northwestern Medicine partnered with Vizlitics on AI-powered trial matching, screening more than 95% of patients before their initial consultations. Meanwhile, New York City-based Mount Sinai’s Tisch Cancer Center launched an AI platform called PRISM, which analyzes patient information and matches individuals with relevant clinical trials.
At the federal level, the FDA unveiled a new clinical trial model in April that will allow the agency to monitor safety signals as trials are conducted. HHS launched Operation TrailBlazer on June 22, directing six agencies to reduce regulatory barriers that have slowed U.S. clinical research relative to other countries, with the FDA targeting a six- to 12-month reduction in early trial timelines.
As health systems invest billions of dollars in cancer care facilities and research capabilities, NCI-designated cancer centers continue to fuel practice-changing breakthroughs and innovation.
Walt Stadler, MD, City of Hope Chicago’s chief clinical officer, framed the stakes at the summit’s closing session: The most underestimated challenge in oncology today is not innovation, it’s access.
“What we underestimate is the last mile problem,” Dr. Stadler said. “How do we deliver all of this to our patients, regardless of where they live and regardless of their economic uncertainties?”
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