Whether it’s Baton Rouge, La.-based Our Lady of the Lake Cancer Institute — part of FMOL Health — becoming the first facility in Louisiana to administer CAR-T therapy in an outpatient setting, or New Hyde Park, N.Y.-based Northwell Health’s $1.1 million investment in outpatient infusion therapy services at the R.J. Zuckerberg Cancer Center in Lake Success, N.Y., oncology care is moving beyond the traditional hospital setting at a rapid pace.
As health systems confront the operational, logistical and cultural challenges that extend far beyond clinical delivery, Becker’s asked11 oncology leaders where their peers may be underestimating the complexity of moving cancer care outside of hospital walls.
The contributors to this article are speakers at Becker’s Oncology Executive Summit in Chicago. Learn how to join Becker’s next event here.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: As cancer care continues shifting beyond the hospital walls, what capabilities do health systems most underestimate when expanding outpatient, home-based or mobile oncology services?
Dhruv Bansal, MD. Director of Immunotherapy and Thoracic Oncology at Endeavor Health (Evanston, Ill.): As cancer care moves beyond hospital walls, health systems often underestimate the operational complexity of safely expanding outpatient, home-based or mobile oncology services. The primary challenges are not necessarily clinical expertise but rather logistics, data integration and escalation pathways. Successful outpatient and home-based oncology care requires real-time symptom monitoring, rapid response protocols, medication management infrastructure and close coordination among oncology teams, nursing, pharmacy and emergency services. Without these capabilities, shifting care settings can increase risk rather than add value.
Adaptation of staffing models is also essential; clinicians and nurses need dedicated time, specialized training and tailored decision support for remote care. In addition, patient education and caregiver readiness are often underestimated but are critical to success. Ultimately, expanding care beyond hospital settings is most effective when infrastructure is designed for reliability and safety as top priorities, rather than for convenience alone.
Richard Barakat, MD. Physician-in-Chief and Executive Director at Northwell Health Cancer Institute (New Hyde Park, N.Y.): Health systems expanding outpatient, home-based or mobile oncology services consistently underestimate the specialized sophistication of patient navigation and care coordination these distributed models demand. This shift isn’t just a relocation of services; it’s a fundamental reimagining of how patients are guided and how their care seamlessly integrates across varied, less controlled environments.
Effective navigation in this new paradigm moves beyond basic appointment scheduling or paperwork, requiring a holistic approach that supports patients through every dimension of their journey. This includes:
- Connecting them with essential non-oncologic support, such as social work and nutrition.
- Actively identifying and mitigating social determinants of health barriers like transportation, housing instability and food insecurity.
- Providing expert guidance on complex financial and insurance matters.
- And crucially, extending comprehensive understanding and support to their caregivers.
Ultimately, this necessitates a profound commitment to redesigning the “how” of care delivery, not merely the “where.” Given the overwhelming nature of a cancer diagnosis and the ongoing shift of care beyond traditional hospital walls, robust navigation is paramount to ensuring continuous, supportive guidance for patients through every phase of treatment and recovery.
Frantz Berthaud. Senior Vice President of Oncology Services at University Medical Center of El Paso (Texas): As care decentralizes, complexity grows exponentially. I think organizations underestimate the invisible infrastructure needed to orchestrate care — safely and efficiently — across the various settings. Looking at home or mobile oncology care, you’re looking at things as micro as drug prep, chain of custody of medicine, courier workflows, the need for remote monitoring, some sort of virtual oversight for symptom management, escalation when things don’t go as planned, etc. I think, oftentimes, health systems assume we can just layer the needs for this different care setting on top of existing pharmacy, technology and nursing operations.
Natasha Carrera. Associate Director of Service Line Management at Fred Hutchinson Cancer Center (Seattle): As oncology care continues to shift, one truth is becoming increasingly clear: the greatest obstacles to scale aren’t clinical — they’re operational. Health systems often underestimate the depth of infrastructure required to deliver cancer care safely in outpatient clinics, homes and mobile environments. It’s not simply a matter of relocating where care happens; it’s about re‑engineering how that care is orchestrated end-to-end.
This transformation begins with a centralized, disease‑specific access and intake engine that ensures patients enter the system smoothly and land in the right place from the start. From there, longitudinal navigation becomes the connective tissue — quarterbacking each patient’s journey across settings, preventing fragmentation and ensuring no handoff is left to chance.
To truly move care outside the hospital, organizations must also build reliable 24/7 escalation pathways capable of managing treatment‑related toxicity in real time, before it becomes an emergency. That same level of readiness must extend to pharmacy and logistics operations, which now serve as critical enablers when complex therapies are administered beyond traditional infusion centers.
Workforce models must evolve as well, blending APPs, RNs and virtual care teams into integrated units capable of supporting patients wherever they are. All of this rests on digital platforms that allow for real‑time monitoring, timely intervention and seamless information flow — technology that turns data into action rather than just documentation.
Operational readiness also depends on the less visible but equally essential underpinnings: contracting strategies that support site‑of‑care shifts and strong network partnerships that allow for true hub‑and‑spoke models across communities and geographies.
The organizations that master this operational “choreography” will do more than expand access — they will define the future architecture of oncology care that is more distributed, more responsive, and ultimately, more patient centered.
Arturo Loaiza-Bonilla, MD. System Chief of Hematology and Oncology at St. Luke’s University Health Network (Bethlehem, Pa.): As cancer care shifts beyond hospital walls, health systems often underestimate the importance of orchestration. Expanding outpatient, home-based or mobile oncology isn’t just about deploying staff or devices. This requires real-time data integration, decision support and rapid escalation pathways across fragmented settings. Without strong coordination, care simply moves locations without becoming safer, more efficient or more patient-centered.
Ruben Mesa, MD. President of the Cancer National Service Line and Senior Vice President at Advocate Health (Charlotte, N.C.) and Executive Director of Atrium Health Wake Forest Baptist Comprehensive Cancer Center (Winston-Salem, N.C.); and Nike Onifade. Senior Vice President of the National Cancer Service Line at Advocate Health: This question sparked a robust discussion among our senior leadership team. We are energized by the growing opportunity to bring cancer care closer to our patients, whether that’s through care at home, mobile infusion services, clinical trial enrollment or expanded screening options like mobile lung CT and mammography. Building on our experience with our system’s nationally recognized hospital-at-home program, we’re exploring new models that make it easier for patients to access high-quality cancer care no matter where they live, including partnering on a federally funded project to revolutionize mobile cancer care by bringing infusion services to rural areas through mobile hospital hubs.
An important challenge health systems underestimate is the cultural barriers to rapidly scaling home and mobile care. These include moving away from a care model centered on ‘visits,’ whether in-person or virtual, and addressing reimbursement structures that have traditionally been tied to facility-based care rather than models that support and incentivize care delivered in the home or community. We’re optimistic these barriers can be overcome, particularly as patient experience, outcomes and access are likely to improve with expanded remote and mobile care options.
Amar Rewari, MD. Chief of Radiation Oncology at Luminis Health (Annapolis, Md.): Health systems consistently underestimate the operational complexity of managing risk outside the hospital.
Delivering oncology care in the home or outpatient setting isn’t just about shifting the site of service; it requires real-time clinical monitoring, rapid escalation pathways and tight coordination across pharmacy, nursing and physicians. Without that infrastructure, small issues become emergency department visits.
The systems that succeed are the ones that build centralized command capabilities and treat outpatient oncology as a continuous care model, not a series of disconnected encounters.
Urshila Shah, PharmD. Chief Pharmacy Officer at Westchester Medical Center Health Network (Valhalla, N.Y): Health systems often underestimate the operational and pharmacy infrastructure required to deliver cancer care outside the hospital. Reliable medication handling, symptom monitoring, escalation pathways and redesigned workforce models are essential for safety and scale. When pharmacy and oncology are aligned under unified leadership, these capabilities can be integrated more effectively, enabling consistent, high‑quality care across outpatient, home‑based and mobile settings.
Walter Stadler, MD. Chief Clinical Officer at City of Hope Chicago: The need for different kinds of nursing support and the fact that electronic communication methods are markedly underutilized by the elderly and underserved populations.
Sai Yendamuri, MD. Chief Strategy Officer and Senior Vice President of Business Development and Outreach at Roswell Park Comprehensive Cancer Center (Buffalo, N.Y.): Health systems are cruise ships, not speedboats. Change is hard, particularly given the operational and legal complexity of healthcare delivery in the United States. While technological limitations are the most easily overcome, systems routinely underestimate regulatory complexity and the financial cost of process change.
Even more difficult is changing the process flow in physician and patient behavior and expectations. In the former case, we have a physician body that is dealing with a lot of burnout and recovering from the false promise that electronic health records will make their lives easier. In the latter case, the generation that develops cancer is not necessarily comfortable with receiving care through mobile health. While this landscape is rapidly evolving on all fronts, operational complexity and acceptance are consistently underestimated.
At the Becker's Perioperative Summit, taking place September 14–15 in Chicago, perioperative leaders and healthcare executives will focus on improving operating room efficiency, enhancing patient safety, optimizing staffing and driving innovation across surgical services. Apply for complimentary registration now.
