The Future of Oncology Is Driving Value, Access, Innovation From Inpatient to Outpatient Care

Novel cancer treatments, such as bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapy, are transforming patient care, but their integration into health systems demands a strategic shift toward outpatient administration to expand access and curb costs, according to experts at session held June 17, 2025.

Presented by The American Journal of Managed Care with the theme “Driving the Future of Cancer Care,” the discussions underscored the critical shift toward outpatient delivery of these therapies, fueled by a desire to reach more patients and a better grasp of how to manage treatments. Experts addressed operational considerations and the collaboration needed to bring treatments close to patients.

Shifting Therapies to Outpatient Care

Tyler Sandahl, PharmD | Image: LinkedIn

“A lot of our main push has been to move as many to outpatient as possible to cut down on those inpatient costs of care. Another piece that we’re looking at, especially in the myeloma group, is extended interval dosing for the long-term therapies, especially with bispecifics,” explained Tyler Sandahl, PharmD, clinical pharmacy specialist at Mayo Clinic in Rochester, Minnesota.

Successful outpatient administration of CAR T and bispecific therapies requires robust infrastructure and comprehensive education, panelists said. This includes developing triage processes and ensuring solid support systems are in place to safely treat patients outside of the traditional inpatient setting. There are 7 FDA-approved CAR T-cell products available for commercial use, and some have been approved in earlier lines of care; the result is a rapidly changing treatment landscape for several blood cancers, including multiple myeloma.1 The panelists also covered the implementation of single-region CAR T models, along with the critical role of pharmacy support.

Challenges persist with reimbursement for CAR T and bispecific therapies, including resistance from insurers for inpatient admissions. Panelists stressed the importance of closely monitoring payers and contracts, especially for patients covered by Medicare or Medicaid. The intricate and costly nature of CAR T-cell treatment requires financial planning and coordination for outpatient CAR T-cell therapy programs.1 Some recommend creating a dedicated reimbursement team or engaging a reimbursement specialist to navigate the intricacies of payments and optimize financial sustainability.

“It’s really important to educate and emphasize…that this access for patients is critical, and we need to do this, and we can do it. Patients can be treated in the outpatient setting, so that’s been our big focus as we’re rolling it out,” said Sara Moran Smith, PharmD, BCOP, oncology pharmacy program manager at Allina Health.

Advancements in NSCLC Treatment
Significant progress in non–small cell lung cancer (NSCLC) treatment is improving patient outcomes, thanks to the arrival of immuno-oncology and targeted therapies such as taletrectinib. The FDA approved taletrectinib (Ibtrozi; Nuvation Bio Inc) on June 11, 2025, to treat patients with ROS1-positive locally advanced or metastatic NSCLC. The approval was based on results from the phase 2 TRUST-I (NCT04395677) and TRUST-II (NCT04919811) trials.2

Robert Kratzke, MD | Image: University of Minnesota

“When the American Cancer Society gives its annual numbers, many of us know that survival is improving for cancer, and the cancer death rate is going down. A lot of that, frankly, if you look at the numbers, is driven by improvements in stage IV lung cancer,” said Robert Kratzke, MD, professor of medicine and section head of medical oncology, Division of Hematology, Oncology, and Transplantation, at the University of Minnesota in Minneapolis.

Testing with next-generation sequencing (NGS) is crucial for patients with NSCLC, although turnaround times for results remain a challenge. Panel experts emphasized the need for broad-based NGS testing and emphasize the need to integrate these results seamlessly into electronic medical records for comprehensive patient management. Reflex testing, in which pathologists automatically order additional biomarker testing based on initial results, is also vital for guiding treatment decisions.

Integration of novel treatments requires robust infrastructure, a point echoed in discussions about pharmacy’s role in managing these therapies. For complex cases involving neoadjuvant therapy, tumor boards are essential in guiding treatment decisions. The panelists consistently emphasized the overarching importance of clinical trials and ensuring timely patient access to innovative therapies.

The discussion also covered the growing role of home infusion in oncology care, with panelists stressing the need for specialized training for nurses who deliver this care. This aligns with the broader theme of patient-centric care and prompt access to new therapies.

“About 50% to 60% of people in Minnesota live in the metro area, but once again, there are people with lung cancer in all these other places. I think even [when] we do the first dose and the step-up dose in a tertiary care center, we should be looking at the ability to give the subsequent doses of [bispecific T-cell engagers] in our other infusion centers,” Kratzke noted.

Bridging Academic and Community Oncology
Effective partnerships between academic and community practices are crucial for improving patient outcomes. These collaborations demand clear communication and standardized approaches, the panelists stressed.
“As we are thinking about this movement and where patients are going, we really need to look at the patient as a whole, the journey as a whole, communicate more, develop protocols where we can, and standardize our algorithms,” said Clayton Irvine, PharmD, MBA, MS, senior manager of oncology cancer care at Mayo Clinic. “Then from a financial side, where does [treatment] make the most sense, not just for the institution, but for the patient? I think that would really help drive some of this as we look at downstream impacts.”

The discussion also delved into the complexities of home infusion services, highlighting the urgent need for innovative solutions. Policy, regulatory frameworks, and reimbursement landscapes significantly impact the viability of home chemotherapy infusion, underscoring the vital role of financial considerations and standardized decision-making algorithms, the panelists noted.

Recognizing the inefficiencies often found in home infusion compared with community centers, panelists advocated for improved patient movement. They proposed academic-community partnerships to optimize patient care, suggesting artificial intelligence algorithms could predict which patients are best suited for treatment at community sites, thus easing the burden on academic centers. A hub-and-spoke model can streamline patient transfers and boost clinical trial participation, they noted. The conversation further explored how academic centers could pool resources and expertise for more efficient clinical trial management.

Finally, the critical issue of drug shortages was addressed, with panelists stressing the need for enhanced collaboration between academic and community centers. The discussion focused on establishing robust interchange networks to navigate drug shortages and ensure optimal therapy choices. Telemedicine in oncology was also proposed to facilitate joint patient visits and discussions about clinical trials.

Challenges in Community Oncology
Implementing National Comprehensive Cancer Network (NCCN) guidelines in community oncology primarily focuses on clinical trial enrollment. Panelists highlighted significant hurdles such as patient education and financial burdens, and they suggested integrating clinical trial information directly into NCCN guidelines to streamline the enrollment process for providers. They also stressed the crucial need for improved education and support for primary care providers to boost trial participation.

Eric Lander, MD | Image: Minnesota Oncology

The panel addressed the widespread use of circulating tumor DNA (ctDNA) testing in gastrointestinal oncology, despite its lack of NCCN endorsement. Adopting new tests without clear NCCN guidelines presents challenges, underscoring the need for practical guidance for community oncologists.
“Maybe the NCCN needs its own guidelines, just for ctDNA, that might be useful. It’s definitely a challenge, and we’ve seen CtDNA used incorrectly sometimes too—where there are no data whatsoever—and people are adjusting their decisions based on that,” explained Eric M. Lander, MD, site research leader at Minnesota Oncology in Minneapolis.

The panelists also touched on the approval and accessibility of NCCN category 2B recommendations. The category 2B recommendation indicates that an intervention is considered appropriate based on lower-level evidence, with a consensus among NCCN panelists (≥ 50%, but < 85%).3 Lander suggested that payers should approve these recommendations to guarantee patient access to beneficial treatments. Understanding payer policies and acknowledging the potential administrative burden of category 2B recommendations remains essential, he said.
The panelists then explored potential cost savings and the market impact of biosimilars. Lander emphasized the importance of quantifying actual time savings and nursing resources to thoroughly evaluate the cost-effectiveness of subcutaneous therapies.

The implementation of survivorship guidelines was a key topic, with panelists stressing the challenges of developing practical guidelines for community oncologists and the importance of dedicated survivorship clinics.

“I hope that the NCCN will have practical guidelines in terms of each disease and the age of [the patient], because sometimes we have a patient with breast cancer in their 30s vs a patient with prostate cancer in their 70s. Those survivorship guidelines should be completely different. I don’t see that we have clear guidelines. I hope we’ll have more guidelines, especially in the community, because 75% of oncology patients are treated as a community. How are we going to do that better? I want to learn more,” Yan Ji, MD, PhD, MS, hematologist and oncologist at HealthPartners Institute, concluded.

References
1. Gatwood K, Mahmoudjafari Z, Baer B, et al. Outpatient CAR T-cell therapy as standard of care: current perspectives and considerations. Clin Hematol Int. 2024;6(2):11-20. doi:10.46989/001c.115793
2. Shaw ML. Taletrectinib approved for ROS1-positive NSCLC. AJMC. June 11, 2025. Accessed June 26, 2025. https://www.ajmc.com/view/taletrectinib-approved-for-ros1-positive-nsclc
3. Development and update of guidelines. NCCN. Accessed June 26, 2025. https://www.nccn.org/guidelines/guidelines-process/development-and-update-of-guidelines