Real-World Analysis Links Community Oncology Care to Markedly Longer Survival in Breast and Lung Cancer

Patients with de novo metastatic breast cancer and metastatic non-small cell lung cancer treated in independent community oncology practices within the Flatiron Health Research Network had survival outcomes that were better than, or comparable to, national SEER benchmarks, according to a new real-world analysis commissioned by the Community Oncology Alliance and conducted independently by Flatiron Health.

The Phase 1 report evaluated overall survival in two common metastatic cancers, using electronic health record-derived data from more than 220 community oncology practices and comparing outcomes with estimates from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. The analysis included patients diagnosed between January 2013 and December 2022, restricted to de novo stage IV disease to improve comparability because SEER does not reliably capture metastatic recurrence.

In the full cohort analysis, median overall survival for metastatic breast cancer was 44 months in the unadjusted Flatiron Health Research Database cohort, compared with 29 months in SEER. After standardizing the Flatiron cohort to match SEER by age, sex, race or ethnicity, and breast cancer subtype, median overall survival was 46 months. For metastatic NSCLC, median overall survival was 11 months in the unadjusted FHRD cohort, 6 months in SEER, and 12 months after standardization.

"Where people receive cancer treatment matters. Community oncologists deliver care associated with longer survival, which means more time spent with family and friends," said Debra Patt, MD, PhD, MBA, president of COA and executive vice president of policy and strategy at Texas Oncology. “Amidst an uncertain business and regulatory environment, community oncology must remain a viable option for patients who depend on it every day, in communities across the country.”

The study also examined treated cohorts to address a key methodological issue: the Flatiron database requires at least two documented oncology visits, which may select for patients more likely to receive active care. Treatment rates were higher in the FHRD cohort than in SEER, 91% vs 58% for metastatic breast cancer and 78% vs 51% for metastatic NSCLC. When the comparison was limited to patients with documented treatment, survival differences narrowed but remained numerically higher in the community oncology cohort, 48 vs 40 months for metastatic breast cancer and 15 vs 13 months for metastatic NSCLC.

The report suggests that higher rates of cancer-directed therapy initiation may partly explain the survival advantage. This interpretation is supported by subtype findings in metastatic breast cancer. In treated patients, median overall survival was higher in FHRD than SEER for HR-positive/HER2-negative disease, 50 vs 44 months, and HER2-positive disease, 67 vs 61 months. By contrast, outcomes were nearly identical in triple-negative breast cancer, 16 vs 16 months, a subtype with poorer prognosis and fewer targeted treatment options during much of the study period.

"Survival is the gold standard of cancer care's effectiveness, and this research underscores community oncology's ability to deliver high-quality outcomes, with both convenience and personal care," said Stephen Divers, MD, a member of COA's board, and medical oncologist and hematologist at Genesis Cancer and Blood Institute in Hot Springs, Ark. "Receiving a cancer diagnosis is never easy, so it can be reassuring for a patient to know they're in good hands at a community oncology practice."

The findings are clinically relevant because most cancer care in the United States is delivered outside academic centers. Community oncology practices, defined in the release as physician-owned and physician-led independent oncology practices not owned or operated by a hospital, health system, academic medical center, or health insurer, often serve patients closer to home. The analysis adds to evidence that these settings can deliver outcomes aligned with, and in some measures exceeding, national benchmarks.

However, the results should not be interpreted as proving that community oncology itself causes longer survival. The report notes several limitations, including residual confounding, incomplete treatment information in SEER, possible selection bias in treated cohort analyses, and the fact that SEER data through 2022 may not fully reflect more recent therapeutic advances.

"Provider partnership is central to how we work at Flatiron, and this collaboration reflects our commitment to advancing care in the community oncology field," said Quincy Weatherspoon, VP & General Manager, Point of Care Solutions at Flatiron Health. “By combining our research-ready data with COA's advocacy voice and relationships, we're helping bring greater clarity to the realities of care in community oncology—and turning those insights into actionable data and better patient outcomes.”