Key takeaways
- Expertise can travel even when patients cannot. Cross-institutional partnerships can help community oncologists interpret complex testing and treatment options without moving every patient to a major center.
- Oncology education remains unevenly accessible, especially in lower-resource settings where structured fellowship programs may be limited or absent.
- Clinical trial access is often limited by the system itself, including transportation barriers, administrative requirements, and the difficulty of opening studies at smaller sites.
- Value-based care investments can strengthen community practices by supporting navigation, remote nursing, social work, and more coordinated team-based care.
- Scale only helps if it improves access without stripping away local control. Networks, partnerships, and investment models work best when community practices remain involved in decisions and resources are shared more effectively.
At the Community Oncology Global Congress (COGC 2026), organized by OncoDaily, Allen Chen, Vice President of Medical Affairs and Clinical Development at BillionToOne, moderated an expert discussion with Roupen Odabashian of Abbotsford Regional Hospital, Debra Patt of the Community Oncology Alliance and Texas Oncology, Fernando Maciel Barbosa of University of Iowa Health Care, and Glenn Balasky of Rocky Mountain Cancer Centers on how community oncology networks can expand access to expertise, diagnostics, clinical trials, and high-quality care across very different healthcare systems.
The conversation stretched from Brazil and Canada to the United States and other resource-limited settings, but the same problem surfaced repeatedly: expertise and innovation exist, yet they remain concentrated in places many patients cannot easily reach.
The challenge was how to expand access to specialist expertise, clinical trials, and diagnostics without forcing patients to leave their communities for every part of their care.
Centralize Expertise, Not the Patient
Barbosa drew on his experience practicing first in Brazil and later in the United States.
In Brazil, access gaps extended beyond molecular testing itself to targeted therapies, immunotherapies, and antibody-drug conjugates. But even when broader genomic testing became available, another problem emerged: clinicians needed support interpreting an increasing volume of molecular information.
A collaboration between Oncoclínicas and Dana-Farber Cancer Institute helped fill that gap.
“Whenever we had a clinical case that we wanted to discuss with the Dana-Farber team, we had the opportunity once a week to meet with people from Boston and get education on how to interpret data from genomic testing.
Once we had broader testing, that created a lot of information and data, but we did not necessarily have the expertise to handle that information.
Having large centers with experts helping us interpret the data and select which patients were the best candidates for a particular treatment made us much stronger in our area.”
For Barbosa, the lesson was not that every complex case needed to move to Boston. The expertise could move instead.
Cross-institutional partnerships can allow community clinicians to retain patients locally while still accessing specialized molecular interpretation and treatment guidance.
Why Is Oncology Education Still So Hard to Access?
For Odabashian, one of the largest opportunities for cross-border collaboration is education.
Having worked across the Middle East, United States, and Canada, he described striking differences in access to structured oncology training.
“The degree of education that I noticed is not available for everyone across the world.
And this is a system issue.
You can go to a platform like edX or Coursera and access world-renowned lecturers from Harvard teaching computer science.
Why do leading oncology institutions not create educational programs for oncologists across the globe and make them available in the same way?
For people in the United States or Canada who can pay, we can pay. But at least make them accessible to people in low- and middle-income countries.
These people need it.”
In some settings, he said, clinicians effectively create their own informal training structures because formal oncology fellowship programs are unavailable.
That means expertise is often passed from one self-trained clinician to the next rather than through a standardized educational pathway.
Chen captured the idea in a simple response:
“We should do Coursera for oncology.”
When the Trial Exists but the Patient Still Cannot Reach It
Odabashian identified clinical trial access as the second major area where existing systems create their own barriers.
Even in Canada, he described a patient living roughly an hour from downtown Vancouver who faced transportation difficulties accessing a trial available there.
The larger frustration was structural.
“Opening a clinical trial in a specific center requires signing more than 200 documents.
If a trial does not exist here, why can’t the drug be shipped from there to here?
Why can’t we enroll a patient on a specific protocol without creating all of these additional layers?
Over the years, we came up with rules. Then we put more rules, and more rules, to the degree that now the system itself limits who can get enrolled in clinical trials.
The system needs to change. It is not us as oncologists.”
If patients near major North American research centers still struggle with trial access, he argued, the problem is likely far greater in lower-resource countries.
Value-Based Care Built More Than a Payment Model
The discussion then moved from global access to lessons from community oncology networks in the United States.
For Balasky, one of the enduring lessons of value-based care is that better cancer care requires a team around the patient.
“The doctor may not be thinking about the psychosocial needs or the transportation needs of the patient, but the social worker is.
So how do we bring that all together?
That means you have to have a team.”
Navigators, social workers, nurses, and other members of the care team can address needs that extend beyond treatment selection while helping practices operate more efficiently.
Patt expanded on what that looked like at Texas Oncology.
Participation in value-based models such as the Oncology Care Model required substantial investment in remote nursing, patient tracking, social work, and other systems. She estimated that the practice invested more than $100 million in infrastructure over time.
But those investments created benefits beyond the payment model itself.
“We put systems in place to serve patients – remote triage nurses answering calls, social workers helping with food insecurity and transportation insecurity.
Those systems actually helped us with operational efficiency in the practice.
Our people are able to act at the top of their license.”
For Patt, focusing only on whether a national payment model generated overall savings misses part of the story.
“People can say value-based care was a failed experiment, if you will, but that is not the whole story.
If you look at the natural consequences of the investments we made, we are actually doing a better job of allowing our people to act at the top of their license and serving patients where they are.”
Scale Can Help – But the Model Matters
Chen closed the discussion with a more difficult question: as independent practices face growing infrastructure and administrative demands, can consolidation and outside investment help – or could they create new barriers?
Patt resisted a simple answer.
“It is complex.
Small independent practices, because of all the infrastructure investments and administrative burden, are finding it increasingly difficult to do everything they need to do and remain successful.
That creates an opportunity for alignment, consolidation, or investment.”
Those options may include hospital systems, clinically integrated networks, or private equity.
Patt emphasized that her own experience shapes her perspective, but argued that physician autonomy can differ substantially depending on the model.
“When you have alignment with a clinically integrated network but remain a physician-independent private practice, you have more autonomy and participation in those decisions because it is a partnership.
We are able to influence a lot of the investments that are made because we are part of the process.”
The issue, then, is not simply whether community practices become larger.
It is whether scale gives clinicians and patients more access, more infrastructure, and more capability without disconnecting decisions from the communities being served.
Break Down the Barriers Between the Resources
Balasky offered the final synthesis.
“There is enough money in cancer care. It is just pocketed in places and protected.
If there were some way to break down those barriers, redistribute some of those resources, and break down that compartmentalization, I think there would be room to help more patients worldwide.”
Chen agreed that the goal should be to build a model in which the incentives work for everyone involved.
Across the panel, the proposed solutions looked different – global education, academic-community partnerships, decentralized trial access, navigation, value-based infrastructure, and stronger networks.
But they pointed toward the same principle.
Community oncology does not become stronger by moving every patient toward the center. It becomes stronger when expertise, research, resources, and support can move outward toward the patient.
Written by Eliz Baloyan, MD, Features Writer and Editor at OncoDaily and CancerWorld
