Beyond Adding Chairs: Thinking About Smarter Expansion of Cancer Care

As cancer care increasingly shifts into the outpatient setting, oncology centers are facing growing pressure to accommodate rising patient volumes, increasingly complex treatments, and limited operational resources.

The 2026 State of Cancer Centers report from LeanTaaS examined these challenges through a survey of nearly 300 leaders across community practices, academic cancer centers, and infusion centers. The findings highlight the need for oncology organizations to think beyond simply expanding physical capacity and consider how scheduling, patient flow, workforce demands, and other operational factors affect the delivery of care.^1,2

In an interview with Targeted Oncology^TM, Donna Berizzi, RN, DNP, OCN, NEA-BC, associate chief nursing officer, oncology service line at Johns Hopkins Medicine, discussed the report's findings and the operational challenges that accompany growth. Drawing on her experience within an academic cancer center, she also addressed how oncology practices can leverage data and artificial intelligence (AI) to improve workflows and how academic and community practices can work together to support patients receiving increasingly complex therapies.

Targeted Oncology: What do you think is the biggest takeaway from this year's State of Cancer Centers report?

Donna Berizzi, RN, DNP, OCN, NEA-BC: I think as cancer care continues to grow, it's not about only adding resources. Now, I'm not saying that resources aren't important… but everyone talks about growth. And unless you live out in the Midwest where you have acres of land to be able to build a building, we've got to think of this differently and not just adding chairs. We have to make sure that our environment is acceptable for our patients, that the workforce is strong, and that our scheduling is on target. Not looking at the big-picture data makes it very difficult to do this.

I think for me, when you look at the statistics from this report that LeanTaaS gathered, when you look at the fact that 65% of cancer centers are expanding services, that's huge; it's all across the country. Not only that, but 61% are still saying that [patient] flow and scheduling are their biggest concerns. So, we have this enormous opportunity here [to identify how we are] going to balance these challenges. We want to expand our services, and really, the push in oncology is we want to move as much of oncology services we can to the outpatient setting, and I would say sometimes we even push the envelope a little bit.

I think we want to make sure that we are not creating more strain for our patients. We are already at the point of squeezing our current resources. Every time we add something else, it has a cascading effect on pharmacy and scheduling, so we have to look at this from a global perspective. For us at Hopkins, we saw this firsthand. Growing patient volumes and more complex treatments bring out more challenges…and that is from a patient education and nursing perspective. The last thing we want is for our patients to have to be here any longer than they need to. So, I think as we experience…any of these daily inefficiencies, it does have a long-term effect on all of those pieces, so we've got to look at it [through] everybody's lens[es].

I think the other piece of data that is very striking is that 74% of the respondents said that the data that they have access to now—or don't have access to—is very difficult to assess… 92% report limitations with their electronic health record; for us, it's Epic, and we know that we are not always able to get the best report from Epic Reports. It's very complicated; you need people to help you set up those reports, so I think that's challenging… I also think that with the partnership with a company like LeanTaaS, we can look at historical data and harness the impact of what those data say.

Where do you think AI tools can provide meaningful value in the oncology clinical workflow today?

I think in the last maybe 2 years, I've understood that we can't do without [AI], but I think that there's so much fear around what AI is going to do to other professions… I think it's part of my role now as a leader to demystify AI. It's not like AI is not going to replace my nursing judgment; it's not going to make any clinical decisions. It should never increase workload. It's not rigid; it's not removing that flexibility and critical thinking piece. It's not a staffing reduction tool, which some people were afraid of, but it's really making sure that scheduling, capacity management, patient flow, and resource planning are all part of the puzzle when we're making meaningful changes. I think in infusion care, AI can better help match patient demand with real capacity. We look at the number of chairs we have, the number of pharmacies and pharmacists, the technicians that have to help with the pharmacy preparation, and our clinic hours. …

How are academic institutions partnering with community practices to support patients and ensure they receive quality care?

We want our patients to be treated in the best possible place for them, and if being treated in their community helps them to go home at night, be supported by their family, their caregivers, then we have to make that work. So, the most important thing we can do, and I can do as a leader within an academic, NCI-designated cancer center, is to partner with those community practices. For example, with any type of bispecific [antibody], if [patients] are starting the process and doing step-up dosing, we know there's a possibility that patients might need to be admitted at some point. Our responsibility is to partner with those community [practices] and say, “Where would your patients most likely be admitted[if needed]?”… Now, we're going to work with you and [the local hospital] to make sure the emergency department, the intensive care units, and the oncology units know about these patients, and finally, that [local urgent care] is also aware of those patients, because anything we can do to keep the patients out of the emergency department is paramount.

REFERENCES

1. The State of Cancer Centers in 2026. LeanTaaS. 2026. Accessed June 25, 2026. https://tinyurl.com/yd8ybtb7

2. High Patient Volume Tops Staffing Shortages as Leading Driver of Burnout in Cancer Centers. News release. LeanTaaS. June 23, 2026. Accessed August 13, 2026. https://tinyurl.com/5xc9s8yy