Elevating the Role of Community Oncology to Reduce Financial Toxicity

In the complex, multipayer American health care system, financial toxicity—the economic burden of care—is a growing and multifaceted challenge. A burden falling heavily on patients, financial toxicity is especially a concern in oncology, where the pace of innovation, rising drug prices, markups, and facility fees may threaten access and affordability.

A comprehensive literature review recently published in The American Journal of Public Health, led by Lucio Gordan, MD, examined this issue in depth. Synthesizing evidence on cost variation across cancer care settings, the study highlighted stark cost differentials between community practices and hospital-based systems, with community practices delivering care at significantly lower costs without compromising quality.^1,2 These findings underscore the importance of elevating the role of community oncology to provide lower-cost, accessible care.

One policy lever contributing to this dynamic, according to the study, is the 340B Drug Pricing Program. A federal initiative originally designed to help safety-net providers stretch limited resources, the study suggests that its current implementation, particularly within hospital systems, may unintentionally exacerbate cost disparities, ultimately contributing to higher overall spending.

In an interview with Targeted Oncology, Gordan, president and managing physician of the Florida Cancer Specialists & Research Institute (FCS) and medical oncologist and hematologist at the FCS Gainesville Cancer Center, discusses the value of community-based care and outlines strategies, including reform of the 340B Program, that he believes are essential to ensuring a more sustainable cancer care system.

Targeted Oncology: How did you define financial toxicity in this study, and what are some ways in which financial toxicity may manifest in patients?

Lucio Gordan, MD: Financial toxicity in the setting of the study and the analysis of all studies…has to do with total cost of care, including chemotherapy, immunotherapy, [and] other infusions. We have shown in our studies in immunotherapy and chemotherapy, and the analysis of other studies in our publication, that the costs are significantly higher—anywhere from 40% to 70% or more—when we use a hospital facility because of the facility fees that are charged, which does not happen in community oncology.

In addition, there's a markup of the drugs in the order of 50% to 600% depend[ing] on which type of drug you’re talking about. So, there's a toxicity for the system, for the commercial and federal payers. There's the toxicity for the whole economy, and there's a toxicity for the patients, because at the end of the day, the patients may be charged a higher fee or copayment, especially in the beginning of the year, after out-of-pocket has not been maximized yet or had happened. So, the toxicity, from a financial standpoint, hits every angle, from the patient to the system at large, to payers and to the providers as well. It gets very complex, very, very expensive, very quickly.

What motivated you and your team to examine financial toxicity specifically in relation to community oncology?

We know that cost of healthcare has to be addressed. It keeps escalating above the level of inflation. [For] novel therapies, the price of progress has been real in a good way as far as patients’ outcomes, quality of life, cure rates, and others. But there's the price tag that has also increased to all consumers, patients, and the system.

Because cancer [care] in the United States is delivered mostly by community oncology—60% to 70% or more—we thought it was important to highlight the role of community oncology insofar as decreasing the total cost of care. We have shown that our side of care, away from expensive venues like hospital systems, hospital clinics, [emergency room; ER] visits is an important way to control cost. We calculated we can save billions on a yearly basis for the system, patients, payers, country, by simply shifting the site of care to community oncology. So, this can be accomplished in different ways.

What were the key findings from your review of the literature? Were any of your findings surprising?

The findings were not news to me or to us in community oncology, but the magnitude, I think, continues to be surprising as to how much [was] saved in terms of costs in the community setting vs hospital-based systems. It varies anywhere from upper 20% to upper 70% depending upon which study one quotes. In the studies that we published a few years ago, the difference was about 30% to 40% on the chemotherapy side, and 25% to 30% on[wards] for immunotherapy drugs. We’re talking about billions of dollars just in 1 company or 1 clinic, [FCS]. So, if you get the whole ecosystem of many thousands of medical oncologists, millions of patients being treated, thousands of clinics, then the number [reaches] the high billions in terms of potential savings.

We also show that the quality of care provided by community oncology physicians, nurse practitioners, [physician assistants], nurses, and others is equal to other places. So, it's not like we're less expensive, but we're delivering less innovative care or we're bringing more risk to the patient. On the contrary, one of our studies on chemotherapy drugs show[ed] that we had less length of stay in the hospital, less ER visits on the community side as compared [with] hospital-based systems. And so that goes along with quality.

So, these are important highlights: Quality is maintained. Access is definitely improved. We are in [the] community…we know our patients, their families, our cities, and we are scattered throughout the country, so we cover where patients and families are. The cost of administration is much lower, [and] cost of drugs is exceptionally lower when payers are dealing with community oncology practices.

Your study outlines several strategies for reform involving a variety of stakeholders, such as policymakers, payers, and advocacy groups. Which of these efforts or stakeholder groups do you think should be prioritized to strengthen the role of community oncology in addressing financial toxicity?

As you said, it's a multipronged approach. I think number one, fixing site parity, in which…hospitals are paid the same as us in community oncology as far as facility fees or lack thereof, is a low-hanging fruit.

A more complex one, but it must be addressed, is [that] a serious 340B reform needs to take place. 340B can be an excellent program, but it has been used inappropriately by several hospital systems and or academic facilities in which they are not truly a 340B facility, and they have access to such drugs. What happens when you're getting 340B price for such hospitals [is] they are administering the drugs at a much higher cost than we are doing in community oncology. This causes a very significant asymmetry in the market. What I mean by asymmetry [is], the hospitals get much more powerful because there's much more financial resources available, and then they start buying out other community oncology practices and further disintegrating a system that is very efficient, responsible, and with high quality.

So, I think site parity [and] 340B are very important ways to start. I think we need to continue to educate policymakers. The commercial payers definitely understand, and hopefully they will take more prescriptive action to help themselves and increase the stability of healthcare in the USA. It's really difficult; I don't think our system is currently sustainable much longer if reforms such as site parity and 340B reform do not happen in short order.

REFERENCES

1. Gordan L, Singh-Bulkan HHN, Warner A, et al. The role of utilizing community oncology care to decrease cancer-related financial toxicity. Am J Public Health. 2025;14(1):1‑7. doi:10.52338/tajoph.2025.5171

2. Fighting financial toxicity: Community oncology practices deliver affordable, high-quality cancer care. News release. Florida Cancer Specialists & Research Institute. November 17, 2025. Accessed January 13, 2026. https://tinyurl.com/5fxp8pbc