The Compass

Study Takeaways

• The median number of procedures per cancer patient varies widely, ranging from 24 for prostate cancer to 62 for liver cancer, highlighting differences in care intensity.
• Outpatient settings play a growing role in cancer care delivery, with ambulatory sites accounting for over 59% of infusion therapies between 2017 to 2023.
• The proportion of mastectomies performed at ambulatory surgery centers (ASCs) rose substantially, doubling from 5.4% in Q1 2017 to 9.0% in Q4 2023, while prostatectomy rates at ASCs remained stable.

The U.S. healthcare system is increasingly shifting toward lower-cost outpatient care settings, driven by efforts to reduce reliance on resource-intensive inpatient settings.¹ Outpatient cancer care exemplifies this trend, influenced by shifts in patient demographics (e.g., younger patients), evolving treatment paradigms (e.g., in-home and virtual care) and advancements in treatment options (e.g., cell and gene therapies).^2,3,4,5 Patients now have a growing number of options for receiving specialty care, including alternate site infusion therapy providers for chemotherapy treatments.⁶ As cancer prevalence continues to grow, outpatient care settings increasingly offer efficient and accessible care at a lower cost than inpatient settings, resulting in more value for money.

The transition of cancer care to ambulatory settings mirrors care delivery trends for other service lines. For instance, orthopedic and ophthalmologic care is more often delivered in outpatient settings, reflecting significant advancements in minimally invasive surgical techniques that offer equivalent or better quality at a lower price.⁷

This analysis seeks to evaluate where oncology stands in this cycle –examining how trends in outpatient utilization differ between medical and surgical oncology – and what these patterns reveal about the broader evolution of cancer care delivery. The evolving oncology landscape underscores the need for a thorough understanding of how outpatient cancer care is adapting to meet patient needs, while navigating challenges such as rising healthcare costs and disparities in access to innovative treatments.

Background

Historically, the majority of cancer treatment has been delivered in inpatient hospital settings, but a growing emphasis on cost containment, patient convenience and therapeutic advancements has spurred the rise of outpatient care. Outpatient care has become an increasingly important part of the oncology patient journey, with outpatient sites providing a wide range of cancer treatments, including chemotherapy, radiation therapy, immunotherapy, surgery and advanced diagnostic imaging.⁸ Notably, outpatient chemotherapy treatment grew 25% from 2014 to 2020.^9,10 While this shift presents opportunities to expand access and improve patient experience and outcomes, community oncologists have raised concerns about maintaining oversight of patient care, particularly given existing gaps in robust data regarding the safety, quality and equitable distribution of oncology outpatient utilization.¹¹

Analytic Approach

We analyzed peer-reviewed findings to determine the median number of procedures per patient by different cancer types together with the rate of hospitalizations and utilization of emergency departments and urgent care clinics for cancer patients receiving and not receiving in-home care. Leveraging national all-payer claims data, we calculated the proportion of mastectomy and prostatectomy procedures delivered in ambulatory surgery centers (ASCs) and the proportion of infusion therapies in ambulatory, hospital and home settings between 2017 and 2023.

Findings

Across 15 of the most common cancer types, the median number of procedures per patient per year ranged from 24 procedures (prostate cancer) to 62 procedures (liver cancer) in 2018 (Figure 1). Notably, lung, stomach, pancreatic, liver and esophageal cancer had the widest range in the number of visits per patient.

As the delivery of cancer care has migrated from inpatient settings to ambulatory settings like physician offices and outpatient clinics, it is also migrating to the home. At-home care, in which patients receive remote vital-sign monitoring, clinician visits, telehealth and intravenous therapies at home, has grown in popularity amid emerging evidence that it can deliver improved outcomes and lower costs.¹² Patients receiving at-home care between January 2019 and September 2020 demonstrated lower utilization of high-acuity care settings compared to those not receiving at-home care. Specifically, urgent care visit rates were markedly lower among patients receiving at-home care (10.0%) compared to those being treated outside the home (25.0%) (Figure 2). Similarly, emergency department (ED) visits were less frequent among patients receiving at-home care, with 40% of this group utilizing ED services compared to 58.3% of patients being treated outside the home. Likewise, hospitalization rates were lower for those receiving at-home care, with 40% of those patients being hospitalized compared to 50% of those being treated outside the home. Whether the reduction in utilization of high-acuity care settings among patients getting home care is due to the effectiveness of the additional monitoring or because they are a lower-acuity cohort of patients is not yet known.

Certain types of surgical cancer care are also increasingly shifting from inpatient settings to outpatient sites like ASCs. While the percentage of prostatectomies performed at ASCs remained relatively stable between 2017 and 2023, the proportion of mastectomies conducted at ASCs shows a notable upward trend over the same period (Figure 3). Starting at 5.4% in Q1 2017, the rate steadily increased to a peak of 9.0% in Q2 and Q4 2023. The steady increase in mastectomy rates in ASCs suggests a broader trend toward decentralizing cancer care from inpatient to outpatient settings, while the stable rates of prostatectomies in ASCs may indicate barriers – such as clinical, technological or logistical constraints – that limit similar shifts in magnitude.

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