Where Cancer Care Plans Break Down

Cancer care has outgrown the systems and manual processes used to coordinate it.

A Growing, Increasingly Complex Population

As of January 1, 2025, an estimated 18.6 million Americans were living with a history of cancer — a number projected to exceed 22 million by 2035.1

As treatment advances and survival improves, cancer care has become less of a single event and more of a long, multidisciplinary journey — spanning diagnosis, active treatment, and years of survivorship monitoring across oncologists, primary care providers, imaging, labs, infusion centers, and supportive care teams, often across multiple locations and systems.

That complexity is a sign of progress. But the infrastructure responsible for coordinating it hasn’t kept pace with it.

The Core Problem: Planning Isn’t Execution

At the center of this gap is a simple but consequential reality: health systems can document a care plan far more reliably than they can confirm it happened.

  • Care plans are documented — but not consistently tracked.
  • Orders are placed — but not reliably followed through.
  • Responsibilities are distributed across teams — but not clearly owned or monitored.

Electronic Health Records serve as the system of record for what was planned. They were not built to track whether a planned step was completed on time, who was accountable for it, or where a patient currently stands in their care journey. As a result, even well-resourced health systems often operate without a real-time answer to a basic question: is this patient’s care progressing the way it was intended to?

Physician on the phone while checking a laptop

What This Costs: Time

Cancer is one of the most time-sensitive diseases in medicine, and the data on delay is unambiguous:

6–8%

A 4-week delay in starting cancer treatment increases the risk of death by 6–8%.2

13%

That risk nearly doubles to 13% when the delayed treatment is chemotherapy or radiation.2

20–30%

And once a delay stretches past 8 weeks, the risk of recurrence climbs 20–30%.2

Delay isn’t a single event — it compounds, and every additional week adds measurable risk.

These outcomes aren’t the result of any single failure. They’re the accumulated effect of small, distributed breakdowns — an unconfirmed referral, an overdue follow-up, a step nobody was explicitly watching — none of which register as a crisis until the delay is already measurable.

Cancer patient with family

A Specific, Preventable Risk: Cardiovascular Complications

One of the clearest examples of this execution gap is cardiovascular risk during and after cancer treatment.

Patients undergoing certain cancer therapies face meaningfully elevated cardiovascular risk: an estimated 59% are at increased risk for heart failure, and 42% face other serious cardiovascular events, with that risk accelerating alongside the growing use of targeted therapies.3

Among breast cancer survivors specifically, cardiovascular disease has now surpassed cancer itself as the leading cause of treatment-related death.4

This isn’t primarily a knowledge gap — cardio-oncology is a well-established clinical field. It’s a coordination gap: primary care physicians are often excluded from a patient’s care team during active cancer treatment, leaving no clear owner for monitoring the cardiovascular risks that treatment itself introduces.5

Nurse Navigators: Essential, and Structurally Under-Resourced

Nurse navigators are the people most often asked to close these gaps — and they do critical work. But they’re doing it with caseloads that have grown faster than the tools available to support them, relying heavily on manual workflows, disconnected systems, and informal follow-up rather than real-time visibility into where each patient’s care stands. There is currently no standardized way to integrate navigators into a shared, accountable view of a patient’s care team — particularly across the oncology–primary care boundary, where coordination gaps are most consequential.5

Nurse working at a computer workstation

The Cost of an Unsolved Problem

Cancer care in the U.S. already exceeds $200 billion annually, and that figure is projected to reach $246 billion by 2030 as treatment complexity and cost continue to rise.6

A meaningful share of that spending reflects the downstream cost of fragmented coordination — delayed treatment, avoidable complications, and hospitalizations that earlier intervention could have prevented.

What’s missing isn’t more documentation, more point solutions, or more well-intentioned manual effort. It’s a system-level capability to track whether care is executing as intended — and to make that visible before a gap becomes a missed step.

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References

  1. Wagle NS, Nogueira L, et al. Cancer treatment and survivorship statistics, 2025. CA Cancer J Clin. 2025. See also: Fast Facts: Cancer Treatment and Survivorship, American Cancer Society (cancer.org).
  2. Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087. doi:10.1136/bmj.m4087
  3. Johns Hopkins Heart and Vascular Institute. Preventing and Treating Cardiovascular Toxicity from Cancer Therapy. Cardiovascular Report, Spring 2022.
  4. Klein, T. (2018, February). Heart failure more likely for some breast cancer and lymphoma survivors. Mayo Clinic News Network.
  5. Ver Hoeve ES, Calhoun E, Hernandez M, et al. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res. 2024;24:550.
  6. Panchal R, Brendle M, Ilham S, Kharat A, Schmutz HW, Huggar D, McBride A, Copher R, Au T, Willis C, Brixner D. The implementation of value-based frameworks, clinical care pathways, and alternative payment models for cancer care in the United States. J Manag Care Spec Pharm. 2023;29(7):1-10.