The structure of academic cancer service lines: Results of an Association of American Cancer Institutes survey.
Authors: Fracasso Paula M. , Si Lim Stephanie J. , Simone Nicole Lynn , Reckamp Karen L. , Honeycutt Hailey , Shaw Kate , Cameron Kendra , Wilke Lee G. 
Published: May 2024

e13566

Background: An integrated cancer service line (CSL) in academic medical centers provides a patient-centered approach with the goals of improving the patient experience and clinical outcomes; managing financial operations; increasing access to clinical research; and decreasing health disparities. The Association of American Cancer Institutes (AACI) Physician Clinical Leadership Initiative Steering Committee sought to evaluate the current state of cancer services lines among the membership of AACI to identify common areas of organizational structure and function and potential areas for enhancing integration. Methods: A 29-question, mixed-methods, descriptive survey with multiple choice and short answer questions addressing the characteristics of the center’s CSL, was sent electronically to the cancer center directors and administrators at 107 academic centers on July 31, 2023, and again on August 24, 2023. Descriptive statistics were used to summarize the survey data. Results: Of 107 centers, 75 (70%) responded to the survey. Of the 68 respondents with clinical services, 58 centers (85%) had a defined CSL. Twenty-three centers (40%) noted that they did not have a formal charter defining governance and structure; 11 (48%) of the 23 are National Cancer Institute (NCI)-Designated Cancer Centers. Twenty-six (45%) reported a defined funds flow. Fifty (86%) cancer centers have a physician as a primary leader and the majority have a leadership team of two or more individuals (55, 95%). While hematology and medical oncology, radiation oncology, and surgical specialties were part of every CSL, pathology (31, 53%) and radiology (28, 48%) were included in only half of the centers. Center respondents noted that quality and safety were a primary focus (48, 83%), with regional growth (45, 78%), ambulatory operations (44, 76%), and budgeting and margin management (43, 74%) as additional responsibilities. Key performance metrics tracked by the CSL included the number of new patients (57, 98%), time to first appointment (55, 95%), and accrual to clinical trials (47, 81%), while 48% (28) tracked palliative care referrals within 90 days of death. Most CSL services, inclusive of records collection (86%), billing (86%), and coding (81%) are centralized within the center’s health system. Conclusions: There is widespread variability in the structure of academic CSLs with 40% and 55% of respondents not having a formal charter or funds flow, respectively. Leadership, key responsibilities, and metrics differed across centers. These results can serve as a tool for centers to refine their existing CSL or as a guide for CSL development. Our survey highlights a potential to evaluate CSL structures, which are inclusive of a broader series of departments and services, to determine the optimal approach for a multidisciplinary patient-centered care model. Efforts to obtain outcome data on CSL structures are warranted.