Document Type

Article

Publication Date

8-19-2026

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This article is the author’s final published version in JAMA network open, Volume 9, Issue 8, 2026, Article number e2629351.

The published version is available at https://doi.org/10.1001/jamanetworkopen.2026.29351. Copyright © 2026 El Khoury CJ et al. JAMA Network Open.

 

Abstract

IMPORTANCE: Cancer survivorship care is a growing public health priority, yet delivery remains variable across health systems. The National Standards for Cancer Survivorship Care provide a framework for high-quality care, but little empirical evidence exists regarding health system readiness to implement these standards in routine practice.

OBJECTIVE: To assess implementation readiness for the National Standards for Cancer Survivorship Care and identify perceived barriers to implementation.

DESIGN, SETTING, AND PARTICIPANTS: This real-time Delphi survey study was conducted from January to March 2025 at a National Cancer Institute-designated comprehensive cancer center. Participants were multidisciplinary experts involved in cancer survivorship care delivery, care coordination, and program implementation.

MAIN OUTCOMES AND MEASURES: For each of the 10 survivorship standards, expert agreement was assessed across 6 implementation domains: importance, anticipated impact, feasibility, consistency of implementation and documentation, existence of formal organizational policies, and presence of health system evaluation mechanisms. Agreement was considered present when at least 50% of respondents selected a single response category.

RESULTS: Of 30 experts recruited, 25 participated (19 [76%] female), for a response rate of 83%. Among the 10 standards, agreement was consistently achieved for importance (9 standards [90%]) and anticipated impact (all 10 standards). In contrast, agreement regarding the existence of formal organizational policies and health system evaluation mechanisms was limited, and respondents frequently indicated absence or uncertainty. Agreement on implementation consistency was also limited, with several standards reaching agreement that implementation was inconsistent across practitioners and settings. Standards requiring coordination across clinicians, care settings, and supportive services were generally perceived as less ready for implementation than those supported by more established workflows. Qualitative findings identified cross-cutting barriers including time constraints, workforce limitations, lack of standardized workflows, and electronic health record limitations.

CONCLUSIONS AND RELEVANCE: Experts endorsed the cancer survivorship standards as important and potentially high impact but identified substantial gaps in the organizational infrastructure needed for consistent implementation. These findings suggest that improving survivorship care will require investments in workflows, accountability structures, and evaluation systems that support routine delivery and measurement of survivorship care.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Additional Files
Data Sharing Statement.pdf (15 kB)

PubMed ID

42616501

Language

English

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