The research team, led by investigators at the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine and collaborators at Thomas Jefferson University, set out to solve a problem that has quietly hindered the survivorship field for years. National organizations including the Institute of Medicine, the National Cancer Institute, and the American Society of Clinical Oncology have long called for survivorship care to become a routine component of high-quality cancer care, and the National Standards translated that aspiration into concrete domains: surveillance, symptom management, supportive services, care coordination, and patient-centered follow-up. But the standards describe what should be delivered, not whether an institution has the workflows, staffing models, referral pathways, and data systems to deliver it. Existing quality frameworks, such as Commission on Cancer Standard 4.8 metrics, the LIVESTRONG Center of Excellence indicators, and ASCO’s Quality Oncology Practice Initiative measures, function largely as checklists or compliance metrics rather than as staged assessments of organizational capability.

Maturity models offer a different lens. Borrowed from engineering and business process management, and increasingly applied in healthcare informatics, maturity models characterize progressive stages of organizational capability, from ad hoc improvisation to fully optimized, data-driven operation. Their value lies not merely in identifying strengths and weaknesses but in providing a roadmap: each successive level describes the concrete processes, resources, and governance an organization must build to advance. Until now, such frameworks had been minimally applied in cancer survivorship, a gap the CSMM was explicitly designed to fill. Crucially, the model assesses organizational capability for implementing the National Standards rather than directly measuring the quality of care itself, a distinction the authors emphasize throughout.

Building the model required a careful methodological translation. Because the ten National Standards define clinical services rather than implementation functions, the researchers could not simply map one standard to one maturity domain. Instead, they consolidated conceptually related standards that depend on shared organizational capabilities into seven broader operational domains: survivorship care planning, risk of recurrence, specialty care, financial hardship and toxicity, lifestyle behaviors and supportive services, practical and social impacts, and physical and psychological effects. For example, the standards addressing lifestyle behaviors and supportive health services were merged because both are typically operationalized through similar screening processes, referral pathways, navigation programs, and community partnerships. Each domain was then described across five maturity levels, adapted from established maturity model frameworks, ranging from level one, ad hoc, to level five, optimized, with descriptors reflecting observable institutional characteristics such as role delineation, documentation practices, and use of data.

To refine and test this preliminary strawman model, the team conducted a mixed-methods, participatory study anchored in five multidisciplinary focus groups at the comprehensive cancer center. Fourteen clinicians and supportive care professionals participated, drawn from oncology, primary care, nursing, social work, rehabilitation, and psychosocial services, and practicing across academic, safety-net, and Veterans Affairs settings. The sessions employed consensus-building techniques adapted from the nominal group technique, a structured approach designed to elicit expert perspectives while preventing any single voice from dominating. Participants completed dot-voting prioritization exercises, ranking the seven domains by three distinct criteria: which would have the greatest clinical impact if implemented, which would be easiest to implement, and which patients would prioritize most highly. They then revised maturity level descriptors and rated their own practice settings against the model.

The prioritization results exposed a striking tension at the heart of survivorship care implementation. Risk of recurrence, specialty care, and survivorship care planning ranked highest for both clinical impact and implementation ease, and these two dimensions correlated moderately with each other. But when participants considered what patients would prioritize most, the picture shifted dramatically toward physical and psychological effects, risk of recurrence, and financial hardship. Statistical analysis confirmed the divergence: clinical impact and perceived patient priority showed a weak negative correlation, with a Spearman’s rho of minus 0.252, and overall concordance across the three ranking dimensions was minimal, at a Kendall’s W of just 0.056. In practical terms, the domains clinicians view as most influential for outcomes are not the ones patients experience as most urgent, a mismatch with direct consequences for how institutions allocate scarce resources.

When participants applied the CSMM to their own settings, the results were uniformly humbling. Maturity ratings clustered between levels one and two, indicating that survivorship care processes remain largely ad hoc or, at best, planned rather than standardized and integrated. Risk of recurrence and specialty care scored relatively higher, suggesting that surveillance and referral activities embedded in routine oncology practice are more established, while lifestyle behaviors, supportive services, and practical and social impacts lagged furthest behind. Variation within the institution was substantial: specialty care ratings ranged from a mean of 1.00 in one focus group to 3.67 in another, revealing uneven development of capabilities even within a single cancer center. The model was then distributed to twelve external stakeholders affiliated with the National Cancer Institute Survivorship Supplement Awardees network, institutions that are among the most survivorship-engaged in the country. Their overall mean rating was 1.93, nearly identical to the internal mean of 1.85, a finding the authors describe as striking, since even these focused centers remain at early maturity stages.

Qualitative analysis of the focus group discussions illuminated why implementation stalls. The most frequently cited barrier, mentioned in five of the groups, was a lack of clearly defined processes and responsibilities, captured in one participant’s observation that there is a lack of workflow clarity about the process and roles. Clinician time constraints followed closely, then variation in survivorship needs across cancer types and settings, limited institutional resources, and technical barriers such as fragmented electronic health record integration. Participants noted that practical and social issues bleed into financial issues, complicating domain boundaries, and that survivorship care is resource-intensive yet rarely supported by dedicated funding or protected time. Importantly, they also identified opportunities: embedding patient-reported needs screening into clinic workflows and creating reliable referral triggers could advance maturity without requiring major new investment.

The CSMM is designed as a structured self-assessment rather than a scoring exercise. Organizations compare current practices against domain descriptors, select the level that best reflects their state, and receive a radar plot of their maturity profile overlaid with aggregate community averages. When completed by multiple stakeholders, divergent ratings are treated not as measurement error but as valuable signals of misalignment between clinical, administrative, and operational perspectives. The model can be administered at baseline and repeated over time to track progress, and the online assessment is publicly available for organizations implementing the National Standards. The authors acknowledge limitations, including the single-center origin of the focus groups, the modest external sample, and the absence of survivor and caregiver perspectives in this development phase, all of which they flag as priorities for future refinement.

The broader significance of the study lies in reframing the survivorship challenge. The field has largely succeeded in defining what good survivorship care looks like; what it has lacked is a way to ask whether institutions possess the organizational capability to provide it. By translating national standards into staged, domain-specific maturity levels, the CSMM gives program leaders, administrators, and clinicians a common language for identifying where processes break down and where the next dollar, hire, or workflow redesign will matter most. As the number of cancer survivors continues to grow and the National Standards evolve, tools of this kind may prove essential for converting well-intentioned national guidance into consistent, patient-centered care that reaches every survivor, not just those fortunate enough to land in a mature system.

Subject of Research: Development of the Cancer Survivorship Maturity Model to assess organizational implementation of the National Standards for Cancer Survivorship Care

Article Title: Supporting implementation of the national standards for cancer survivorship care: development of the cancer survivorship maturity model (CSMM)

Article References: Dowst, H., Shirzadi, M., Mims, M., Hilsenbeck, S., Wang, L., & Badr, H. (2026). Supporting implementation of the national standards for cancer survivorship care: development of the cancer survivorship maturity model (CSMM). Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02131-0

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02131-0

Keywords: cancer survivorship, maturity model, National Standards for Cancer Survivorship Care, implementation science, health care management, organizational maturity, oncology, nominal group technique, quality improvement, patient-centered care, health services research, survivorship care planning