A major new effort is underway to change that. In a special section of the Journal of Cancer Survivorship, researchers led by Kimberly A. Miller of the University of Southern California, Vida A. Passero of the VA National TeleOncology program and the University of Pittsburgh, and Michelle A. Mollica of the Medical University of South Carolina present an overview of the National Standards for Cancer Survivorship Care, early lessons from their real-world testing, and a roadmap for what must come next. The standards, developed by the National Cancer Institute in partnership with the Department of Veterans Affairs and several Health and Human Services agencies as part of the Biden Cancer Moonshot and Cancer Cabinet initiatives, are designed as recommendations for health systems rather than mandates for individual clinicians. Together they form a nationally relevant blueprint of essential health policies, care delivery processes, and evaluation indicators intended to guide the creation and strengthening of survivorship programs across wildly different care settings.

The development process was deliberately structured and consensus-driven. Drawing on methods used to build the Victorian Quality Cancer Survivorship Framework in Australia, the team began with a comprehensive landscape review of survivorship and cancer-specific clinical guidelines, the Commission on Cancer survivorship standard, existing quality frameworks, state cancer control plans, and the peer-reviewed literature. NCI and the VA then convened three iterative virtual meetings with national and international survivorship experts to prioritize candidate indicators by importance and feasibility. The result was a final set of 30 indicators organized across three domains—health system policies, care delivery processes, and assessment and evaluation—with 10 indicators in each. The architecture is intentionally practical: it asks health systems to examine what they promise survivors, how they actually deliver care, and how they measure whether that care works.

Knowing whether a blueprint survives contact with reality required testing it in the field. In 2024, NCI released an administrative supplement funding opportunity inviting current grantees to examine or improve survivorship care in alignment with the new standards. Eighteen demonstration projects were funded across the United States, spanning NCI-designated comprehensive cancer centers, children’s hospitals, integrated health systems, and community oncology programs. The portfolio covered the full implementation continuum, from readiness assessment and mapping of existing services to strategic planning, program implementation, and evaluation of care quality and outcomes. It also reached a striking diversity of survivor populations, including pediatric and adolescent and young adult survivors, older adults, rural communities, underserved groups, and survivors of specific cancer types, underscoring both the breadth of survivorship needs and the adaptability of the standards across contexts.

The early findings are sobering in places and encouraging in others. One study evaluating a large regional health system in the American Southeast found that practices met only about half of the indicators on average, revealing multilevel barriers and facilitators that will shape any national rollout. A team at a rural comprehensive cancer center characterized patient experiences with digital survivorship services, suggesting that telehealth and portal-based programming can meaningfully extend the reach of survivorship care to patients who might otherwise never access it. Researchers analyzing electronic health record data for head and neck cancer patients in their first year after diagnosis identified persistent gaps between what the standards call for and what clinical practice delivers, particularly when comparing rural and urban locations. Survivor-reported evaluations at a comprehensive cancer center found stronger alignment on physical and emotional concerns than on financial and practical needs, pointing to financial navigation as a critical weak link in the survivorship experience.

Several projects zeroed in on populations whose needs standard models often miss. The Adolescent and Young Adult National Standards Consortium drew on insights from nine healthcare systems to map the challenges of aligning AYA survivorship care with the new framework, while a mixed-methods study of an AYA survivorship clinic documented strikingly low utilization and identified limited awareness and weak referral patterns as key barriers. Caregivers emerged as another underserved group: one study found substantial unmet emotional, social, and health needs among cancer caregivers that must be addressed if standards covering their care are to be met. Meanwhile, a new Cancer Survivorship Maturity Model offers institutions a structured way to stage their readiness across survivorship domains, revealing heterogeneous maturity even among engaged organizations and providing a practical path for implementation planning.

Across all 18 projects, several cross-cutting themes crystallized. Organizational readiness consistently proved to be the foundational determinant of implementation. Health systems with existing survivorship leadership, defined roles, and dedicated infrastructure were far better positioned to engage in strategic planning, pilot testing, and measurement, while settings with limited staffing or fragmented accountability often had to focus first on readiness assessment and capacity building. In one multi-site health system, main campuses with dedicated survivorship infrastructure met more standards, whereas regional clinics with constrained staffing and time delivered what researchers described as only a bare minimum of survivorship care. The standards, in other words, function not just as a quality framework but as a diagnostic tool that exposes variation in institutional preparedness and highlights where foundational investment is most needed.

A second theme was definitional variability. Projects differed in who they counted as survivors, when survivorship care should begin, and what services fell under the survivorship umbrella—whether post-treatment specialty visits alone or care from diagnosis through advanced disease spanning oncology and primary care. This heterogeneity complicated standardization, particularly for adolescents and young adults, people living with metastatic disease, and patients whose care crosses multiple settings, but it also demonstrated the flexibility of the standards to accommodate diverse models of care. A third theme involved the hard technical work of workflow integration. Translating standards into referrals, assessments, documentation, and follow-up required alignment with existing clinical roles and data systems, and teams repeatedly ran into limited structured data, uneven electronic health record functionality, and reliance on manual processes. Innovative responses included maturity models to stage infrastructure, standardized EHR templates for symptom and distress screening, and embedded telehealth and digital navigation that extended survivorship processes beyond in-person visits.

The practical lessons emerging from this early implementation are clear at every level of the system. At the systems level, improving alignment is tightly linked to leadership engagement, clear ownership, and dedicated survivorship infrastructure, while the absence of structured EHR data to capture survivorship indicators forced many sites into manual workarounds—evidence that sustainable implementation requires coordinated investments in leadership, governance, and data infrastructure. At the clinical level, survivorship care proved most feasible when woven into existing oncology and primary care workflows through structured care pathways, standardized assessments, and formalized referral processes, though gaps in psychosocial, financial, and supportive care needs persist. At the patient level, survivors continue to report unmet needs in symptom management, psychosocial support, financial burden, and care coordination, and barriers such as limited awareness, access challenges, and navigation complexity continue to limit the reach of even well-designed programs. The consistent message is that standardized frameworks must be paired with population-specific adaptation for adolescents and young adults, rural survivors, caregivers, and other groups whose needs do not fit a single template.

The authors frame the standards as a foundation for a more consistent, equitable, and accountable national approach to survivorship care, and they lay out distinct agendas for research, practice, and policy. Future research should identify which of the 30 indicators are most sensitive to change, refine measurement strategies, and apply implementation science methods to understand how organizational context shapes uptake and sustainability. Health systems seeking to scale survivorship services will need to invest in leadership engagement, workforce training, data infrastructure, and cross-disciplinary coordination, embedding the standards into team-based care and EHR optimization. On the policy front, harmonizing the standards with existing accreditation requirements such as the Commission on Cancer’s Survivorship Standard 4.8, quality reporting initiatives, and payer priorities could accelerate adoption and reduce fragmentation, particularly for underserved populations and resource-limited settings. What began as a conceptual blueprint is now being stress-tested in real-world settings, and the early evidence suggests that with sustained partnership among health systems, researchers, clinicians, survivors, caregivers, and policymakers, the national standards could transform survivorship from a set of discrete, unevenly distributed services into a coordinated, system-level function of American cancer care.

Subject of Research: Development and early implementation of the National Standards for Cancer Survivorship Care in United States health systems

Article Title: Advancing the national standards for cancer survivorship care: overview, early implementation insights, and future directions

Article References: Miller, K. A., Passero, V. A., & Mollica, M. A. (2026). Advancing the national standards for cancer survivorship care: overview, early implementation insights, and future directions. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02122-1

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02122-1

Keywords: cancer survivorship, National Cancer Institute, health care standards, care coordination, survivorship care quality, implementation science, electronic health records, adolescent and young adult survivors, telehealth, health policy, psychosocial support, health systems