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Chan K, Reilly E, Janczewski LM, et al. . J Am Coll Surg. November 2025.

Patients who do not complete full oncologic treatment have worse outcomes. This prospective national quality improvement collaborative included 194 cancer centers and gathered data from 99,057 patients over 2 years scheduled for radiotherapy. Sites performed community scans, identified local barriers, and implemented tailored interventions from an ACStoolkit (navigation, workflows, EHR prompts, and reminder processes) and aimed to reduce missed radiotherapy by 20%. 

Across the 99,057 patients scheduled for radiotherapy, missed-visit rates fell from 8.3% to 5.0% at the patient level (relative −39.8%) and program-level medians declined from 8.2% to 5.6% (relative −31.7%).

Transportation and intercurrent illness (not treatment toxicity) were the most common actionable barriers. Programs most often responded by formalizing workflows and protocols, as well as building internal resources, with many layering in patient reminders and EHR enhancements to streamline referrals. Community hospitals showed the highest baseline no-show rates and the least change by study end, signaling that local resource context and facility density matter.

For surgeons leading cancer programs, this offers a pragmatic framework: measure a consistent radiotherapy adherence metric, pair it with barrier mapping, and deploy low-cost, system-level fixes (navigation, standardized workflows, referral triggers, reminders), with special attention to transportation logistics. While patient-level outcomes were not captured, the scale and effect size argue that a national, surgery-led collaborative can move adherence metrics rapidly and at breadth.