Where a person lives far too often determines the quality of cancer care they receive and, ultimately, their chances of survival. Despite decades of progress in precision oncology, stark disparities persist between patients treated in urban academic centers and those in rural or underserved communities. A JAMA Network Open study of nearly 37,000 patients found that when rural and urban patients receive the same, protocol-driven care, their outcomes are nearly identical. This finding underscores a critical truth: the gap in cancer survival is not about biology, but about access.

At the same time that the geography gap has widened, cancer care itself has become vastly more complex. As our understanding of cancer’s molecular underpinnings deepens, oncologists no longer think of “lung cancer” or “breast cancer” as single diseases. What were once broad categories are now recognized as dozens of biologically distinct subtypes (amounting to more than 100 unique cancer types), each requiring tailored treatment pathways. This rapid evolution in precision oncology is leaving many community practices struggling to keep pace. The result is a widening divide in the quality of care, driven not by effort or expertise, but by unequal access to specialized knowledge.

Against this backdrop, remote second opinions, which are virtual reviews of cancer cases by subspecialists at academic centers, are emerging as a powerful tool for expanding access to expert guidance beyond the walls of major academic cancer institutions.

More equitable access to cancer care

Patients in rural or socioeconomically disadvantaged communities are more likely to face delays in diagnosis, limited access to clinical trials, and reduced exposure to cutting-edge therapies. We know that treatment at National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers is associated with better adherence to evidence-based guidelines and improved patient outcomes, yet fewer than 20 percent of U.S. cancer patients are treated at these centers.

Research presented at the ASCO Quality Symposium and published in JCO Oncology Practice provides compelling evidence of how remote oncology reviews can help bridge this divide. In a study of community-based cases, remote second opinions by cancer subspecialists led to changes in anticancer treatment recommendations in more than half (52 percent) of cases, including changes in chemotherapy, immunotherapy, targeted therapy, or radiation therapy to better align with current evidence. Importantly, patients from the most socioeconomically disadvantaged regions were 25 percent more likely to receive such recommendations than those in more affluent areas.

Remote second opinions represent more than a technological convenience; they’re a structural innovation. By allowing expertise to flow outward from tertiary centers, they bring the highest standards of cancer care to patients who might otherwise be left behind.

How remote second opinions work

In most second opinion programs, treating oncologists at community or regional hospitals submit patient data, including medical history, pathology reports, imaging, and genomic testing. The reviewing experts provide evidence-based guidance that can include confirmation of the current plan, recommendations for alternative regimens, suggestions for additional testing, or identification of clinical trials.

This process is collaborative, not competitive. The subspecialist supports the community oncologist, rather than replacing them, and offers peer consultation that enhances confidence in treatment plans by providing access to deep subspecialty knowledge.

For oncologists managing a broad range of malignancies, such reviews are particularly valuable in rare or complex cancers like sarcomas, leukemias, or certain gastrointestinal tumors.

Support for clinicians: extending the reach of expertise

Community oncologists often care for hundreds of patients across multiple tumor types, while academic specialists may dedicate their entire careers to a single subtype. Remote second opinions effectively serve as just-in-time knowledge transfer, helping community oncologists align with evidence-based cancer care and integrate rapidly evolving data on targeted therapies, immunotherapy combinations, or molecular testing standards.

This model reflects the “hub-and-spoke” approach to care delivery, in which academic centers serve as hubs of expertise radiating outward to community spokes. It not only extends the reach of subspecialty knowledge but also helps mitigate clinician isolation in smaller practices by offering peer validation, reducing uncertainty in decision-making, and strengthening professional networks.

Access to and awareness of clinical trials are critical components of the value oncologists receive from remote second opinions. A study by City of Hope, found that 73 percent of oncologists said availability of clinical trials was the main reason they referred patients to tertiary centers, while 82 percent reported limited awareness of such trials in their region. Remote second opinions can help close that information gap, linking patients and physicians to research opportunities they might otherwise never encounter.

Redrawing the map of cancer expertise

This new data reinforces a simple but transformative idea: cancer expertise doesn’t need to be bound by geography.

Remote second opinions won’t eliminate every barrier to equitable care, but they signal a paradigm shift, one where the quality of cancer care depends less on where a patient lives and more on how far knowledge can travel.

As oncology grows more complex and personalized, ensuring that expertise travels as far and as fast as the disease itself may be one of medicine’s most equitable frontiers.

Yousuf Zafar is a nationally recognized oncologist, health care executive, and population health researcher with more than 20 years of experience in cancer care, informatics, and value-based delivery. He is a practicing oncologist and adjunct professor at Duke University and chief medical officer at AccessHope, where he focuses on expanding access to expert cancer care knowledge for patients treated in the community. Dr. Zafar is helping to facilitate knowledge-sharing within the oncology community by partnering with National Cancer Institute-Designated Comprehensive Cancer Centers to remotely deliver the latest cancer knowledge to the people and places who need it most: bridging a critical gap for those who do not have access to specialized centers.

Previously, he was senior vice president of medical informatics at Optum and Change Healthcare and held leadership roles at Duke Cancer Institute, where he led development of an AI-driven cancer risk model that reduced readmissions by 50 percent and doubled appropriate hospice referrals.

Dr. Zafar has authored over 100 peer-reviewed publications, which are available on ResearchGate, and has led research funded by the National Institutes of Health and the American Cancer Society. His expertise spans clinical trials, real-world evidence, precision medicine, and health equity.

He is a fellow of the American Society of Clinical Oncology and serves on advisory boards including Health Evolution, the Personalized Medicine Coalition, and WCG IRB. In addition, he is a board member of Family Reach, a nonprofit helping families manage the financial burdens of cancer care. Dr. Zafar also shares professional insights and updates on LinkedIn and X @yzafar.