The Oncology Market in 2025–2026

The global oncology market was valued at roughly $243.25 billion in 2025 (Nova One Advisor, 2025), and most forecasters expect it to more than double within a decade. One widely cited projection puts it at $600.97 billion by 2034 at an 11.54% CAGR (BioSpace, 2025). That double-digit growth is rare in healthcare and it is driven by an ageing population, earlier detection, and a pipeline of high-cost biologics and targeted therapies.

For a founder, the headline number matters far less than where the money is captured. The United States alone is projected to reach $211.78 billion by 2034 (Towards Healthcare, 2025), and a growing share of treatment has shifted out of hospital outpatient departments into community infusion centres, where care is delivered at lower cost. That migration is the single biggest reason a well-run independent oncology practice can exist alongside hospital systems instead of being crushed by them.

The UK story is structurally different. Most cancer care is delivered free at the point of use through the NHS, so the private opportunity sits in self-pay and insured patients who want speed, choice of consultant, or access to a specific therapy. Private operators such as HCA Healthcare UK and The London Clinic Cancer Centre serve exactly that segment. A new entrant in Britain is not competing for the whole market; it is competing for the slice of patients willing to pay to skip a queue.

The practical takeaway for your plan: do not anchor your projections to a trillion-dollar abstraction. Anchor them to the number of referrals you can realistically convert, the chairs you can keep full, and the payer contracts you can actually sign in your first 18 months.

It is also worth understanding who already owns the community-oncology space, because your plan needs to position against them honestly. The US Oncology Network spans more than 1,400 physicians nationally. Florida Cancer Specialists & Research Institute is the largest privately held hematology and oncology practice in the country, with over 250 physicians and close to 100 locations. The American Oncology Network, founded in 2018, has grown to more than 290 providers across 21 states. These networks compete on procurement scale, group-purchasing power and brand. A new independent does not beat them at scale; it beats them on a tightly defined catchment, shorter waits, and a patient experience a large network struggles to replicate. Saying that plainly, and then proving it with local data, is what makes a single-site plan fundable in a consolidating market.

Who Your Patients Are, and Where They Come From

An oncology practice does not acquire patients the way a retail business acquires customers. Almost no one walks in off the street. Patients arrive through referral, and the strength of your plan rests on showing, concretely, who refers and why they would choose you. Underwriters and investors read this section to judge whether your chairs will ever fill.

There are three referral engines worth mapping in detail. The first is primary care: GPs and family-medicine physicians who detect a worrying symptom or abnormal result and send the patient onward. The second is the screening and diagnostic pipeline: mammography, colonoscopy, imaging centres and pathology labs that flag malignancy and need a destination for treatment. The third is surgical and specialist colleagues, where a surgeon removes a tumour and the patient then needs adjuvant chemotherapy or ongoing systemic therapy. A practice that wins all three referral types keeps its schedule full; a practice that depends on one is fragile.

Your patient base also splits by payer, and the payer mix quietly determines your margin. In the US, a Medicare-heavy panel anchors to Part B reimbursement and the modest drug spread that comes with it, while a healthier share of commercial insurance lifts realised revenue per administration. In the UK, the relevant split is self-pay versus privately insured, because both pay outside the NHS and both expect speed and choice in return. Spelling out this mix, rather than assuming an average, is what separates a credible oncology plan from a generic one.

• Recurring infusion patients: the backbone of utilisation, on multi-cycle regimens that fill the same chairs week after week.
• New diagnoses from the screening pipeline: the growth engine, dependent on relationships with imaging and pathology partners.
• Surgical adjuvant referrals: high-acuity, often higher-value, gated by surgeon trust.
• Second-opinion and continuity transfers: patients seeking choice, more relevant to private and self-pay models.

The strategic point your plan should make is simple: capacity follows referrals, not the other way around. Build a referral map for your specific catchment, name the feeder practices and imaging centres you can realistically partner with, and tie your chair-ramp schedule to that pipeline. A forecast that adds chairs on a calendar rather than on confirmed referral volume is the fastest way to lose a lender's confidence.

Questions Founders Ask First

These come up in almost every early conversation we have with clinicians moving from a hospital system into their own practice. Short, direct answers, then the detail follows in the sections below.

Is community oncology more profitable than hospital-based oncology?

For the operator, often yes, because the cost base is lighter and care is delivered at a lower price point that payers favour. The catch is the 340B program: hospitals enrolled in 340B earned margins equal to roughly 45% of total reimbursement on cancer therapies in 2022, more than ten times the spread a non-340B community provider sees (American Cancer Society CAN, 2025). Your plan should be honest that you are competing on efficiency and patient experience, not on drug-discount arbitrage.

How many patients do I need to break even?

It is a function of chair utilisation, not just headcount. A centre needs enough recurring infusion patients to keep chairs productive across the working day. We model breakeven on administrations per chair per week rather than total registered patients, because a panel of 400 patients who infuse quarterly behaves very differently from 120 who infuse weekly.

Can a single oncologist open a practice alone?

Clinically, yes, but the economics push toward at least a small group or an advanced-practice-provider model. With one physician, every vacation day is a revenue gap and a coverage problem. Most durable community practices pair physicians with nurse practitioners and physician assistants to keep the schedule moving.

What is the biggest hidden cost?

The drug-inventory float. Under buy-and-bill you purchase the chemotherapy and biologic agents up front and wait weeks for reimbursement. A practice can be profitable on paper and still fail on cash timing if it under-sizes that float. We treat it as a financing line in the plan, not an afterthought.

What It Costs to Open

A community oncology and infusion practice in the US typically needs $250,000 to $900,000 before its first reimbursed claim. In the UK, an independent cancer clinic runs about £180,000 to £650,000. The range is wide because two clinics with the same chair count can differ enormously depending on whether they lease a finished medical suite or build out raw space, and how heavy their drug mix is.

Cost Breakdown

• Clinical fit-out & infusion suite build: $80K–$300K (£60K–£220K). Plumbing, negative-pressure considerations, hand-wash stations, and a compliant drug-prep area.
• Medical equipment: $60K–$180K (£45K–£140K). Infusion chairs, IV pumps, a biological safety cabinet, refrigeration and a backup generator.
• Licensing, CLIA & accreditation: $20K–$70K (£15K–£55K). CMS enrolment, a CLIA certificate, pharmacy compliance and, optionally, CoC accreditation.
• Drug inventory float (buy-and-bill): $50K–$200K (£40K–£160K). The working capital that sits in your veins, literally, until payers reimburse.
• Staffing ramp & working capital: $40K–$150K (£30K–£120K). Three to four months of payroll before claims volume catches up.

Labour is the structural cost that never goes away. Across infusion centres it typically lands at 35% to 50% of revenue (Crestmont Capital, 2025), and oncology pulls the high end of clinical wages. Medscape's 2025 compensation data put oncology and hematology physician pay at about $472,000, with starting hematologist-oncologist offers reaching roughly $490,000 after a double-digit jump (AMN Healthcare, 2025). Your forecast has to carry that number from day one, not phase it in.

Equipment & Clinical Build List

This is the physical core of an infusion-led oncology practice. Lenders and landlords both want to see it itemised, because it tells them whether your capital ask is grounded in reality.

• Infusion / treatment chairs: $1,500–$4,000 each. A 10-chair suite is a common starting footprint.
• Smart IV infusion pumps: $2,000–$6,000 each, usually one to two per chair.
• Class II biological safety cabinet (BSC): $8,000–$18,000 for compliant cytotoxic drug preparation.
• Pharmacy-grade refrigeration & freezers: $3,000–$12,000 with temperature monitoring and alarms.
• Backup power / UPS & generator: $5,000–$40,000 depending on suite size.
• Vital-signs monitors & emergency / crash cart: $4,000–$15,000.
• Oncology EHR & practice-management software: recurring per-provider licensing. Common platforms include OncoEMR (Flatiron), Epic Beacon, and athenahealth.
• In-house lab / CLIA-waived analysers: $5,000–$30,000 if you process counts and chemistries on site.
• Sharps, cytotoxic spill kits & hazardous-waste contracts: ongoing operating cost, not a one-off.

Most cost guides on this topic stop at the chair count. The number that actually drives your build budget is the drug-prep area: a compliant BSC and aseptic workflow can be the difference between passing a pharmacy inspection on the first visit and rebuilding a room you already paid for.

How the Money Actually Works

Oncology revenue is not one stream, it is four stacked on top of each other, and they have very different margins:

• Physician services: new-patient consults, follow-ups, treatment planning. Steady, scheduling-limited.
• Infusion administration: the time-based and per-drug administration codes for delivering therapy in the chair.
• Drug margin (buy-and-bill): the spread between what you pay for a drug and what the payer reimburses.
• Ancillaries: in-house lab, pathology, imaging and pharmacy, each adding margin when kept on site.

The drug margin is where oncology economics surprise newcomers. Under Medicare Part B, reimbursement is typically the drug's average sales price plus a small percentage, historically around 4% to 6%. On a $10,000 dose that is roughly $600 of spread; on a $100 drug it is about $6 (The Focal Points, 2024). Because the percentage is fixed, high-cost biologics carry the practice. That is also why the float is so large and why payer-mix shifts can move your whole forecast.

Worked example: a 10-chair community centre

Take a 10-chair suite running at roughly 70% chair utilisation, around 3,000 administrations a year, with a blended revenue of about $2.6M across consults, administration codes and drug spread. Hold labour near 42% of revenue, layer in rent, drug cost of goods, lab, and compliance, and a disciplined operator lands in a 19% to 24% operating margin. Push chair utilisation toward 85% with a richer biologic mix and the margin climbs toward the 35% ceiling that the best-run centres report. Let referrals stall and chairs sit empty, and the same fixed-cost base drags the margin into single digits fast.

The lesson your projections should encode: in oncology, the swing factor is utilisation and drug mix, not headline patient count. Two practices with identical registers can post wildly different margins based on how full the chairs run and which therapies flow through them.

There is a second-order revenue lever that strong plans capture and weak ones miss: keeping ancillaries in-house. When a practice runs its own CLIA-certified lab, processes pathology on site, and bills its own imaging where regulation allows, each touchpoint that would otherwise leak to an outside provider becomes a margin line. The same patient visit can generate a consult charge, an administration code, drug spread, and a lab panel without the patient ever leaving the building. Mapping these ancillary streams against your service lines, and showing which are realistic in year one versus year three, turns a flat revenue projection into a layered one that underwriters find far more believable.

Equally, your model should stress-test the downside. A change in drug-spread policy, a single large payer renegotiating its contract, or a key referring surgeon retiring can each move the forecast materially. A plan that names these risks and shows a response, a diversified referral base, a working-capital cushion, and a balanced payer mix, reads as written by an operator rather than an optimist.

Staffing, Chairs & Day-to-Day Operations

Oncology is an operationally dense business. The plan that earns funding shows the reader you understand how a treatment day actually runs, not just that you can hire an oncologist. Three operational levers decide whether a centre thrives: the staffing model, chair scheduling, and the pharmacy workflow that sits behind every infusion.

The staffing model

A durable community practice rarely runs on physicians alone. The economical structure pairs each oncologist with advanced-practice providers, nurse practitioners and physician assistants, who handle follow-ups, symptom management and routine visits while the physician concentrates on new diagnoses and complex treatment planning. Infusion nurses are the clinical heartbeat of the chair area, and their ratio to active chairs governs how many patients you can safely treat at once. A practice manager and a billing or revenue-cycle function are not optional overhead; in a buy-and-bill model, the speed and accuracy of claims directly determines cash flow.

Chair scheduling

Chair utilisation is the single metric most new operators underweight. Empty chairs still carry rent, nursing cost and the fixed overhead of a licensed facility. The art of scheduling is matching infusion length to chair availability across the day, so that short administrations backfill the gaps around long ones. Building a schedule template that targets a realistic utilisation rate, then ramping it as referrals grow, is more predictive of survival than any single headline revenue figure.

Pharmacy and drug handling

Behind every chair is a compliant drug-preparation workflow. Cytotoxic agents must be prepared in a biological safety cabinet under aseptic conditions, by trained staff, with documented chain-of-custody. This is where many first-time operators underestimate both the capital cost and the regulatory scrutiny. Inspectors look closely at the prep area, the storage temperatures, and the disposal of hazardous waste. Getting this right at the design stage avoids the expensive rework of a room that fails inspection after you have already opened.

Tie these three levers together in your operations plan and the financial model stops looking like a wish and starts looking like a system. That is the tone healthcare underwriters reward.

SBA & Funding Data

For US founders, the SBA 7(a) program is the workhorse. It funds infusion-centre startups, fit-outs and acquisitions, with loans up to $5M and terms up to 25 years for real estate. Lenders expect the owner to have relevant clinical experience, a sound plan with financial projections, and an owner-equity injection of 10% to 20% (Crestmont Capital, 2025). A board-certified oncologist with a credible plan is close to an ideal 7(a) borrower because the experience box is so clearly ticked.

• SBA 7(a): up to $5M, 10–25 year terms, 10–20% owner equity expected.
• Healthcare-specific equipment finance: covers chairs, pumps and refrigeration, preserving cash for the drug float.
• Lines of credit: sized specifically to bridge buy-and-bill reimbursement lag.
• Physician equity & partnership buy-in: the most common source of the required owner injection.
• NIH and non-profit grants: realistic for research-linked or community-access models, not for a standard clinic.

In the UK, where there is no SBA equivalent, funding usually combines the founders' capital, asset finance for equipment, and commercial lending from banks with a healthcare desk. The Start Up Loans scheme (up to £25,000 per founder at a fixed rate with mentoring) can seed early costs but will not, on its own, fund a clinical build. Our bespoke plans format the financials the way each of these underwriters expects, which is often the difference between a yes and a request for more information.

Accreditation & Legal Requirements

Oncology is one of the most heavily regulated businesses you can start. The plan needs to show you understand the sequence, because each approval gates the next, and most of them gate your first paid claim.

United States

• NPI + CMS certification: enrolment plus a state-survey-agency inspection on behalf of CMS. Plan for 3 to 9 months.
• CLIA certificate: required for any in-house lab testing, issued by the CMS CLIA program; cost scales from a couple of hundred dollars to over a thousand by test complexity (CMS, 2025).
• State medical-facility licence & pharmacy/board oversight for drug handling and aseptic preparation.
• DEA registration for controlled substances used in supportive care.
• HIPAA compliance program for patient privacy, baked into your EHR and policies.
• Commission on Cancer (CoC) accreditation from the American College of Surgeons is optional and prestige-driven, with caseload thresholds and a multi-month review (American College of Surgeons, 2025).

United Kingdom

• Register with the Care Quality Commission under Treatment of Disease, Disorder or Injury; treating patients without it is a criminal offence (Care Quality Commission, 2025).
• Separate CQC registration for any independent diagnostic imaging (CT, MRI, ultrasound) you run.
• Oncologists must hold GMC registration on the Specialist Register.
• Home Office controlled-drugs licence for cytotoxic and opioid handling, plus pharmacy oversight for aseptic compounding.
• Expect CQC registration to take roughly 10 to 14 weeks, and budget the annual fee scaled to your size.

Australia (one further jurisdiction)

• Oncologists must be registered with AHPRA and hold the relevant specialist qualification.
• Therapeutic goods are regulated by the TGA; state health departments license the facility itself.
• Medicare provider numbers are required for the practice to claim, and private-health-insurer agreements shape the self-pay and insured mix.

Terms your plan should define

Oncology business plans are read by lenders who may not be clinicians. Defining the vocabulary plainly signals competence and removes ambiguity from your financials.

• Buy-and-bill: the model where the practice purchases the drug, administers it, and bills the payer afterward, carrying the inventory cost in between.
• Average sales price (ASP): the Medicare benchmark a Part B drug is reimbursed against, plus a fixed percentage add-on.
• Chair utilisation: the share of available chair-hours actually used for treatment, your most important operational metric.
• 340B: a federal drug-discount program available to qualifying hospitals, which gives them far larger drug margins than a community practice earns.
• Credentialing: the payer-by-payer process of being approved to bill an insurer, which runs in parallel with licensing and often gates your first reimbursed claim.
• Aseptic compounding: the sterile preparation of infusible drugs in a biological safety cabinet, a regulated workflow inspectors scrutinise closely.

One more sequencing point that catches founders out: licensing and credentialing are not the same thing, and both gate revenue. You can hold a state facility licence and a CLIA certificate and still be unable to bill a commercial insurer because credentialing with that payer has not completed. Because each payer runs its own timeline, often months long, the practical rule is to start credentialing the day your corporate entity exists, in parallel with the build, rather than waiting until the doors are ready to open. Plans that show this parallel timeline, rather than a naive sequential one, consistently read as more credible to healthcare underwriters because they reflect how cash actually starts to flow.

Mistakes That Sink New Practices

Across oncology plans we have reviewed, the same five errors recur. Each one is avoidable in the planning stage and brutal to fix once the doors are open.

• Under-sizing the drug float. Buy-and-bill means you bankroll therapy weeks before reimbursement. A practice can be profitable and still run out of cash. Model the float as a financing line, not a rounding error.
• Assuming hospital-level reimbursement. Community Part B economics are thinner than 340B hospital margins. Build your forecast on the spread you will actually earn, not the one a big system enjoys.
• Treating accreditation as paperwork. CMS survey timing, CLIA and pharmacy compliance gate your revenue. Map them on the timeline and credential with payers in parallel from week one.
• Building chairs ahead of referrals. Empty chairs still carry rent and staff. Tie your capacity ramp to a concrete referral pipeline from local GPs, surgeons and screening programs.
• Writing it as generic healthcare. A plan that ignores payer mix, drug spread and chair utilisation reads as if the founder has never run an infusion suite. Underwriters notice instantly.

Sample Business Plan Preview

Here is an extract from an oncology plan structured by our team, so you can see the level of specificity that wins funding:

What's in the Template

Every Avvale business plan template includes these sections, pre-structured for an oncology and infusion practice:

• Executive Summary - Your practice, model and ask, written to hold an underwriter's attention in the first minute.
• Company Overview - Legal structure, physician ownership, location and the clinical model (community infusion, private clinic, or hybrid).
• Market & Referral Analysis - Local demand, referral sources, and where your patients will actually come from.
• Service Lines - Consults, infusion, lab, pathology and any imaging, with the payer mix attached to each.
• Competitor Analysis - Hospital systems and networks such as the US Oncology Network and American Oncology Network, and where a focused independent wins.
• Operations & Compliance Plan - Staffing, chair scheduling, accreditation sequence and credentialing timeline.
• Marketing & Referral Strategy - How you build and protect the referral pipeline that keeps chairs full.
• Management Team - Physician bios, advanced-practice providers, and the practice-manager hire.

The optional Financial Forecast add-on (included in our $300/£250 and $1,000/£800 packages) provides a 5-year Excel model with income statement, cash flow, balance sheet, break-even analysis, the drug-float financing line, and the startup capital requirement formatted for SBA and healthcare underwriters.

Need a different angle? Browse our full library of free business plan templates, or look at an adjacent niche such as the medical clinic business plan template if your model is broader than oncology alone.

Frequently Asked Questions