Advanced practitioners called on to ease cancer care shortage, but challenges remain

The cancer community is in critical need of additional providers. The demand for oncology services is expected to increase by 40% or more by 2025, while the supply of oncologists is only expected to grow by 25%, according to a study by the American Society of Clinical Oncology.

To fill this expected shortage, oncologists have called on a workforce that dominates the primary care arena: advanced-practice providers. The majority of cancer providers — an estimated 75% — say they deploy advanced practitioners to meet oncology demands, up from 55% of oncologists in 2014 . These oncologists also support a larger paradigm shift in oncology care to more team-based care approaches.

But successfully incorporating advanced practitioners unfamiliar to cancer treatment presents challenges for oncologists, who must set aside the time to train, mentor and incorporate these new providers into the workflow. It's also critical for oncologists to oversee practitioners' work thoroughly to ensure patient care quality doesn't deteriorate.

"While having advanced practitioners as part of the practice can be very beneficial, it requires up-front investments," said Dr. Michael Halpern, an associate professor of health services administration and policy at Temple University. "One of the things oncologists need to recognize is there is often going to be a learning curve for advanced-practice providers."

Nurse practitioners and physician assistants are mainly trained in primary care specialties like pediatrics or women's health when they receive their certifications, as their roles are intended to help ease the primary care shortage by providing preventive care for patients. They also aren't required to receive additional certification to work in cancer practices although a few certification programs specific to oncology for practitioners have popped up in the last decade.

Halpern said it can take up to two years to successfully teach advanced-practice providers the skills required for cancer care. This can be tough for oncologists who are already crunched for time.

There are no national standards for oncology training for advanced-practice providers, and state laws vary on how they can participate in cancer care. Generally, oncologists will train practitioners to conduct patient assessments and evaluate patient symptoms, perform screenings and coordinate patient care including managing referrals and tests. Also because practitioners have more one-on-one time with patients, they can recruit patients for clinical trials. Oncologists often don't have the time to explain clinical trials to patients, so advanced practitioners can ease that burden, Halpern said.

But even after an advanced-practice provider is trained, oncologists must continue to evaluate and review the work of their practitioners to ensure safety and quality of care isn't negatively impacted, said Dr. Debra Patt, immediate past chair of the American Society of Clinical Oncology's clinical practice committee.

Patt, who is also the vice president of an oncology practice in Texas, said all of the patient care notes of the 140 advanced practitioners in her practice are reviewed by oncologists. If any changes are made to the care plan, an oncologist will meet with the patient and the practitioner to discuss it further to ensure quality standards are still met. "There does have to be an appropriate supervisory relationship," she added.

It can be hard to implement this type of review program in states that allow advanced-practice providers to treat patients without direct physician oversight, and it's unclear whether advanced-practice providers have an impact on patient safety and quality, Halpern said.

Despite these concerns, advanced-practice providers are essential in the push to treat cancer more like a chronic illness that requires frequent follow-up care, Patt said. This shift in treatment has led to a more collaborative approach to cancer care.

Cancer care plans increasingly involve therapies to help patients understand and manage their disease after they've been treated. Often called survivorship programs, they can include addressing diet, exercise and social determinants of health for patients.

Advanced-practice providers can play an important role in managing and maintaining these efforts while oncologists work on more complex care needs for patients, Patt said.

"In this more team-based care approach, I've found advanced-practice providers to be a value-add to my practice," she added.