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Advanced practice providers (APPs) have increasingly become integral members of the oncology care delivery team, according to the first large-scale study of nurse practitioners (NPs) and physician assistants (PAs) in oncology published in the Journal of Oncology Practice (2018; The study was conducted collaboratively by ASCO, American Academy of PAs (AAPA), Association of Physician Assistants in Oncology (APAO), Advanced Practitioner Society for Hematology and Oncology (APSHO), and Oncology Nursing Society (ONS).

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"Nurse practitioners and physicians assistants are critical health care providers in the delivery of quality cancer care," said ONS Chief Executive Officer Brenda Nevidjon, MSN, RN, FAAN. "This survey is the first step toward better understanding their roles, needs, and challenges in today's oncology care environment."


According to data from ASCO's annual Practice Census, the number of oncology practices in the U.S. who have reported employing APPs has grown dramatically-from 52 percent in 2014 to 81 percent in 2017. However, despite this rapid growth, very little systematic research has been done on the total number of APPs in oncology and their specific roles and responsibilities on the care team.


"As the number of individuals with cancer and cancer survivors in the United States continues to grow, advanced practice providers have become increasingly important to ensuring patient access to high-quality cancer care," said ASCO President Monica M. Bertagnolli, MD, FASCO. "This new study provides an important benchmark to understanding their critical role on the cancer care delivery team."


To address the lack of data, ASCO, AAPA, APAO, APSHO, and ONS undertook a collaborative effort to identify the number of APPs currently working in oncology. The analysis identified 5,350 oncology APPs-and it is believed there could be as many as 7,000-practicing in the U.S. The organizations also conducted a survey of APPs in oncology, which asked questions about the demographics of the APP workforce in oncology. The results of those efforts provide the first detailed examination of APPs in oncology.


"APPs play a pivotal role in providing high-quality collaborative care for people with cancer," said President of the APSHO Board of Directors, Pamela Hallquist Viale, RN, MS, CNS, ANP. "APSHO is thrilled to work with our interdisciplinary colleagues on this important research into the nature of our work."


Varied Roles in Cancer Care

"This study is yet another affirmation of the value that APPs bring to the table, specifically in a specialty like oncology where collaboration leads to stronger health care teams and better patient care," said AAPA President and Chair of the Board of Directors, Jonathan E. Sobel, PA-C, DMSc, MBA, DFAAPA, FAPACVS.


The study results suggest that oncology practices with APPs routinely rely on them for direct patient care, with APPs spending an average of 85 percent of their time providing patient counseling, prescribing and managing treatments, and handling follow-up patient visits. Nearly all (92.5%) of APPs who provide direct patient care reported conducting independent patient visits. APPs who practice in independent models (where APPs typically see patients alone but work with a care team to address the most critical care decisions) report the highest level of professional satisfaction. However, the majority of APPs in oncology (90%) are satisfied or very satisfied with their position and their collaborative practice with oncologists (80% NPs, 76% PAs).


Oncology APPs Earn More

The study found that APPs in oncology earn an average of between $113,000 and $115,000 per year, or about $10,000 higher than non-oncology APPs. Practitioners working in Western states, academic practices, and large practices earned higher salaries than their oncology peers. Compensation also increases with annual hours worked. Male APPs earn about 7 percent more than female APPs, even after adjusting for other factors, including years of experience and hours worked. Approximately two-thirds of APPs say they are either satisfied or very satisfied with their compensation.


"The Association of Physician Assistants in Oncology is dedicated to providing team-based care for the oncology patient," said APAO President, Richard Lindsay PA-C. "We are proud of our close working relationship with ASCO through our medical liaison for nearly 15 years and our partnership in the development of oncology training for the APP through ASCO University."


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