Advanced Practice Providers Role Growing in Oncology

September 4, 2018

The number of nurse practitioners and physician assistants in oncology is growing, according to a new study.

Advanced practice providers, including nurse practitioners (NPs) and physician assistants (PAs), are a growing group in the care of patients with cancer, according to the results of a study published recently in Journal of Oncology Practice. The study identified more than 5,000 advanced practice providers involved in oncology care.

“The survey results suggest that practices that incorporate advanced practice providers in oncology care predominantly involve them in direct patient care, which includes counseling, prescribing, management, and, follow-up,” wrote study researcher Suanna S. Bruinooge, MPH, of the American Society of Clinical Oncology, and colleagues. “With the growing complexity of care, an independent model in a collaborative setting results in greater APP satisfaction and increases patient care capacity.”

Previous research has shown that the use of advanced practice providers in oncology practices contributes greatly to cancer care. Bruinooge and colleagues wanted to identify how many advanced practice providers are involved in oncology care, and get more information on personal and practice characteristics.

First, the researchers identified at least 5,350 advanced practice providers in oncology and an additional 5,400 more who might practice oncology. A national list of oncology advanced practice providers does not exist, to find this information, the researcher's extracted data about all members from the American Society of Clinical Oncology, the Advanced Practitioner Society for Hematology and Oncology, the American Academy of PAs, the Association of Physician Assistants in Oncology, and the Oncology Nursing Society. They also used data from Provider 360, a health care provider database, and the National Plan and Provider Enumeration System, a CMS database.

“Our ability to identify all of the NPs and PAs who work in oncology in the United States was greatly constrained by the lack of a database of advanced practice providers and by the relatively low response rate to the survey,” the researchers noted.

Bruinooge and colleagues surveyed 3,055 advanced practice providers about their roles in clinical care. The response rate for the survey was only 19%.

Focusing on responses from PAs and NPs, the study showed that the majority were satisfied with their career choice. NPs and PAs spent most of their time (80%) in direct patient care, including patient counseling, prescribing, treatment management, and follow-up visits.

The survey also examined compensation of oncology advanced practice providers. The average annual compensation was between $113,000 and $115,000, which is approximately $10,000 greater than the average compensation for non-oncology advanced practice providers. Advanced practice providers working in Western states, academic practices, and large practices earned higher salaries than their oncology peers, according to the study.

Compensation also increased with annual hours worked. Male advanced practice providers earn about 7% more than female advanced practice providers, even after adjusting for factors including years of experience and hours worked. Approximately two-thirds of advanced practice providers responded that they are either satisfied or very satisfied with their compensation.

“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," ASCO President Monica M. Bertagnolli, MD, FASCO, said in a press release. “This new study provides an important benchmark to understanding their critical role on the cancer care delivery team.”

Commenting on the importance of this study, Dean F. Bajorin, MD, FACP, FASCO, an attending physician at Memorial Sloan Kettering and a professor of medicine at Weill Medical College of Cornell University of New York recalled a 2007 study published in The Journal of Oncology Practice, that predicted that advanced practice providers would likely have an increasing role in oncology care. The 2007 study predicted that demand for oncology care services would increase by 48% from 2005 to 2020, and that this growth would exceed the supply of services. Included in the multifaceted strategy suggested to ensure oncology services in 2020, was increasing the use of non-physician clinicians.

“The 2007 study predicted that APPs, NPs, and PAs would fill that void,” said Bajorin, who was not involved with this study. “That is exactly what has happened,” Bajorin told Cancer Network.

Bajorin commended Bruinooge and colleagues for conducting this survey study and its collaboration between medical societies.

“Prior estimates of how many APPs existed in this country were woefully inadequate and inaccurate, and this study shows that,” Bajorin said. “It also shows that this is a seasoned workforce with the average NP having 11 years of oncology care experience and the average PA having 10 years.”