Cancer patients experiencing symptoms often have trouble reaching their care teams due to difficulty scheduling same-day appointments with oncologists or not knowing who to turn to. As a result, these patients visit emergency departments (EDs) and are sometimes admitted inpatient (IP).

In fact, the most common entry point to cancer-related acute care is through the ED. But EDs are not always equipped to adequately support cancer patients, which drives up avoidable costs.

Allow APPs to manage urgent care, which boosts quality for cancer patients in need of acute care compared to the general care they would receive in an ED. This also gives APPs more autonomy — an appealing incentive to APPs looking to feel more engaged in their work.

APPs managing urgent care also benefits oncologists, who can provide support to APPs as needed but simultaneously have more time to work with complex and specialized patients.

By minimizing unnecessary ED visits and IP admissions, providers can reduce total cost of care. All around, this strategy improves providers’ performance under value-based payment arrangements.

Leaders at Anne Arundel Medical Center realized that physicians were at capacity, making it difficult for them to quickly respond to nurses’ and patients’ symptom management questions. To better manage patients’ urgent needs, program leaders created a new role: one NP embedded within medical oncology whose priority is seeing patients with urgent symptoms.

To ensure appropriate use of the NP’s time, program leaders created standard care protocols, scheduling processes, and patient and caregiver education materials. In addition, they created standardized referral criteria for their phone triage nurses to use when patients call the center.

Few APPs receive oncology-specific training during their education. This gap has led to physician wariness over APPs practicing at top of license, as it is unclear if APPs have the expertise required to make autonomous clinical decisions. 

Overlap APP training with oncologists to foster trust, teamwork, and cooperation, as well as a shared understanding of the medical knowledge expected of APPs to make autonomous decisions. Cancer programs can do this by offering combined educational experiences for APPs and physicians in oncology fellowship programs, allowing early-career clinicians to gain exposure to multidisciplinary care.

In addition to equipping APPs with cancer-specific expertise they may not have received in school, overlapping training also helps them understand the thought processes behind oncologists' clinical decisions.

The UTSW Harold C. Simmons Comprehensive Cancer Center started a 12-month APP fellowship centered on postgraduate education in adult oncology. The fellowship includes didactic and clinical experiences with rotations in several oncology specialties through a multidisciplinary team approach.

Training overlaps with the hematology-oncology fellowship for their physicians to foster teamwork and cooperation between physicians and APPs. Additionally, educational opportunities like this help support workforce restructuring. 

Demand for cancer services is continuing to climb, resulting in oncologists working at capacity and managing treatment for a wide array of patients. Not all these patients have the same acuity level or require the same level of care, so some cases could be off-loaded to APPs.

On top of this, oncologists are increasingly choosing to specialize due to the vast variety of cancers and treatment innovations available, creating potential opportunities for APPs to handle more general oncology care.

Allow APPs to independently oversee care for patients with lower-acuity and more common cancers. With APPs providing general oncology care at top of license, oncologists can simultaneously operate at top of license by providing specialized care to the most complex patients.

Secondarily, establish a strong triage system to match individual patients to the appropriate care team member for their situation. This will reduce delays in care and streamline time to appointment, helping to improve the patient experience and prevent further risk of disease progression. 

At Allina Health Cancer Institute, hematology is an area with tremendous volume and capacity constraints. To improve efficiency, the hematology-oncology department implemented a system where APPs triage incoming hematology patients, pre- and post-diagnosis, with hematologist supervision. Low-acuity patients are referred to their PCP, higher-acuity patients see the APP, and the highest-acuity patients get a clinical spot with a board-certified hematologist.

Through e-consults and adequate triage, 80% of patient volumes have been redirected from needing a visiting with the hematologist.

Only 3% of medical oncologists practice in rural areas. Notably, 1 in 5 rural Americans live over 60 miles from a medical oncologist, which places significant travel burden on patients and prevents timely diagnosis and treatment. The consequences of this are significant: more advanced disease at diagnosis, inappropriate treatment, worsened prognosis, and declining quality of life.

Prioritize recruiting APPs in rural areas where physicians can remotely supervise them. Data shows that the APP supply in non-metro markets already outpaces physician supply, so APPs are well-positioned to manage care in these areas.

An increase in APPs in rural areas also minimizes the need for rural patients to travel far to receive care.

Bridge Oncology offers a radiation oncology service delivery model with specialty trained NPs who can be deployed to understaffed, rural practices. Additionally, Bridge Oncology has a proprietary platform to which member practices can subscribe, connecting providers, operational experts, and support staff to ensure quality care regardless of geographic challenges.

Bridge Oncology also offers a one-year training program for APPs, which enables them to work in any radiation oncology office. Overall, their model overcomes access gaps and removes barriers to care to provide a smoother and higher-quality care journey. 

Currently, many APPs do not have the knowledge needed to practice completely autonomously.  This could change with advancements in AI and CDS tools, which could help APPs make care decisions without need for significant oncologist intervention and oversight.

Adopt and implement AI and CDS tools to technologically enable APPs to make accurate and trusted clinical decisions for lower-acuity and common cancer cases with simpler treatment plans.

For example, we believe future AI and CDS tools will help guide APPs to a suggested course of treatment for common cancer diagnoses, taking into account clinical guidelines, patient characteristics, and other factors. New tools will also flag patients who may qualify for participation in clinical trials. This extra support and knowledge could diminish the need for oncologist supervision in APP-led cases.

• Massive Bio is a company that utilizes artificial intelligence to provide concierge services to cancer patients.
• The Oncology Institute (TOI) is a provider of specialized, value-based cancer care.

Massive Bio and TOI announced a partnership in which Massive Bio will provide AI-driven precision medicine technology to “empower patients and ordering physicians at TOI with clinical decision-support” and evaluate patient eligibility for TOI’s clinical trial portfolio. The partnership aims to establish a nationwide network connecting patients to potentially life-saving treatments and trials.

Additionally, the two companies want to expand cancer research through Massive Bio’s ChatGPT-powered chatbots for oncology research. Dr. Arturo Loaiza-Bonilla, an oncologist who helped develop this technology, believes “the integration of AI-driven chatbots with clinical decision-support tools will revolutionize the way researchers access and analyze oncology data.”

Though this model does not specifically pertain to using AI to advance APP autonomy, a similar model could be used for this purpose in the future.