A scoping review of the nurse practitioner workforce in oncology

Abstract

The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed®, the Cumulative Index to Nursing and Allied Health Sciences (CINAHL®), Web of Science, Journal Storage (JSTOR®), Google Scholar, and SCOPUS®. Using the scoping review criteria, the research question was identified “How much care in oncology is provided by nurse practitioners (NPs)?” Key search terms were kept broad and included: “NP” AND “oncology” AND “workforce”. The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs.

Geographic disparities in residential proximity to colorectal and cervical cancer care providers

“…In addition, some health systems have begun to implement the administration of oral chemotherapy in a patient's residence by sending nurses to treat patients in the home setting. Nurse practitioners and physician assistants have been playing an important role in cancer care provision, especially in rural areas, in which physicians trained in oncology‐related specialties are lacking . Increasing such lower‐cost workforce models has the potential to improve access to cancer care providers .…”

The Challenge of Addressing the Rheumatology Workforce Shortage

“…Rapid growth in APP utilization has been demonstrated in the US, including within oncology, gastroenterology, and nephrology, all of which face similar workforce challenges. 16,17,18,19 Several publications have examined the effectiveness of APP care in rheumatology. Solomon et al found that patients seen in practices with nurse practitioners (NPs) or physician assistants (PAs) had lower rheumatoid arthritis disease activity compared to physician-only practices.…”

Better Late Than Never: Fully Incorporating Oncology Advanced Practice Providers Into Cancer Clinical Trials

“…As with routine clinical care, a single model will not fit every practice. 3 APP prescribing of investigational therapy may fit only certain centers' operations and state regulations. Some practices may have independent APP visits, whereas others have shared visits with physicians.…”

“…1,2 These individuals work across practice settings, including private and academic, and ambulatory and inpatient. 3 Within these practices, more than 90% of APPs report participating in patient counseling and prescribing, whereas more than 80% report involvement in treatment management and follow-up visits. 4 Driven by a doubling of the number of Americans age 65 years and older and an 80% increase in people living with or surviving cancer, the increase in demand for oncologists is projected to outpace the increase in supply three-fold.…”