Role of oncology-advanced practitioners to enhance clinical research.

Abstract

95 Background: Oncology Advanced Practitioners (APs), including Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, and Pharmacists are highly trained health care providers that contribute significantly to quality cancer care. Given low clinical trial enrollment among adult oncology patients, understanding current research responsibilities of APs could lead to identification of opportunities to leverage this workforce to enhance accrual and conduct of clinical trials. Methods: A 65-item validated survey addressing attitudes, beliefs and responsibilities of oncology APs participating in clinical research was distributed from January 22 through March 6, 2020. Outreach via the Association of Community Cancer Centers (ACCC) and Harborside was utilized to reach a sample set of 14,601 oncology APs’ emails. The survey was administered and data were analyzed using Survey Monkey. Results: 408 U.S. oncology APs completed the survey. Respondents were primarily white (83%), female (92%) and nurse practitioners (71%). Thirty-five percent practiced in an academic setting and 62% practiced in a community setting. Nearly all respondents believed that clinical trials are important to improve oncology care standards and more than 90% reported that clinical trials were available at their practice. Nearly 80% reported that they are comfortable discussing treatment options with patients, discussing clinical trials in general, and know where to find clinical trials. Furthermore, 80% participate in the care of patients enrolled on clinical trials. Only 60%, however, are comfortable discussing trials available at their practice and only 38% routinely explore whether a clinical trial is available for their patients. While 70% of APs approach eligible patients about clinical trials at their practice, only 20% reported doing so “a great deal” or “a lot”. Ninety percent of APs reported that they should play a role in clinical research and 75% would like to be more involved in the clinical trial process. Barriers to greater involvement in clinical trials include lack of time, inadequate awareness of clinical trial specifics, and under-representation on research committees. Conclusions: The majority of oncology APs are engaged and interested in clinical trials and believe that research is important to improve cancer care. However, they are not being utilized to their full scope. Multidisciplinary team integration, trials-related education, and policy change is needed to allow this group of skilled professionals to realize their full potential within cancer clinical trials.

Defining the Role of the Advanced Practice Provider Within the National Cancer Institute Community Oncology Research Program

“…As previous survey results and literature have shown, to date, the primary role of the APP in clinical research has been providing clinical care for patients on trials. [4][5][6][7][8] By contrast, several areas for improvement still exist for integrating APPs in clinical research. Only 43% of practices reported that APPs are involved in presenting and discussing clinical trials to patients.…”

“…The APP curriculum does not routinely include oncology clinical research, and the majority of APPs are initially educated as generalists. 5 Few oncology fellowship programs are available throughout the country and are primarily located at academic or large cancer centers, [29][30][31] One might question whether increasing APP research involvement will simply shift the work and recognition to APPs. This may be true in some circumstances, but as the number of oncology APPs has grown significantly in the past 10 years, 1,2 so has the complexity of oncology care, the needs of cancer patients, and survivors.…”

“…As such, utilization of oncology APPs in clinical research is beginning to expand. [4][5][6][7][8] In 2020, Braun-Inglis et al 5 completed the first national survey examining oncology APPs and clinical trials. More than 400 APPs across the country from both community and academic centers completed the survey.…”

“…Existing barriers were identified within National Cancer Institute (NCI) policy at the time, limiting APP scope within the realm of NCI-sponsored trials. 5 For example, despite APPs being experts in symptom management and care coordination, [1][2][3] they could not independently enroll patients in cancer control, cancer prevention, or cancer care delivery trials sponsored by the NCI Community Oncology Research Program (NCORP). In addition, APPs could not order medications on NCI-sponsored trials without a physician investigator co-signature.…”

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

“…In a recent nationwide survey of more than 400 oncology APPs, over 70% reported that their practice participated in National Cancer Institute (NCI) clinical trials. However, only 35% were registered with the NCI as investigators, 7 which means the majority are not participating in any NCI trial-related activities, such as adverse event review, assessment of performance status, physical examination, and review of concomitant medications. Nonetheless, more than 95% of respondents reported believing that clinical trials are important to advancing oncology care, and more than 80% felt adept at finding information on specific trials and discussing clinical trial options with patients-findings that suggest this discrepancy may reflect lack of opportunity or awareness rather than lack of interest.…”