Scope of Practice

All advanced practice providers (APPs) in radiation oncology should practice to the full scope of their training, Drapek said. However, more published information about the role is needed, and as of April 2020, the United States has only 16 APPs in radiation oncology.

“Learning new ways to be innovative and build your practice is the key to being a successful APP in radiation oncology,” Bukolt added. “Having a chance to dialogue and network with others about our role is the most important focus of our talk.”

Significant barriers limit optimal APRN practice in radiation oncology. For example, although they can optimally manage radiation treatment-related effects, the Centers for Medicare and Medicaid Services does not acknowledge their role in managing radiation treatment because they are not radiation oncologists, Drapek said.

Drapek discussed how some states limit independent practice for APNs. “This is secondary to legislative procedures influenced by physician organizations,” she said. “Education of the public, politicians, and physicians can help us achieve this goal. Physician support would be key.”

“The hallmark of APP practice is treatment of symptoms related to cancer care, and this is the arena where they are most effective,” Bukolt added. “Allowing language in this law that is inclusive of the APP role in clinical management would make the implementation of their role in the department of radiation oncology smoother and have less barriers to practice.”

In addition, radiation oncology is falling behind other oncologic disciplines in terms of advanced practice collaboration, Drapek explained. “In the recent publication from ASTRO, Safety Is No Accident, the responsibilities of RNs, nurse practitioners, physician assistants, and clinical nurse specialists are listed as ‘nonphysician providers’ in one single category. There has traditionally been a lack of understanding of the advanced practice role in radiation. In defense of radiation oncologists, the role of the APRN in radiation oncology has been in existence for a little more than 10 years, whereas hematology/oncology has had APPs for more than 25 years,” Drapek said.

The Future of Advanced Practice

Although APPs have been well accepted in medical and surgical oncology, radiation oncology has been slow to include nursing, Bukolt said. However, as the demand for radiation increases and more oncology care shifts to an alternative payment model, more practices are embracing the role of APPs in radiation oncology. “I think as radiation oncologists come up through fellowship, they have been more exposed to the role of an APP in cancer care,” Bukolt said.

Other future areas for APRNs in radiation oncology include independently running survivorship clinics, as well as virtual visits. “Conducting and participating in clinical trials are also key areas of development for APPs,” Drapek said.

Bukolt emphasized the innovative and resilient qualities of APPs in “leading the charge” to expand practice. “Nursing in general continues to be the most trusted profession,” she said. “Patients instantly connect with APPs, and many times we can use that as a segue into the trusted space of survivorship, advanced care planning, and follow-up care. The options are endless.”