An Expert’s Bona Fide Guide: Life as an Oncology NP
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“What I find exciting about oncology is the mixture of science and holistic care, which is really well-partnered. Every single day, new information comes out about treatments that potentially prolong patients’ lives. There’s been a shift in thought processes when it comes to oncology. There’s a lot more hope these days.”
Maura Abbott, PhD, Assistant Professor of Nursing and Oncology Program Director at Columbia University School of Nursing
An oncology nurse practitioner (NP) is a highly-trained, board-certified health professional who specializes in treating patients who have been diagnosed with cancer. They also consult with families, provide ongoing education, and work both independently and in close collaboration with other members of the care team. Oncology is a subspecialty that’s both highly complex and continually evolving: as our scientific understanding of cancer and its treatments changes, so does the way that oncology NPs interact with their patients.
May is Oncology Nursing Month—and we know more about cancer than ever before. Over the last decade, medical researchers have identified hundreds of different types and subtypes of cancer. This has led to a shift away from universal treatment methods, and towards precise and personalized therapies. In the last few years, the Food and Drug Administration (FDA) has approved many new anticancer therapeutics, many of which are molecularly targeted agents. And while the number of diagnosed cases of cancer is increasing, so are the chances of survival: there are over 28 million cancer survivors worldwide.
Increased survivorship is, obviously, a good thing. But it also means the number of oncology patients is increasing. A 2020 study in JAMA Oncology suggests that the rate of new oncologists can’t keep pace to fill the need. Specialized advanced practice providers (APPs) such as oncology NPs can and will play an increasingly critical role in delivering oncology care, and their holistic, patient-centered approach is well-suited to meet the needs of the new era of oncology.
Meet the Experts: Lisa A. Kottschade and Maura Abbott
Lisa A. Kottschade, APRN, CNP
Lisa Kottschade is an associate professor of oncology, a nurse practitioner in the Melanoma and Cutaneous Oncology Clinic, and holds associate status at Mayo Clinic. Kottschade is also the chief operations officer for the Midwest Melanoma Partnership and chair for the Alliance in Clinical Trials of Oncology Nursing committee. She obtained her BSN from Winona State University and her MSN from St. Louis University.
Kottschade has published extensively on both melanoma and side effect management and is currently leading the Immunotherapy Toxicity Working Group at Mayo Clinic. She is also Secretary of the Board for the Advanced Practitioner Society For Hematology and Oncology (APSHO).
Maura Abbott, PhD, AOCNP, CPNP, RN
Dr. Maura Abbott is an assistant professor of nursing and oncology program director at Columbia University School of Nursing. She is also a nurse practitioner in the Columbia University Medical Center Department of Hematology and Oncology.
Dr. Abbott earned her MSN and her PhD in nursing from Yale University, where she also served as an instructor in the graduate pediatric nurse practitioner (PNP) and family nurse practitioner (FNP) programs before joining the faculty at Columbia University.
The Evolving Role of Oncology NPs
“APPs [advanced practice providers], including NPs, have become very sought-after in oncology,” says Lisa A. Kottschade, an associate professor of oncology at Mayo Clinic. “They can care for patients across the continuum, from diagnosis, through treatment, and end-of-life care. The practice has grown significantly over the last 10 to 15 years.”
In some ways, the role of an oncology NP has stayed the same: they are the patient-centered health professional who helps provide continuity through the diagnosis, treatment, and management of cancer patients.
But in other ways, it’s evolved in tandem with the field of oncology itself. Part of that evolution has been an expansion into outpatient settings, where patients may do better when allowed to be at home, with family, in their own bed, and not susceptible to hospital-based infection. The majority of the changes, however, have come as a result of breakthroughs in medical research.
“What I find exciting about oncology is the mixture of science and holistic care, which is really well-partnered,” says Dr. Maura Abbott, an assistant professor of nursing at Columbia University. “Every single day, new information comes out about treatments that potentially prolong patients’ lives. There’s been a shift in thought processes when it comes to oncology. There’s a lot more hope these days.”
The Impact of Personalized Therapies
With continued progress, it’s not infeasible that cancer could one day be viewed in a similar manner as diabetes: a chronic disease that, with proper management, wouldn’t preclude a patient from having a high quality of life. That future isn’t fully here yet, but it’s on its way, thanks to the impact of personalized therapies on the field of oncology.
“Fifteen years ago, patients in my particular tumor group had a median survival of nine months,” Kottschade says. “Now I’m seeing these patients three, four, five years later, and some of them are still on active treatment, which needs active follow-up. All the new immunotherapies and targeted therapies that have come out have really added to the practice.”
“The idea that you can go into a waiting room, and there are ten different people with colon cancer, and they might all be on a different therapy—that’s revolutionary,” Dr. Abbot adds. “It’s really exciting that we can tell patients: we have a plan for you. And it’s not one size fits all.”
The Average Day of an Oncology NP
Oncology NPs can work in a wide variety of settings, capacities, and subcategories. In the outpatient setting, an NP might work in a disease-specific clinic, seeing patients who have been newly diagnosed, patients coming in for toxicity checks, or patients who need a change in therapy. In an inpatient setting, an NP might work through a roster of patients, examining them, ordering and interpreting tests for them, and informing patients of their care plan for that day.
“Nothing is ever typical,” Dr. Abbot says. “You never know what’s coming through that door.”
Dr. Abbot runs an outpatient urgent care center. Patients come in with some sort of chief complaint, such as nausea, vomiting, and/or pain. She works up these patients independently, prescribes a treatment plan, and evaluates that treatment plan.
“It’s kind of like detective work,” Dr. Abbot says. “I know what their cancer is. I know what treatment they’re on. So why is their pain worse today? Are they nauseous from their chemo, or is something else going on? I’ll do my best to fix what’s going on with that patient that day, then send them home with a plan, so that they feel better and don’t have to be admitted to a hospital unnecessarily.”
No matter their particular setting or focus, oncology NPs are fiercely passionate about their work, and strong advocates for the patients under their care. Both Kottschade and Dr. Abbot have deeply personal stories about how they got into oncology as a subspecialty. And when they tell those stories, the words that repeatedly bubble to the surface speak volumes of the new era of oncology and the role that oncology NPs play within it: words like passion, compassion, excitement, spark, and hope.
“Nurses are often near the top of the list for the most trusted professions, and that’s because people know we’re there to be their advocate,” Dr. Abbot says. “We love our patients. We know their families. We know their stories. As an oncology NP, it’s a privilege to be able to take care of these patients. It’s the greatest privilege of my life.”
Advocacy for Oncology NPs
For oncology NPs, the biggest professional advocacy issues are related to the scope of practice. In some states, NPs still face barriers in practicing to the full extent of their training. The lack of continuity between states is an issue, particularly in oncology practices close to state lines, where patients in one state may not be able to receive the same level of care from an oncology NP as those in another.
“In several states, scope of practice is not what it should be,” Kottschade says. “It ranges from where you’re not able to independently see patients, to where you always see them in conjunction with an MD, to states that have full practice authority.”
In oncology specifically, some states don’t allow APPs or NPs to initiate a chemotherapy treatment plan independently. Instead, the NP must have a physician co-signature. Different states also have different rules on prescriptive authority for oncology NPs; that’s a major issue, as oncology patients often require strong narcotic medications, and putting barriers on an oncology NP’s ability to prescribe and manage those medications can create gaps in care. Professional organizations like APSHO are pushing back.
“APSHO was created to be a scientific advocacy research-based society, specifically for APPs in hematology and oncology,” Kottschade says. “A big part of the advocacy that APSHO has done has been to make sure APPs have a voice in the oncology arena, and have a seat at the table when new guidelines are being put out. I think APSHO has done a good job collaborating with other groups, as well even just individually standing up for APPs in oncology.”
Old restrictions on NP practice seem to run counter to the advancements in NP education. In the oncology NP program at Columbia, students gain a comprehensive understanding of oncology nursing through didactic, clinical, and simulation education. The curriculum also stretches into areas like cancer symptom management, socioeconomic and racial disparities, and the mental health needs of cancer patients.
Five years ago, the Columbia program had ten students, today it has 34. These graduates are entering into a different era of oncology than the era in which the most restrictive rules on NP practice were issued.
The Future for Oncology NPs
The role of the oncology NP will continue to grow, especially in community settings. There’s been a marked transition away from big cancer centers and towards local providers. But the new treatments and medicines approved for cancer patients require a high degree of maintenance. Highly trained oncology NPs can provide a critical link here, partnering with community sites on side effects and providing overall patient management.
“As time goes on and we have more patients who are either on maintenance therapy for decades, like a chronically ill patient, or patients who survive and come off therapy, I think the role of oncology and primary care NPs will grow,” Dr. Abbott says. “Because that’s what we are really trained to do: to take care of patients and provide health maintenance. It’s a role where we’re able to thrive, and function independently, and really promote health maintenance and longevity for these people who survive cancer. I think that’s a great thing.”
“This can be a very rewarding career,” Kottschade says. “There are lots of opportunities in where you can practice and how you can practice. It’s exciting to be on the cutting edge of new treatments, and being able to deliver those to patients and see those results firsthand in a disease that used to be uniformly fatal.”
Resources for Oncology NPs
Oncology is a rapidly evolving field, with new medications, new treatments, and new ways of thinking appearing all the time. To stay up to date, oncology NPs can look to a number of professional associations for advocacy, research, and networking opportunities. To connect with the wider oncology community, check out some of the resources below.
- American Association of Nurse Practitioners (AANP): With over 118,000 members, AANP is the largest organization for nurse practitioners, and they play a crucial role in advocating for NPs and their patients across the nation. You can find their resources for Oncology and Hematology here.
- American Cancer Society (ACS): The American Cancer Society is a nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem. Their research and advocacy in the areas of cancer and cancer treatments are unparalleled.
- Association of Community Cancer Centers (ACCC): Founded in 1974, ACCC is a powerful community of more than 25,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide. An estimated 65 percent of the nation’s cancer patients are treated by a member of ACCC.
- Advanced Practitioner Society for Hematology and Oncology (APSHO): APSHO brings together all advanced practice providers in oncology—NPs, physician assistants, clinical nurse specialists, advanced degree nurses, and pharmacists—to improve the quality of care for patients with cancer.
- American Society of Clinical Oncology (ASCO): Founded in 1964, ASCO is the world’s leading organization for physicians and oncology professionals caring for people with cancer. Learn more about the benefits of ASCO membership for NPs here.
Matt Zbrog is a writer and researcher from Southern California, and he believes a strong society demands a stronger healthcare system. Since early 2018, he’s written extensively about emerging topics in healthcare administration, healthcare research, and healthcare education. Drawing upon interviews with hospital CEOs, nurse practitioners, nursing professors, and advocacy groups, his writing and research are focused on learning from those who know the subject best.