Nurse practitioners (NPs) and physician assistants (PAs) are the clinicians who provide oncologic care to more than half of older US patients with cancer, an analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare claims database for 2013 has shown. The findings from this study were published in the Journal of the American Geriatrics Society.

The increasing proportion of the US population that is aged 65 and older, as well as the increased incidence of many cancers in this age group, are factors that are increasing the need for complex cancer care. Nevertheless, information related to the cancer workforce, particularly as it applies to nonphysician providers, is very limited.

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Cancer registries linked to the SEER-Medicare database were interrogated to investigate characteristics of providers and recipients of ambulatory cancer care for older patients in the United States between January 1, 2013, and December 31, 2013. Providers were classified as nurse practitioners, physician assistants, hematologists, medical oncologists, hematology/oncologists, and gynecologic oncologists. Demographic characteristics of patients, including geographical location (Northeast, Midwest, South, and West) and its associated population density (rural or urban), as well as their disease-related characteristics, including type of malignancy (GI tract, breast, GU tract, lung, head and neck, gynecologic, melanoma, and hematologic malignancies; other) were collected.

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A central finding of this study was that in this dataset, taken together, NPs (4806 [32%]) and PAs (3767 [24%]) comprised 56.2% of cancer care-specific providers compared with hematologists (368 [2.4%]), medical oncologists (661 [11%]), hematology/oncologists (4222 [28%]), and gynecologic oncologists (403 [2.5%]).

With a focus on NPs, the results of this study showed that, compared with other cancer providers, NPs cared for fewer patients aged 85 years or older (9% vs 12%; P <.05), a higher percentage of patients with hematologic diagnoses (22% vs 13%; P <.05), fewer patients with genitourinary cancers (24% vs 35%; P <.05), and a higher percentage of patients living in high-poverty areas (21% vs 18%; P =.05).

Regarding geographic location, NPs (odds ratio [OR], 1.84; 95% CI, 1.65-2.05; P <.05) and PAs (OR, 1.57; 95% CI, 1.40-1.77; P <.05) were much more likely than physicians to provide cancer care in rural areas. Although NPs (OR = 0.71; 95% CI = 0.64-0.79; P <.05) and PAs (OR =0.49; 95% CI = 0.43-0.54; P <.05) were less likely than physicians to provide cancer care in the Northeast, patients with cancer in the Southern states were more likely to receive care from an NP (OR, 1.36; 95% CI = 1.24-1.49; P <.05), but not a PA (OR, 0.82 (0.74-0.91; P <.05), compared with a physician.

Interestingly, a 2017 survey of the Oncology Nursing Society, the American Society of Clinical Oncology, and the American Academy of Physician Assistants identified 3623 NPs and 1796 PAs as oncology-specific providers, but this study found 4806 and 3767 NPs and PAs, respectively, using only the SEER-Medicare database as a source.

The study authors noted that “solutions that address the shortage of cancer care providers for older adults need to be based on a realistic understanding of who is providing that care. NPs and PAs can help improve care access, particularly in regions of the United States with lower-income adults.”


Coombs LA, Max W, Kolevska T, Tonner C, Stephens C. Nurse practitioners and physician assistants: An underestimated workforce for older adults with cancer [published online May 6, 2019]. J Am Geriatr Soc. doi: 10.1111/jgs.15931