The following article features coverage from the 46th Annual Oncology Nursing Society (ONS) Congress. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

The capacity of nurse practitioners (NPs) to practice autonomously is widely recognized; however, legal requirements and institutional policies can restrict their prescribing cancer therapy. States employ any of 3 models for the role of NPs, with varying levels of independence granted.

Prescribing chemotherapy can be considered a core competency or a privilege, depending on where an oncology NP practices. A discussion on the role of advanced NPs in prescribing oncologic therapies was the focus of an oral presentation at the 46th Annual Oncology Nursing Society (ONS) Congress.

The trajectory of NP licensure in the US has risen rapidly over the years, explained Kim Noonan, DNP, ANP-BC, AOCN®, of Dana Farber Cancer Institute in Boston, Massachusetts. However, NPs today are experiencing difficulty with finding mentorship and with finding clinical placements, especially given COVID. “We really are almost at a crisis with this,” noted Dr Noonan.

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Many reasons exist for allowing NPs to order cancer treatment, including a shortage of oncologists while incidence of cancer increases, but assessing the skills and knowledge of an NP is difficult.

Although laws vary from state to state, some have established requirements that allow NPs to prescribe chemotherapy and the American Society of Clinical Oncology and Oncology Nursing Society provide safety standards. These requirements include obtaining sufficient education, demonstrating an ability to perform dose calculations, and ordering cancer therapy under the supervision of another provider a minimum number of times.

The most important qualities for ordering cancer therapy are knowledge of the type of cancer, cancer therapies in general, the therapy being prescribed, and how to order the therapy in the electronic medical record system, explained Suzanne McGettigan, MSN, ANP-BC, AOCN®, of the University of Pennsylvania Abramson Cancer Center in Philadelphia, Pennsylvania. An advanced NP can be the prescriber, monitor for toxicities, and complete documentation.

Ordering cancer therapy is complex and there are many factors for the NP to consider, including state laws and institutional policies. “Oncology NPs are educated, trained, and experienced, and can play a very essential part of the therapy plan for patients with cancer,” concluded Ms McGettigan.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original video for a full list of authors’ disclosures.

Read more of Oncology Nurse Advisor‘s coverage of the 46th Annual ONS Congress by visiting the conference page.


Rodgers Noonan K, McGettigan S. The role of the APRN in prescribing oncologic agents. Oral presentation at: 46th Annual ONS Congress; April 20-29, 2021. Accessed April 30, 2021.