Anti-Cancer Therapy Privileging for Oncology Nurse Practitioners and Physician Assistants

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Supporting Evidence

The 2009 and 2011 ASCO/ONS Chemotherapy Administration Safety Standards definitions of a licensed practitioner who can order chemotherapy state that such an individual includes “physicians, advanced practice nurses (nurse practitioner or clinical nurse specialist), and/or physician assistants as determined by state law.”^7,8

Domain 3: Ordering, Preparing, Dispensing, and Administering Chemotherapy

Under domain 3 of the ASCO/ONS safety standards,⁹ the following are stated:

• 3.1. The healthcare setting defines standard chemotherapy regimens by diagnosis with references.

• 3.2. The healthcare setting verifies institutional review board approval of research regimens.

• 3.3. Orders for chemotherapy are signed manually or by using electronic approval by licensed independent practitioners who are determined to be qualified by the healthcare setting.

• 3.4. The healthcare setting has policy for managing chemotherapy orders that vary from standard regimens. The policy requires a supporting reference and/or authorization by a second licensed independent practitioner.

  • 3.4.1. The rationale for an exception order is documented in the medical record.

• 3.5. The healthcare setting has a policy for chemotherapy orders that ensure:

  • 3.5.1. Verbal orders are not allowed except to hold or stop chemotherapy administration.

  • 3.5.2. New orders or changes to orders, including changes to oral chemotherapy regimens, for example, dose adjustments communicated directly to patients, are documented in the medical record.

The National Academy of Medicine’s The Future of Nursing: Leading Change, Advancing Health ¹⁰ states:

• Recommendation 1. Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. (See also, Assessing Progress on the Institute of Medicine Report The Future of Nursing.¹¹)

From a UCSD Moores Cancer Center internal and national survey of institutions, below are institutions that privilege APPs to order established anti-cancer treatment plans:

University of California (San Francisco, Los Angeles, Irvine)

• Stanford Health Care

• Massachusetts General Hospital

• Northwestern Medicine

• Mayo Clinic

• Dana-Farber Cancer Institute.

Additional information

Notes on contributors

Archana Ajmera

Archana Ajmera, MSN, ANP-BC, AOCNP, helps treat people with prostate cancer, renal cell carcinoma, urothelial carcinoma, testicular germ cell tumors, and penile carcinoma at the University of California San Diego Moores Cancer Center in San Diego, Calif. Her scope of practice includes collaborating with her physician colleagues in physical evaluations, diagnosis, treatment, symptom management, supportive care, and end-of-life care.