Study Highlights Barriers to Greater AP Understanding of Immuno-oncology

According to results from a survey of U.S. oncology advanced practitioners (APs), APs express growing familiarity with immuno-oncology (IO) therapies, though issues such as patient demand and reimbursement remain persistent challenges. The findings were shared by Una Hopkins, RN, FNP-BC, DNP, director for research and evidence-based practice at the Montefiore Medical Center in New York, at JADPRO Live Virtual 2021.

“Oncology advanced practitioners represent a key role in the care of patients with cancer who are receiving immunotherapy,” Dr. Hopkins said. “Not only do they participate in the treatment of these patients, including monitoring for adverse events, but many also provide education, counselling, and navigation services.”

In this report, researchers sought to characterize the knowledge, practice patterns, and perceived barriers of oncology APs who care for patients being treated with immunotherapies using data from the Association of Community Cancer Centers’ annual Immuno-Oncology Census. The survey was administered to multidisciplinary cancer care team members between July and August 2021. Survey questions assessed respondents’ familiarity with various immunotherapies, current practices when treating patients with immunotherapies (including supportive care services), and perceived challenges when using immunotherapies or supporting patients.

Oncology APs (i.e., advanced practice nurses, nurse practitioners, pharmacists) comprised roughly one quarter of all survey respondents (24.5%; n=12). Half were advanced practice nurses or nurse practitioners and half were pharmacists (50%). Most respondents were based in community practices and programs (58%), located in urban settings (50%), and had been in practice for more than five years (92%).

When asked about their familiarity with different IO agents, most APs were familiar with immune checkpoint inhibitors (58% “extremely familiar”) and combination treatment regimens that incorporate IO agents (42% “extremely familiar”). However, familiarity with cellular therapies, such as bispecific antibody and chimeric antigen receptor (CAR) T-cell therapies, was mixed, with 8% of respondents reporting no familiarity with bispecific antibody therapies (FIGURE).

Oncology APs listed the following as the most significant barriers (ranked “very” or “extremely challenging”) to using IOs confidently in the clinic:

  • addressing patient financial toxicity (50%)
  • navigating coverage and reimbursement issues (42%)
  • managing patient demand and expectations (33%)
  • identifying and managing infusion-related adverse events (AEs; 33%)

Regarding discussions with patients about IO therapies, most respondents reported discussing issues such as treatment decisions, biomarker testing, and toxicity management. However, topics such as survivorship or palliative care, sexual health and fertility, and care coordination with other members of the patient’s care team were less likely to be discussed. For example, only about 20% of respondents reported discussing these topics “often.”

Results from this analysis support previous findings that oncology APs are well versed with established IO therapies and are becoming more familiar with emerging IO therapies, Dr. Hopkins and authors concluded. “While the sample size is limited, we have also now gained new insights into the more distinct challenges related to oncology APs’ role in supportive care, such as mitigating financial toxicity and holistic care conversations,” they added. To increase oncology APs’ knowledge of and familiarity with IO therapies, the authors recommend implementing educational content related to cellular therapies, financial toxicity prevention, cancer treatment reimbursement, and managing patient demand.

The authors report no relevant conflicts of interest.


Hopkins UT, Schrag J, Lucas L, et al. Immuno-oncology in 2021: knowledge, practice patterns, and perceived barriers among oncology advanced practitioners. Poster JL909. Presented at JADPRO Live Virtual, October 7-17, 2021.

FIGURE. Familiarity with select immuno-oncology agents