“Be Part of the Revolution”: APPs as Primary Investigators in Oncology

Nurse practitioners and physician assistants are able to occupy important roles in oncology research, such as primary investigators, according to an associate clinical investigator Erin Pierce, MSN, APRN, FNP-C.

Pierce, who works at HonorHealth Research Institute in Scottsdale, Arizona, emphasized the array of purposes advanced practice providers (APPs) can serve in oncology research, which also includes referring patients to clinical trials and advising on unmet needs that could be addressed in future trials.

Pierce highlighted that APPs are not traditionally seen in primary investigator roles in research, and that it takes some effort to push into the research space. However, she added that there are some existing efforts to change this, such as a program she attended at HonorHealth with the purpose of educating oncology APPs on how to become a bigger part of research.

Transcript

My name is Erin Pierce. I’m a nurse practitioner and clinical investigator at HonorHealth Research Institute in Scottsdale, Arizona.

I think [APPs] could play a role in every single part of research. HonorHealth, which is where I’m currently working, in 2018 started a bootcamp for [APPs who are] interested in research and who wanted to go into these primary investigator and subinvestigator roles, and really gave them a 1-week crash course on what research is and where [APPs] belong.

That is where I met my mentor, Gayle Jameson, [MSN, NP, ANCC], and she was helping to lead this project. And never in a million years did I think [an APP] could actually be a primary investigator on a phase 1 [or] phase 2 study.

I’m like, “No, that’s physicians.” It’s a lot of old-school thinking still. She was doing it, and she was there, and it really opened my eyes. And so I went back to New Orleans, and I talked with my physician, and I was like, “You know, I could do this.”

And he was like, “You know what? Yes, you can, and we’re going to do it.” He helped, and he held my hand, and I was the primary investigator on a couple of studies back in New Orleans.

We know there are nursing shortages. We know there are provider shortages. [APPs] are there to step up for that, whether it be just an absolutely stellar subinvestigator who knows the ins and outs of a specific trial and helps with [adverse event] management, or somebody like me or one of my colleagues, Gayle Jameson, who like to lead and actually be the primary investigators on these studies.

Also, [APPs], if you’re working in the community and you don’t have access to clinical studies, you can be a referring provider and be knowledgeable about what is going on in the centers around you, or at least within your state, to be able to refer patients and know, “Hey, what other [treatment] can we give these patients, besides that standard of care?”

[APPs], in fact, are often our best recruiters in identifying patients for studies, especially when they’re being looked at on tumor boards or weekly meetings and just identifying, “Hey, what available trials do we have going on at our own institution?”

And definitely last, but not least, is that all [APPs] should be playing a part on our trial committee selections. Being part of the group that decides, what trials do we need based on our patient population? What am I seeing in my rooms A through B down the hall that I think really could benefit my patients?

There’s a lot of areas we [APPs] could step into. You’re going to have to push barriers being an [APP] in research. You’re going to have to fight for it, and [have] it be something that you want, but there is such a space for us, and I think that we’re just right now at the tip of the iceberg, and that within the next couple of years, the use of [APPs] in oncology research is going to explode and just continue to expand. So jump on the train now and be part of the revolution.

This transcript has been edited for clarity and conciseness.