Mentoring APPs Across the NCTN
Oncology advanced practice providers (APPs), including nurse practitioners, pharmacists, physician assistants, and clinical nurse specialists, serve critical roles in providing oncology clinical care. Increasingly, they're also serving as key members – and at times leaders – of oncology research teams conducting National Cancer Institute-sponsored clinical trials.
Over the past few years, the NCI has recognized the untapped potential of these health-care professionals and has expanded the roles they can perform in NCI-supported studies.
In 2020, the NCI’s Division of Cancer Prevention and Division of Cancer Control and Population Sciences posted new guidelines that allowed APPs with specific qualifications to take on enhanced roles in developing and conducting trials sponsored by the NCI Community Oncology Research Program (NCORP).
These roles include serving as chairs or co-chairs of NCORP-sponsored studies and serving as local investigators in consenting and enrolling patients.
In 2021, the Cancer Therapy Evaluation Program (CTEP) also expanded the roles APPs can perform on CTEP-supported trials – for example, allowing qualified APPs to write patient orders for study agents without a physician co-signature.
The extent of these enhanced roles may be limited by local institutional and state policies, which take precedence, but these expansions have allowed NCI-sponsored trials to more efficiently deploy APP expertise and capacity, and they enlarge the group of enrolling investigators, meaning fewer patients lost to trials.
I’ve written before about efforts by APP leaders within SWOG to encourage and advance this expansion, with key leadership provided by Christa Braun-Inglis, DNP, APRN, AOCNP, and Jamie S. Myers, PhD, RN, ACONS, FAAN, among others.
As the next step in these efforts, The Hope Foundation, working with Braun-Inglis and others, has recently launched the NCTN MAPP program – formally the Mentoring Intervention for Advanced Practice Providers Across the NCTN program.
Implemented with generous support from Gilead, the MAPP program is a year-long mentoring intervention designed to engage APPs with SWOG and the National Clinical Trials Network.
The program leverages SWOG’s APP task force, which has been building capacity over the last two years, and follows on educational initiatives that have included:
- a multidisciplinary symposium at the spring 2022 group meeting to raise awareness within SWOG of what APPs can do to help enhance participation in clinical trials, and
- a workshop conducted at the fall 2022 group meeting to provide APPs “the nuts and bolts” of engaging with clinical trials.
The task force first met at the spring 2023 group meeting to discuss barriers to APP integration in the cooperative groups, research bases, and local institutions, and it has been hard at work since, collaborating extensively with leaders from the NCI and other cooperative groups and NCORP research bases, to lower those barriers.
In the MAPP program, members of this task force will serve as mentors, and starting in January, up to six APP mentees will be paired with a mentor for 12 months.
The program also leverages the recording of the fall 2022 APP workshop (now available in SWOG’s learning management system) as a training tool for these mentees.
The goal is to help those advanced practice providers who are interested in being more involved in clinical research to take that step.
The program will bring mentees to both SWOG group meetings in 2025 and will also support their travel to an additional APP-focused professional development opportunity, so they can continue making connections.
There are additional opportunities at NCORP practices, as Braun-Inglis and Myers will lead a similar mentorship intervention in collaboration with Wake Forest and SWOG, with the focus on APP roles in cancer control and prevention trials (COACH APP) throughout the NCORP. Details on those opportunities are forthcoming.
If MAPP sounds like a great professional development opportunity for you or an APP you know, applications to the program are being accepted until November 1st. The program is open to APPs from across the NCTN.
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Trial of the Week
S1914: A Randomized Phase III Trial of Induction/Consolidation Atezolizumab + SBRT versus SBRT Alone in High Risk, Early Stage NSCLC
Clinical trial S1914, a joint trial of SWOG and NRG Oncology, is enrolling patients with high-risk, early-stage non-small cell lung cancer (NSCLC) who are not candidates for surgery or choose not to undergo surgery.
These patients are randomized to stereotactic body radiation therapy (SBRT) with or without the immune checkpoint inhibitor atezolizumab.
The primary endpoint is overall survival, and secondary endpoints include progression-free survival, treatment failure rates, toxicities, and quality of life.
SBRT is standard of care for medically inoperable early-stage NSCLC, but the failure rate after treatment is significant. S1914 tests whether adding an immune checkpoint inhibitor can reduce that rate and, ultimately, extend survival.
On the investigational arm, atezolizumab treatment is started before SBRT and continued throughout and after radiation therapy. This timing is based on preclinical data showing increased synergy between SBRT and immunotherapy when the immunotherapy is started first to prime an immune response.
Drs. Megan E. Daly, of UC Davis Cancer Center, and Charles B. Simone, II, of New York Proton Center are S1914 study co-chairs.
The trial activated in May 2020 and has accrued 412 patients toward the overall enrollment goal of 480. Among the almost 400 institutions that have opened the study, the top-accruing sites are University of Wisconsin Carbone Cancer Center and University of Arkansas for Medical Sciences.
Learn more about S1914 at the SWOG S1914 page or the CTSU S1914 page.
A patient-friendly summary of the trial, useful when first presenting the study to a patient, is available at both of the links above and at swog.org/S1914 (also available in Spanish).
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