In today’s dynamic oncology landscape, advanced practice providers (APPs) are vital pillars of care. The second episode in the state oncology APP webinar series A Day in the Life of an Oncology APP Across Various Practice Settings brought together 4 experienced APPs to offer an in-depth look into their roles, responsibilities, and challenges across academic institutions, community-based practices, and rural centers. Moderated by Dan Carrizosa, MD, president of the North Carolina Oncology Association, the session gave attendees and viewers a multifaceted view of oncology care through the lens of APPs across the country. Each speaker detailed their practice environment, daily workflow, interdisciplinary collaboration, and personal reflections, painting a vivid picture of the realities facing oncology APPs today.

Navigating Rural-Like Complexity in a Suburban Setting 

Karley Trautman, DNP, ANP-BC, AGACNP-BC, senior instructor and medical oncology and nurse practitioner, kicked off the webinar by walking through her role at UCHealth Highlands Ranch, a community site 30 minutes from the University of Colorado Hospital main campus. Though technically suburban, the site functions similarly to a rural center with limited onsite specialists and a broad scope of practice. 

Her day-to-day responsibilities include clinic visits, prechemo evaluations, infusion center coverage, and hospital rounding. “The APP’s job is really to be that continuity of care,” Trautman explained, noting that while anchor physicians rotate through, APPs provide the daily clinical glue that holds the system together. 

One significant challenge is the diversity of tumor types and treatment protocols she must be familiar with. “When you’re in a setting where you’re seeing multiple tumor types, that’s a huge challenge,” she said, describing the steep knowledge demands of the role. The infusion coverage responsibilities also make for long, complex days—managing urgent issues, coordinating with remote physicians, and ensuring safe administration of therapies, all while fielding triage calls from nurses and patients. 

The APP as Clinical Glue in a Community Academic Hybrid  

Jessica Leibelt, MSN, NP-C, AOCNP, shared her experience working as a nurse practitioner at a community satellite of Fred Hutchinson Cancer Center in Seattle, Washington. Although part of a robust academic system, her site operates independently, serving a large volume of patients with limited physical resources. “We’re not a walk-in clinic, but inevitably we have people that come in and we try hard not to turn anyone away and help in that moment,” Leibelt noted, referencing the constant triaging, unscheduled consults, and infusion reactions that define much of her day.  

Working mostly with solid tumors and stable hematologic malignancies, Leibelt’s schedule includes 12-14 patient visits per day, with little time for documentation or unexpected emergencies. She emphasized the “invisible labor” that APPs shoulder—charting, adjusting orders, answering questions from infusion nurses—all of which often go unbilled and unnoticed.  

Despite these pressures, Leibelt underscored the importance of teamwork. Her clinic benefits from strong interdisciplinary collaboration, including pharmacists, social workers, and even embedded palliative care APPs. “We are the bridge,” she said, describing the APP’s central role in clinical operations, coordination, and patient advocacy.  

Micro Practice, Macro Impact 

Rachel Pink, APRN, nurse practitioner at Mohtaseb Blood and Cancer Center in Henderson, Nevada, offered a compelling contrast by detailing her work in a “micro-practice”—a 2-provider private clinic with minimal staff and maximum responsibility. “It is [just] me and the doctor,” Pink explained. “One infusion nurse, 2 medical assistants, and 1 person who does the front desk and scheduling.” 

Pink’s role encompasses everything: consults, treatment planning, survivorship care, chemotherapy education, quality improvements, and sometimes even drug administration when the nurse is out. She also handles referral coordination, grant applications, and adherence with regulatory standards, drawing from her extensive experience in infusion and oncology nursing.  

While the practice may lack administrative support and access to in-house specialists, Pink values the deep patient relationships and unmatched autonomy. “It is a small group that you see, but it is your friends and neighbors, which makes you feel like you’re giving back to the people around you,” she said.  

The tradeoffs are real: limited peer collaboration, fewer professional development opportunities, and the pressure of balancing care decisions with financial realities. But for Pink, the ability to make a meaningful impact on patients and staff in her community outweighs the drawbacks. 

Academic Specialization with System-Level Influence 

Evan Eastman, PA-C, a physician assistant (PA), closed the panel with insights from his 9 years in The University of Iowa’s thoracic oncology department. Compared to the other panelists, Eastman’s practice is highly specialized, focusing on lung and thymic malignancies. He works 4 clinic days a week, seeing 12-15 patients per day, alternating between independent and joint visits with oncologists. 

At a teaching hospital, his responsibilities extend beyond patient care. Eastman facilitates shadowing opportunities for pre-PA students, coordinates student rotations, and participates in multidisciplinary tumor boards. He often presents complex cases to teams of surgeons, radiation oncologists, and radiologists, which is an invaluable resource that helps guide care plans.

Despite the robust infrastructure, Eastman faces his own set of challenges. Clinical trial patients must be seen by MDs, often delaying flow. APPs can’t sign chemo orders, leading to administrative bottlenecks. And, like others, he finds himself performing tasks beyond his role, such as printing after-visit summaries and adjusting infusion schedules when short-staffed.

Still, Eastman praised the collaborative environment and emphasized the crucial role of APPs in academic medicine. “APPs play an essential role in team-based care, [collaborating] with pharmacists, nursing staff, the infusion suite, and supervising doctors.” 

Common Threads: Burnout, Balance, and Belonging 

While each speaker represented a different setting, common themes emerged: high patient volumes, invisible labor, the need for constant learning, and the emotional toll of oncology care. Burnout was a recurring concern, especially given the deep relationships APPs form with patients and the cognitive overload of managing complex, often terminal, illnesses. 

Yet there was also a palpable sense of fulfillment. APPs serve as both stabilizers and innovators within their organizations, driving process improvements, mentoring staff, and filling care gaps. Whether in a rural clinic or an academic tower, APPs are indispensable.

Several speakers also stressed the importance of mentorship and institutional culture. As Trautman and Pink noted, stepping into a lone APP role may not be ideal for new grads. “You need someone who knows the role and understands the kind of buffer that we need,” Trautman advised. Leibelt added that professional organizations and state societies are invaluable for fostering connection and support, especially in isolated or underserved areas.  

Final Reflections 

Oncology APPs wear many hats, such as clinician, coordinator, mentor, educator, and patient advocate. It is due in part to this variability that their work is nuanced, demanding, and deeply impactful. To echo Dr. Carrizosa’s words in closing the webinar, “Thank you very much to all of you for giving us a great glimpse into what you do.” 

Find more information on this APP webinar series, including speaker profiles and links to the webinar recordings, with additional resources on the Rocky Mountain Oncology Society, Empire State Hematology and Oncology Association, North Carolina Oncology Association, Iowa Oncology Society, Nevada Oncology Society, and Washington State Medical Oncology Society APP resources webpages.