Key Takeaways

• Oncology APPs are well positioned to identify gaps in care delivery and lead scalable innovations, including APP-led consult services, clinical trial programs, remote symptom monitoring, and decentralized treatment models.
• Research presented at the 2026 ASCO Annual Meeting highlighted how APP role expansion and electronic patient-reported outcomes (ePROs) can improve access, increase clinical capacity, and reduce hospitalizations without compromising quality of care.
• Emerging approaches including artificial intelligence (AI), hospital-at-home programs, prophylactic toxicity management, and remote therapeutic monitoring may help oncology APPs reduce administrative burden, identify symptoms earlier, and bring complex therapies closer to patients.

Madeline Merrill, AGNP-BC, MSN, discusses care delivery innovations highlighted at the 2026 ASCO Annual Meeting and their implications for oncology APPs. Merrill emphasizes that innovation extends beyond new drugs and technologies to changes in how cancer care is organized, monitored, and delivered, highlighting research on APP-led hematology consults, expanded APP roles in clinical trials, hospital-at-home treatment models, electronic patient-reported outcomes, and AI-assisted clinical decision support. She notes that APPs’ frontline clinical experience makes them particularly well positioned to identify workflow gaps, pilot new approaches, and participate directly in care delivery research. For oncology APPs, these emerging models offer opportunities to expand access, reduce acute care utilization and administrative burden, decentralize complex therapies, and take a more prominent role in developing and implementing evidence-based improvements in cancer care.

Transcript

Hi, I’m Madeline Merrill. I’m a nurse practitioner at Memorial Sloan Kettering Cancer Center in New York City. I work primarily in research. I’m a clinical trials nurse practitioner in the phase 1 and 2 group working in solid tumors. The service is Early Drug Development, and I am also an education specialist in terms of research for all APPs at the institution.

Care delivery innovation in oncology is not just new technologies. It’s any change to how care is delivered, how it’s organized, how it’s sequenced, that improves outcomes, access, and efficiency without waiting for new drugs or new treatments to become FDA approved.

I think care delivery has become really important in terms of research because there have been a lot of changes in the treatments that we offer to patients. The changes have really outpaced the changes in how our clinics are run and the traditional methods of delivering care. Now we have really good drugs and good treatments, but the clinics are unable to give them because of limitations on the location and the resources that are available.

There’s also a workforce shortage in oncology, and there’s a growing patient volume with a lot of patients that are now being diagnosed younger, and that kind of makes efficiency nonoptional. Additionally, we have value-based care and many reimbursement models that now demand measurable outcomes and not just access to the treatments. There are multiple reasons why it’s become a really important area for research and why it continues to be really important for patients.

APPs sit at a really interesting intersection. They have a lot of clinical depth, and they’re able to identify workflow gaps. They also have a lot of bedside experience as well. In a high-volume clinic, patients are seeing APPs more frequently. We’re not oftentimes bogged down with the administrative work or the politics that come with some of these academic institutions. We’re often the first to spot patterns. That can be a symptom that shows up, or a step in the care pathway that patients stumble on, or a gap in education or follow-up for patients.

That frontline vantage point really means that we’re uniquely poised to notice a problem, characterize the trend of the problem, and then propose a fix, which kind of closes the loop from observation to solution. Beyond that, we’re frequently the providers that are actually piloting new protocols, such as triage pathways or survivorship clinics, or doing symptom management because of the flexibility that we have within our practice.

I think that one of the things that we have to acknowledge first is that in 2026, AI was a big topic at ASCO this year. But beyond that, there were other care access posters and presentations that I thought were really interesting and kind of a workforce-driven model of care.

Several posters really focused on decentralizing care and changing who delivers the care. One of the first ones that I saw came out of The US Oncology Network. It was presented by Eileen Vella, and she had shown that APP-led consult models in a benign hematology clinic cut time to a first appointment roughly in half at one site, and then consult volume grew 5 times what it was previously over a period of 4 years. It was a workforce capacity innovation that did not impact any outcomes but was able to increase access to care for patients and kind of create a very good model for a consistent problem and making sure that patients can get access to hematology clinics.

Another one that I personally thought was really interesting came out of the University of Hawaii with Christa Braun-Inglis presenting. That was one that formalized APP roles, particularly in clinical trials, showing that APPs can be used for enrollment, for referrals. They can also serve as site PIs and review feasibility for studies as well. That actually led to APPs driving 51% of eligible trial accrual by 2025. The plan was to extend their model into the neighbor islands and into Guam.

I also saw an interesting access-to-care poster about the Hospital-at-Home program for tarlatamab for small cell lung cancer. Tarlatamab has the risk of cytokine release syndrome and oftentimes has to be given at a large academic institution where there’s access to ICUs. MSK had actually piloted a program using Hospital-at-Home where we partnered with paramedics and other local institutions and local hospitals so that patients could get the tarlatamab infusions and then be monitored at home, but have fast access to care should cytokine release occur. They found that the care model led to increased patient satisfaction and still the same quality of care, but was able to make it easier on patients with less travel and having to get hotels and those types of things close to an academic center.

In terms of the innovations, I think AI has the potential to decrease administrative burden for everyone and kind of let clinicians, APPs, and physicians work and focus more on clinical care as opposed to working to do extra documentation and things like that.

There is also potential, I think, for APP role expansion in these consult models. It’s pretty low friction, and it’s pretty immediately scalable on the list. It just kind of requires workflow changes within an institution.

There are lots of decentralization models. Tarlatamab in Hospital-at-Home was the one that I had spent the most time engaging with as a poster. But there’s a high potential for therapies that have monitoring requirements to be given in the communities. I think that that’s really impactful and is likely scalable.

I think that there were some other interesting posters and presentations on prophylaxis. Switching from management of symptoms over to the prophylaxis of symptoms, there were multiple posters, specifically in the heme space. I work in solid tumors, so I didn’t spend a lot of time engaging with those posters, but there were a lot of posters talking about the use of prophylactic tocilizumab, especially in myeloma and CAR T-cell therapy and T-cell–stimulating bispecific antibodies.

I think that is also very easy for institutions to do. Rather than having these stringent monitoring requirements or having to admit patients, there is an idea that we could potentially give medications to prevent the side effects safely and then have patients be treated in communities and be able to stay at home. I think that that’s a very easy, scalable innovation that can really impact the outcomes for patients and their quality of life.

I think that the findings from Eileen Vella and from Christa Braun-Inglis were really important in challenging the current perceptions around how care is delivered. The idea that APPs can not only do the symptom management and toxicity management and follow-up visits and survivorship clinics, but they can also function as PIs. They can function as principal investigators on research projects. They can do the consults.

Not only is that really good for access to care—it gets patients into clinics faster and it means that they’re not waiting at home with high risks—but also the care is really the same; the outcomes are the same for patients. I think that that challenges a lot of the current model and is something that is really important to note.

Kind of through everything that we’ve talked about so far, I think the barriers to care aren’t usually about the therapy itself, but they’re about the access to and the coordination of the care, really the infrastructure around it.

In terms of the innovative care models, there was a lot on electronic patient-reported outcomes this year at ASCO, or ePROs, which are really about remote symptom monitoring. It’s one of the more evidence-backed and mature approaches.

There was a Canopy study, which was, I believe, done in Arkansas across 5 community oncology practices. That one, with the use of an ePRO, showed a 28% reduction in hospitalization of patients. But then there’s also a large swath of data and studies that show that using ePROs for symptom management and patient-reported symptom management improves symptom control, lengthens patients’ time on treatments, improves overall quality of life, allows us to detect recurrence earlier, and impacts overall survival as well, with increased overall survival, in addition to decreasing emergency room visits and hospital stays. I think that that’s a really important improvement to the patient experience and to overall patient outcomes.

I think that the ePRO is something that is specifically designed for community oncology practices. I think that that’s probably the easiest and the most scalable in terms of innovative technology use for community practices.

I also think that the utilization of APPs across consult services and for trial engagement is really important, especially in multisite community oncology. I think that that is also something that is scalable and possible within community oncology practices.

I also think that things like Hospital-at-Home and the decentralization of care, especially around some of these innovative therapeutics and specifically around bispecifics, are potentially scalable but require a lot of coordination. It would be really exciting for a community practice to be able to give something like tarlatamab in the community.

I would also like to point out that, specifically for the technologies, there is now billing infrastructure that is coming into play. CPT codes now exist for remote therapeutic monitoring, which ultimately generates revenue, which makes it more practical for community oncology practices.

In terms of digital tools that helped patients deliver better care this year, I think that’s where AI really played a role. It’s becoming a really useful tool. There was one study by Jahanzeb* [see Author's Note] out of Northwestern that was presented as an abstract. They had 400 real-world cases across 5 different tumor types, and they were reviewed by an expert multidisciplinary review committee, including radiology, medicine, surgery, radiation, and hematology-oncology via a video conference. They compared the leading 3 AI models’ treatment recommendations against those of the panel and found that there was concordance. Really, the AI model was recommending the same treatment pathway forward for patients as the multidisciplinary committee.

I think we will see that more, using AI as a tool to help with treatment planning in the future. I think it’s really important as well. A big theme of ASCO this year was making sure that there’s still a human in the loop and making sure that there’s appropriate oversight and that people understand the recommendations from these AI models.

Additionally, there was an FDA-cleared tool called ArteraAI, which is for breast cancer, and it looked specifically at women with breast cancer, postmenopausal women with node-positive, hormone receptor-positive breast cancer. It showed that the AI model was able to identify chemotherapy benefit pretty well. It was now prospectively validated against real clinical trial cohorts with good survival outcomes. I think that that was also an important piece. But really, I think that tools, especially in breast cancer prognostication, are kind of really the most mature area of AI clinical decision support. I think that that is kind of a good jumping-off place for other cancer types. I think that we will see more of that as well.

The streamlining of these workflows and the streamlining of access to care through digital tools, I think that that will really ultimately impact patients and help them kind of navigate the complicated landscape of oncology and the complicated landscape of trying to figure out all of the appointments and make sure that they’re receiving the best care.

I think APPs can be enthusiastic about some of these AI tools. I think there will be an administrative burden reduction. We can use AI for documentation. We can use it to kind of synthesize large swaths of data. There are lots of ambient AI scribes. There are a lot of tools for data extraction. I think that’s one place that is really burgeoning and exciting.

I also think that the ePRO stuff is really exciting because there’s this very strong evidence-based reimbursement pathway with CPT codes and it really directly expands what we’re able to monitor and act on between visits.

I also think that there’s a lot to be said for APP-led model expansion with the studies from Eileen Vella and from Christa Braun-Inglis, which furthers the scope for APPs.

I think that it is encouraging in general just to see APPs presenting at ASCO and having posters that really did impact patient care and access to care. I think that that’s a really exciting place and an exciting push forward for APPs. I think historically APPs have covered the clinics while the physicians went to ASCO, and being a part of the science and delivering on the science is very exciting and should inspire a lot of APPs to work on projects themselves.

*Author's Note: The study cited at 11:17 was erroneously attributed to Haines, while the correct first author for this study is Jahanzeb.