Advanced Practice Providers Leading Quality Improvement in Oncology Care

Oncology care is best described as continually evolving. Within this ever-changing environment, advanced practice providers (APPs) are often the clinicians who recognize patterns in patient symptoms related to specific treatments, identify workflows that could be improved, and uncover gaps in education among oncology team members that may directly affect patient outcomes. Although large clinical trials drive changes in cancer treatment, quality improvement (QI) projects led by APPs are equally important and play a critical role in improving everyday practice.

The following examples highlight QI projects, published in the Journal of the Advanced Practitioner in Oncology, led by APPs that addressed common clinical challenges and produced meaningful improvements in patient care.

Quality Improvement in Chemotherapy-Induced Nausea and Vomiting

A recent study by Ryan Gennette, DNP, NP-C, and colleagues focuses on chemotherapy-induced nausea and vomiting (CINV), which is one of the most common and often most distressing adverse effects (AEs) of systemic cancer treatment.¹ The authors note a gap between evidence-based antiemetic guidelines and real-world prescribing practices for CINV. Although the American Society of Clinical Oncology and NCCN guidelines recommend prophylactic olanzapine (Zyprexa) for patients receiving highly emetogenic chemotherapy (HEC), regional self-audit data demonstrated an average adherence rate of only 23% for appropriate olanzapine prescribing in this patient population.

Barriers to olanzapine prescribing include its established use for schizophrenia and bipolar I disorder. This underscores the importance of oncology clinicians clearly explaining to patients why olanzapine is being prescribed for CINV and reassuring them that the prescription does not indicate a new mental health diagnosis.

This QI project used a team-based educational approach focused on olanzapine for CINV prevention in patients receiving HEC. Pharmacists, infusion nurses, social workers, and prescribing providers participated in all phases of the project to ensure multidisciplinary perspectives were included. Education was delivered during monthly provider meetings and reinforced through one-on-one sessions as needed and printed materials.

Following implementation, regional audit data demonstrated a substantial improvement in guideline-adherent prescribing, with appropriate olanzapine use increasing to 94.7%.

Following antiemetic guidelines and making sure olanzapine is prescribed appropriately is a simple, practical step that can be put into practice in any outpatient oncology clinic. Regular staff meetings and one-on-one education sessions give providers easy opportunities to stay up to date and understand how preventing CINV can improve both patient comfort and overall quality of life.

Improving Naloxone Coprescribing for Patients Receiving Cancer-Related Opioids

Pain is common among patients with cancer, and although opioids remain essential for management, they carry risks of misuse and overdose. An article published by Kristin Begger, DNP, NP-C, AOCNP, and Jeanne Burnkrant, DNP, MSHS, MS, AGNP-C, described a QI project aimed at increasing take-home naloxone (THN) coprescribing for patients with cancer who were at high risk of opioid overdose.² Despite evidence supporting THN to prevent fatal overdoses, coprescribing rates were historically low. At the Cheyenne Regional Medical Center outpatient oncology clinic, baseline data revealed that only 1 in 22 patients at increased risk for opioid overdose received a THN prescription.

The project targeted patients receiving at least 100 morphine mg equivalents (MME) per day or opioids with a concomitant high-risk medication, such as benzodiazepines or gabapentinoids. Interventions included implementing an electronic health record (EHR) alert to identify at-risk patients, providing evidence-based education to providers, and giving patients education on the safe use of THN.

Following implementation, THN coprescribing increased significantly: 38% for patients receiving at least 100 MME per day (a 29-point increase from baseline) and 57% for patients receiving opioids with a concomitant high-risk medication (a 53-point increase). All patients who received THN also received comprehensive education, and staff used the EHR alert 84.62% (95% CI, 75.54%-91.33%) of the time. There were no emergency department visits or hospitalizations due to unintentional naloxone administration, and patient satisfaction scores remained stable.

This project highlights that combining provider and patient education with EHR alerts can effectively increase THN coprescribing in oncology clinics. The interventions were low-cost and scalable while providing a practical framework for other settings seeking to improve safe opioid prescribing and enhance patient safety.

Managing Cancer-Related Fatigue During Active Treatment

Jennifer D. Bernt, DNP, FNP-C, AOCNP, and colleagues evaluated the Start Walking to Improve Fatigue Throughout Treatment (SWIFT) program, a structured, low-cost walking intervention designed to help patients receiving oral chemotherapy manage cancer-related fatigue.³

The program encouraged participants to work toward 150 minutes of walking per week over a 6-week period, consistent with national physical activity recommendations. Patients received individualized education from nurses, a step-tracking pedometer, and weekly motivational text messages to support gradual increases in activity, goal setting, and sustained engagement. Walking was intentionally selected because it is accessible, safe for most patients, and can be easily adapted to fluctuations in energy levels during treatment.

Although statistically significant reductions in fatigue scores were not observed (mean, –0.6; SD, 1.5; median, –0.1; P = .240), most participants reported perceived improvements in fatigue and motivation to remain active. Researchers noted that the failure to meet statistical significance for fatigue improvement was likely due to the small sample size (n = 20).

These findings are clinically meaningful, as cancer-related fatigue is often persistent, multifactorial, and poorly responsive to pharmacologic interventions. Regular walking may help reduce fatigue by improving physical conditioning, supporting sleep quality, enhancing mood, and counteracting deconditioning commonly seen during cancer treatment. Even modest, consistent movement can help patients maintain functional independence and a sense of control over their symptoms.

Importantly, this project highlighted the critical role of oncology nurses and APPs in fatigue management. Nurse-focused education improved confidence and knowledge related to counseling patients on physical activity and fatigue. The SWIFT program demonstrates how structured walking interventions can be realistically integrated into routine oncology care, offering a practical, evidence-based approach to addressing fatigue and improving quality of life for patients throughout treatment.

Advanced Practice Considerations

These QI projects highlight the critical role APPs play in improving oncology care through practical, evidence-based initiatives. They demonstrate that even relatively small, low-cost interventions can have a meaningful impact and offer a model for other oncology teams seeking to translate evidence into everyday clinical practice and enhance patient care. Hopefully these projects inspire oncology nurses and APPs alike to take a close look at their own practice areas, identify opportunities for improvement, and take action to make a difference for the patients they serve.

References

1. Gennette RL, Dontje K, Rana J, et al. Improving the appropriate prescribing of olanzapine for chemotherapy-induced nausea and vomiting: a quality improvement initiative for the outpatient oncology practice. J Adv Pract Oncol. Published online November 10, 2025. doi:10.6004/jadpro.2025.16.7.29
2. Begger K, Burnkrant J. Implementation of an electronic health record alert to improve naloxone coprescribing for adult patients with cancer at risk for opioid overdose. J Adv Pract Oncol. Published online September 2, 2025. doi:10.6004/jadpro.2025.16.7.24
3. Bernt JD, Million R, Pham NS. A pilot program implementing an evidence-based walking plan to improve cancer-related fatigue in adult patients on oral cancer treatments. J Adv Pract Oncol. 2025;16(3):95-103. doi:10.6004/jadpro.2025.16.3.2