The Role of the Palliative Medicine and Supportive Oncology APP

Advanced practice providers are key in an interdisciplinary palliative and supportive care model.

A cancer diagnosis can bring an avalanche of psychosocial and physical obstacles for patients to navigate. The introduction of enhanced supportive care, including palliative medicine, early in the patient’s journey has shown better patient outcomes and quality of life (QOL) and has long been known to enhance cancer care.¹ Advanced practice providers (APPs) are key in providing quality supportive care.

The collaborative relationship between multidisciplinary providers provides a stronger network of care and support for patients. Including supportive oncology and palliative medicine as part of the treatment team fortifies the support network of both patients and caregivers, allowing for care focused on each patient’s individual needs from diagnosis through survivorship and even end of life (EOL).²

The American Society of Clinical Oncology (ASCO) guidelines recommend that patients with cancer be referred to interdisciplinary palliative care teams within 8 weeks of diagnosis.³ Early palliative referral benefits patients with high symptom burden, both physical and psychosocial, and enhances caregiver support.

The ASCO guideline draws on the National Consensus Project’s definition of palliative care, highlighting its focus on the patient and their family and its purpose of improving QOL by not only treating but also anticipating and preventing suffering. It also emphasizes the multidisciplinary nature of palliative care and the importance of patient autonomy and education.

Highly trained supportive oncology APPs are an integral part of the patient experience, offering compassion, kindness, and presence supported by well-honed skills in managing symptoms and solving problems.

Incorporating an Embedded Clinic Model

Atrium Health Levine Cancer Institute’s Department of Supportive Oncology has a robust offering of services designed to support patients and caregivers as they navigate treatment from diagnosis through survivorship and EOL. These include psycho-oncology, senior oncology, cancer rehabilitation, palliative medicine, sexual health, and integrative oncology.⁴ APPs work throughout the department alongside physicians to provide expert care for patients with complex medical and psychosocial issues.

The Department of Supportive Oncology at Atrium Health Levine Cancer Institute employs 8 APPs with rich backgrounds in oncology and palliative medicine spanning many years in practice. Our APPs consistently work to discover the unmet needs of cancer patients throughout the Charlotte, North Carolina, area and have developed several novel APP-led initiatives to meet these needs.

Understanding that patients with high symptom burden often struggle with appointment fatigue, especially at initial diagnosis, we developed 2 oncology palliative medicine embedded clinics: one in a thoracic oncology clinic and one in a regional gastrointestinal oncology clinic. The thoracic palliative clinic operates 1 half day per week in a clinic with 4 oncology providers and offers palliative medicine consultations after the patient is seen by their oncologist. The gastrointestinal palliative clinic offers 1 day of consultation per week and follow-up care at the regional site as needed with ancillary providers at one of our palliative medicine–specific sites.

These embedded clinics reduce the number of offices a patient must visit and allow for a gentle introduction to palliative medicine in a familiar and comfortable space. They also create opportunity for immediate palliative medicine introduction at oncology consult, encouraging faster inclusion of palliative medicine into cancer care.

Patients will follow up in the palliative medicine clinic as appropriate. This has been well received by both patients and providers. We have found that once patients have been introduced to palliative medicine and to our providers in the oncology clinic they are familiar with, they are more likely to follow us in the palliative clinic.

This strategy has been effective in easing patients’ fears surrounding palliative medicine. The embedded clinic model not only offers patients easier initial consult visits but also allows them to be referred to other sections in the Department of Supportive Oncology, such as massage, acupuncture, psycho-oncology, cancer rehabilitation, and others.

Change in sexual health and function is another undertreated need that oncology patients face. To address this concern, one of our APPs staffs a sexual health clinic 1 day a week to address the needs of patients struggling with sexual adverse effects or new sexual concerns due to cancer or its treatment.

In addition to the novel APP-led clinics discussed above, we also have APPs working in demographic- and need-specific palliative, integrative, and survivorship settings. One APP specializes in senior oncology, a subspecialty now widely recognized in oncology care that requires a high level of training and skill in geriatric care and oncology palliative medicine. Atrium Health Levine Cancer Institute holds an Age-Friendly Health Systems Committed to Care Excellence designation, and our senior oncology APP has earned specific certifications in age-friendly care.

We have an APP in integrative medicine (another subspecialty in the Department of Supportive Oncology) whose integrative practice is supplemented with advanced training in nutrition. Some APPs in our department work to help motivated patients quit smoking as a part of our oncology-specific tobacco cessation clinics, whereas other APPs in our department see oncology patients long term by managing posttreatment survivorship visits. These clinics offer multimodal care by competent APPs who have achieved specific training to meet identified patient needs.

Why APPs?

APPs in Atrium’s Department of Supportive Oncology have been innovative in their passion to move out into the places patients occupy rather than waiting for the patients to be presented to them. Our APPs support oncology providers and patients on-site in our embedded clinics by seeing unmet needs in our patient population, creating new clinics to address them, and finding patient demographics that need extra support, accommodation, and education.

Supportive oncology APPs are an invaluable part of patient care in the oncology setting, skillfully managing patients as they navigate through the disease process from diagnosis to survivorship. APPs also offer flexibility of location, adaptability of training, and the willingness to go above and beyond for patients. Innovative practice ideas such as these can be carried into other oncology settings by dedicated APPs who wish to better meet patient needs.

References

1. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi:10.1056/NEJMoa1000678
2. Berman R, Davies A, Cooksley T, et al. Supportive care: an indispensable component of modern oncology. Clin Oncol (R Coll Radiol). 2020;32(11):781-788. doi:10.1016/j.clon.2020.07.020
3. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice guideline update. J Clin Oncol. 2017;35(1):96-112. doi:10.1200/JCO.2016.70.1474
4. York B, Self J, Walsh D. Supportive oncology development in a major metropolitan area: regional services. Support Care Cancer. 2025;33(7):536. doi:10.1007/s00520-025-09565-9