how the role of physician assistant is bridging cancer care gaps
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nicole boetto, left, is a physician assistant at southlake health, seen here with oncology nurse serena gucciardi. boetto describes the role as "the dream job for me," recognizing the need for deeper patient relationships and holistic care, especially with a cancer diagnosis.
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nicole boetto wanted a career in medicine that would be collaborative, drawing on the strength of a team-based approach. with the stress on healthcare services, staff shortages and limited budgets—and the sobering fact that nearly six million canadians don’t have access to a family doctor—making the most of coordinated team care comes at a critical point.
boetto, 33, has a degree in nutritional sciences and a bachelor of education, first working in nutrition at a diabetes clinic and volunteering at the hospital for sick children (sickkids) in toronto. her interest in pediatrics and young adults grew from there, along with her introduction to the role of physician assistant at sickkids that champions the team model of care.
physician assistants (pas) work with supervising physicians and the broader healthcare team. the role was first introduced by the canadian military as a term for senior medics, moving into the public health sector in the early 2000s, according to the canadian association of physician assistants. national accreditation and a two-year postgraduate program saw the first pas graduate in 2010, with growing demand.
supporting team-based care
“we all work together to really assess patients, diagnose and treat patients holistically. and an aspect that i love about being a pa is really the versatility and the flexibility of the role. we’re trained as generalists, so that means we can practice across many different specialties,” says boetto, who works in the adolescent young adult cancer program at southlake health based in newmarket, ont.
“as a pa, there is time within our role to really take a whole person or a whole-patient centered approach,” she says. “so we can manage acute symptoms in collaboration with our supervising physicians, but there’s also space within the role to really take the time to focus on addressing additional lifestyle factors, which is something i really like. so that’s the health promotion piece, the preventative care piece and also the patient education and counselling, which is why i thought it was a really good fit for me.”
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in holistic care, patients are connected with mental health and social services, supported more fully through treatment and educated about managing daily living with chronic conditions.
while southlake health has physician assistants in emergency and other areas, boetto is the first physician assistant to join the cancer program as a pilot early in 2026.
“so this was embarking on new territory,” says dr. alisha kassam, physician leader of the hospital’s regional cancer program, which is linked to the princess margaret cancer care network. she says the adolescent young adult cancer program for ages 18 to 43 was the perfect fit for the new role, given the program’s care addresses the unique needs of young adults.
while cancer care is robust in pediatrics, health systems for adults with cancer were designed for older adults based on volumes. there was a gap in care for younger adult patients who need support for fertility, survivorship and meeting their needs as they juggle treatment with raising kids, other family commitments and taking time off from work.
“it’s a lot more involved than one oncology visit where the focus can often be and should be on the complexity of their treatments and their care,” she says.
because treatment can impact fertility, discussions on fertility preservation give people a plan if they want to have their own children later on. in some cases, the start of cancer treatment can wait so that fertility preservation like freezing eggs or embryos can happen first.
physician assistant addresses all care aspects
“we needed a specialist who not only would follow these patients throughout their journey but also support all aspects of their care,” dr. kassam adds. “they’re going to be involved in fertility counselling for these patients. they’re going to approach all of the psychosocial aspects.”
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she sees the pa role as a “physician extender,” providing continuity, help with care coordination and more follow-up to support the entire oncology team to help meet the needs of the patients. months into this first pilot, it’s opened her eyes to expanding the pa role in other areas of oncology.
“i have to say, it’s been really transformative, both from feedback for the patients and just the versatility of the role to be able to adapt to meet the needs of the oncology teams, but also the needs of the patients, and support for the social workers, the dietitians, the nursing staff, so that we can all work stronger together.”
boetto is dedicated to what she describes as “the dream job for me,” recognizing that having a deeper relationship with patients and their families can be a lifeline in all the uncertainty and fear surrounding a cancer diagnosis.
“this aspect of care is so important, really taking the time to counsel patients, educate them and really be able to provide supportive care to them, especially in this age group,” boetto says. she’s helped connect patients with peers and see them in person as they’re going through treatment.
“i’ve had patients say it’s just like having a really good friend who knows what they’re going through and is able to understand their experience and then provide support for them. so it’s nice that there is that additional touchpoint outside of the amazing work that the oncologist and the interprofessional team is doing as well.”
making the transition to adult care easier
southlake regional cancer care is partnered with princess margaret cancer centre, so that patients in complex pediatric cancer care at the renowned academic hospital can transfer more easily when they turn 18 to adult care at southlake (if they live in the local area). boetto is also working with princess margaret for ongoing learning and professional development with their oncology teams and follows patients who come to the area who need further support and access to community resources.
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while very few studies have assessed the burden of chronic medical conditions in adolescent and young adult cancer survivors, a research team led by the university of california davis comprehensive cancer center looked at the risk of these conditions among adolescent and young adult cancer survivors compared to a matched cohort without cancer.
the study, published in 2025 cancer, an international interdisciplinary journal of the american cancer society, revealed that survivors had a two-fold increased risk of being diagnosed with any medical condition as well as developing two or more conditions. risk was highest among survivors of hematologic cancers and those diagnosed with advanced-stage disease. elevated risks were observed within all sociodemographic groups.
as the authors note, “long-term surveillance, risk mitigation through lifestyle modifications and effective disease management are crucial to reduce premature mortality.”
dr. kassam sees the value of continuity of care for her young adult patients. “for the patient experience, since we do share patients with princess margaret, that is a game-changer. with the trend in patients aged 18 going into adult care from pediatric care, the opportunity to see the same clinician to support those transitions is another really powerful aspect of this role.”
the biggest takeaway for dr. kassam and her colleagues is that oncology teams can adapt the pa role over time as needs and priorities change. for example, southlake is building a survivorship program where boetto is helping lead some of that work to make sure the needs of their young adults are met.
oncology teams work to their full scope
the pa is not about creating redundancies but providing expertise to allow patients to get the right care at the right time. a key benefit is helping everyone in the oncology team work to their full scope, says dr. kassam.
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“[boetto] is not replacing the oncology nurses who are supporting the day-to-day clinic operations and the phone calls related to oncology care. when there’s more of a fertility concern or a sexual health concern comes up, they can turn to her for clinical support. our social workers are there to support a lot of the practical aspects of having a cancer diagnosis, and they will reach out to her when it seems like mental health is more of a concern.”
as well, the oncologists in her program say that the pa role allows them to still touch on important conversations with their young patients, but when there needs to be more time and detail, they can reach out to boetto knowing that that’s part of her scope to support these conversations in a more fulsome way.
“as we look to the future, both here at southlake and with cancer in general, we know the complexity and the volumes are expected to increase,” says dr. kassam.
“so we need to think about how we can thoughtfully integrate roles like physician assistants to make sure that we’re filling in some of the gaps.”
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