Abstract
Access to expert gynecologic oncology care is hampered by geographic (1), racial (2), and socioeconomic disparities (3). As cancer care grows in complexity and expense (4) with an aging and increasingly diverse population, the Institute of Medicine and others have called for improvements in cancer care delivery and research (5, 6). The growing workforce gap in supply of gynecologic oncologists – where demand is increasing, but number of providers remains stagnant (2) – highlights the need for fully utilizing the skills of all clinicians working across the cancer control continuum (prevention, screening, treatment, survivorship, and end of life). To that end, nurses can have an enormous impact on improving and expanding access to oncology care as clinicians, designers, and leaders of initiatives to improve care. Nurses comprise the largest group of health-care providers in the U.S. (7). In its 2010 report on the future of nursing, the Institute of Medicine called for all nurses to practice to the full extent of their nursing “education, training, and competencies” (5). We argue that promoting and expanding nurses’ roles within innovative, multidisciplinary models of care in women’s health is essential in order to improve growing gaps in cancer care.
Highlights
Access to expert gynecologic oncology care is hampered by geographic [1], racial [2], and socioeconomic disparities [3]
nurse practitioners (NPs) and certified nurse midwives (CNMs) play important roles in providing primary care by performing cervical cancer screening, referring women for mammography and colon cancer screening, and collaborating with or transferring care to specialist physicians as necessary [22]. Despite their education, training, and evidence that their quality and patient satisfaction outcomes are equal or superior to that of physicians [7, 16, 23], NPs and CNMs are still underutilized in extending the reach of cervical and breast cancer screening in underserved communities [24, 25]
Prescott et al [41] described a shared medical visit model in which a multidisciplinary team, including the oncologist, NPs, nurses, and social workers, provided standardized education visits for gynecologic oncology patients planning to begin their series of platinum-based chemotherapy sessions
Summary
Prevention of common women’s cancers includes promotion of healthy lifestyles and vaccination, though the potential for widespread dissemination is hampered by ineffective implementation. The prophylactic human papillomavirus (HPV) vaccine is a groundbreaking prevention tool which is available to prevent cervical cancer. Uptake of the vaccine among youth in the U.S is inadequate despite widespread insurance coverage and availability. Gallagher et al.’s systematic review demonstrated that, despite challenges, school-based HPV vaccination programs in the U.S and other countries have achieved higher levels of vaccine uptake when compared with those conducted at health-care facilities [11]. School nurses are integral to such programs, where qualitative research by Boyce and Holmes demonstrated that they have the potential to promote vaccination of medically underserved children [12]. School nurses often serve as opinion leaders in middle schools – where the target population for HPV vaccination is found – and can intervene with targeted education, follow-up, and tool kits to promote vaccination among students and parents [13, 14]
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