The Role of Nurse Practitioners in Global Cancer Care

Abstract

2020 has been designated by The World Health Organization (WHO) as the Year of the Nurse and Midwife, shining a light on the role nurses play in improving healthcare around the world. The WHO predicted a global deficit of 12.9 million physicians, nurses, and midwives by 2035, highlighting the need for more trained health professionals. Nurse Practitioners (NPs) are nurses who have completed postgraduate training, providing them with skills needed to evaluate patients, counsel, prescribe, manage treatment, and provide follow up and survivorship care. 85% of cervical cancer cases occur in low- and middle-income countries (LMICs), where limited resources and lack of trained providers are key factors in the high rate of morbidity and mortality from this preventable disease. The aim of incorporating NPs as providers, teachers, and mentors into the fight to eradicate cervical cancer is to broaden the depth and scope of services worldwide, including in LMICs, remote environments, and high-risk areas such as in South and East Texas. As a Nurse practitioner, I participate in a cervical cancer prevention group, associated with an international tele-mentoring organization, with the goal of improving patient outcomes in regions where patients lack access to specialized healthcare. I have taught cervical cancer prevention in Guatemala, Africa, and South and East Texas. I participate in training physicians and advanced practice providers in colposcopy, biopsy, and LEEP (loop electrosurgical excision procedure). Didactic training includes identification of abnormalities of the cervix and HPV vaccination. A current research project in Mozambique is assessing the effectiveness of this intervention in reducing morbidity and mortality due to cervical cancer. A long-term goal is for local providers to become the teachers and mentors. Initial data from the project in Mozambique suggests that utilizing a multi-pronged approach including 1) community outreach and education, 2) patient navigation within existing systems, and 3) training of providers to improve care locally through remote and in person training, is an effective way to prevent cervical cancer. This project enrolled 898 women with a follow up rate of greater than 95 percent, indicating that women will come for screening and treatment if it is made available. Nurse practitioner training broadens the scope of practice for nurses, to include medical knowledge and skills required to effectively manage cancer patients. The WHO goal for 2030 is for 90% of women with cervical disease to receive treatment for precancerous lesions or invasive cancer. NPs can help reach this goal through the identification and treatment of precancerous lesions and training of healthcare providers. Mozambique now has one linear accelerator to serve a population of approximately 30 million people, creating a potential role for nurses and NPs in radiation oncology going forward.