Gynecologic Cancer Awareness: Dr. Teplinsky Discusses Nursing Roles

September marks Gynecologic Cancer Awareness Month, highlighting critical diseases that affect tens of thousands of women annually. The 5 main gynecologic malignancies encompass cervical, ovarian, uterine or endometrial, vaginal, and vulvar cancers. Currently, only cervical cancer features a reliable screening protocol, making early symptom recognition and patient self-advocacy essential for timely diagnosis.

In this Oncology Nursing News Q&A, medical oncologist Eleonora Teplinsky, MD, examines the evolving treatment landscape. Rapidly expanding therapeutic modalities—such as targeted agents, antibody-drug conjugates, and immunotherapies—require proactive toxicity management from oncology nurses to preserve patient adherence and safety.

Teplinsky emphasized incorporating supportive care discussions regarding treatment-induced menopause, sexual health, and fertility, topics featured in her new book, “Beyond the Pink.” She also highlighted strategies for nurse navigators to dismantle racial and socioeconomic disparities in clinical trial access.

The treatment landscape for gynecologic cancers has rapidly evolved with targeted therapies, antibody-drug conjugates (ADCs), and immunotherapies. From a practical nursing perspective, what are the most critical emerging side effect profiles that clinical teams must proactively manage to ensure patient adherence?

As our therapies become more targeted, the toxicity profiles can also become more specific, and that makes patient education incredibly important. With ADCs, nurses may be monitoring for toxicities such as ocular toxicity, peripheral neuropathy, cytopenias, pneumonitis or interstitial lung disease, and gastrointestinal side effects, depending on the agent. With immunotherapy, immune-related adverse events can involve essentially any organ system and may occur during treatment or even after treatment has stopped. Targeted therapies bring their own considerations, including hypertension, fatigue, diarrhea, dermatologic toxicities, cytopenias, and metabolic or laboratory abnormalities.

For nursing teams, the key is helping patients understand what to expect, what they can manage at home, and what requires immediate reporting. Early recognition and intervention can prevent a low-grade toxicity from becoming something much more serious and help patients remain on treatment safely.

Your book, “Beyond the Pink,” highlights often-overlooked topics like treatment-induced menopause, sexual health, and fertility concerns. How can oncology nurses integrate structured, supportive care conversations into fast-paced clinical workflows to address these quality-of-life challenges?

One of the biggest opportunities is simply to normalize these conversations and make them part of routine cancer care rather than waiting for patients to bring them up. Patients may assume that hot flashes, vaginal dryness, sexual dysfunction, musculoskeletal concerns, sleep changes, or changes in body image are things they just have to live with or they may feel uncomfortable mentioning them.

This does not necessarily require a lengthy conversation at every visit. Nurses can incorporate a few standardized questions into treatment education and follow-up: Are you having symptoms related to menopause? Has treatment affected intimacy or sexual health? Is there anything affecting your quality of life that we haven't discussed?

Identifying the problem and creating a pathway to the appropriate resource — gynecology, menopause care, sexual medicine, pelvic floor physical therapy, reproductive endocrinology, psychosocial support, or another specialist — can make an enormous difference. These are topics that are part of comprehensive cancer care.

Younger women diagnosed with gynecologic cancers face unique psychosocial, financial, and reproductive hurdles. What concrete steps can oncology care teams take to streamline timely referrals for fertility preservation and age-appropriate survivorship resources?

Fertility needs to be addressed early at diagnosis and before treatment begins. Rather than relying on an individual clinician to remember to make a referral, health systems can build workflows or pathways based on age, diagnosis, and planned treatment. Having an established relationship with reproductive endocrinology and a mechanism for expedited appointments can prevent unnecessary delays.

We also need to think beyond fertility. Younger patients may be navigating premature menopause, sexual health concerns, relationships and dating, parenting young children, careers, insurance, financial toxicity, and fears about the long-term impact of treatment. Age-appropriate resources should therefore include social work, financial navigation, psychosocial support, sexual health and menopause care, and peer or community support when desired. The goal is to identify these needs early rather than waiting until treatment ends.

Significant racial and socioeconomic disparities persist in gynecologic cancer outcomes and clinical trial enrollment. How can advanced practice providers and nurse navigators work together to dismantle barriers to equitable care and clinical trial access within their communities?

We have to look at the barriers to access that our health care systems create. Transportation, childcare, time away from work, insurance concerns, language, health literacy, mistrust, and the logistics of getting to an academic center can all influence whether someone can realistically access specialty care or participate in a clinical trial.

Advanced practice providers and nurse navigators are uniquely positioned to identify those barriers early. That can mean screening for social needs, connecting patients with transportation or financial resources, ensuring access to interpreters, providing culturally and linguistically appropriate education, and helping patients understand what clinical trial participation actually involves.

Clinical trials should also be discussed as a potential treatment option when appropriate and not only after standard therapies have been exhausted. Improving equity requires both expanding where trials are available and ensuring every eligible patient has a meaningful opportunity to learn about them.

Patients often struggle to navigate complex treatment pathways or advocate for themselves when non-specific symptoms are initially dismissed. How can nursing staff empower patients to effectively articulate their concerns and self-advocate during oncology visits?

Nurses can help patients translate what they are experiencing into information that clinicians can act on. Patients can be encouraged to describe when a symptom started, how often it occurs, whether it is changing, what makes it better or worse, and how it is affecting their daily activities.

Patients can be encouraged to come to visits with their questions written down and to prioritize the two or three things they most want addressed. Bringing a family member or support person, when possible and desired, can also be helpful.

Most importantly, we need to create an environment in which patients feel comfortable saying, “This is new for me,” “This is getting worse,” or “I am concerned that something is being missed.” Patient self-advocacy works best when the health care team makes space for it and takes those concerns seriously.

Looking at the multidisciplinary care team — physicians, PAs, nurse practitioners, and bedside or navigation nurses — what does seamless interprofessional communication look like when managing high-risk genetic factors like BRCA or Lynch syndrome?

A pathogenic variant can affect treatment decisions, surgical planning, cancer screening, risk-reducing strategies, and potentially family members, so there needs to be a clear process for communicating results and documenting what happens next.

Ideally, everyone on the team understands who is responsible for each step: ordering appropriate testing, reviewing the result with the patient, making genetics referrals, incorporating findings into treatment decisions, coordinating recommended surveillance or risk-reduction strategies, and ensuring that patients understand the potential implications for relatives.

What advice do you have for oncology nursing teams on building long-term trust with patients navigating complex or advanced-stage gynecologic cancer diagnoses?

Trust is built through consistency, communication, and honesty. Patients with advanced gynecologic cancers may be with their oncology teams for years, through multiple treatments, scans, periods of stability, progression, and tremendous uncertainty.

It is important to acknowledge uncertainty. We do not always know exactly how long a treatment will work or what the next scan will show. Being transparent about what we know, what we do not know, and what the plan will be if circumstances change can be incredibly reassuring.

And we cannot lose sight of the person behind the cancer. Asking what matters to someone — their symptoms, goals, family, work, sexuality, fears, and what they want their life to look like — allows us to provide care that is not only focused on treating the cancer, but on helping someone live as well as possible while receiving that treatment.