Navigating Gynecologic Cancer Care

September marks Gynecologic Cancer Awareness Month, an annual observation focused on increasing public and clinical awareness of gynecologic malignancies, including ovarian, endometrial, cervical, vulvar, and vaginal cancers.

These diseases present significant diagnostic and therapeutic challenges due to subtle early clinical presentations and complex care pathways. Oncology nurse navigators serve a vital role within multidisciplinary clinical teams, facilitating timely diagnostic evaluations, coordinating multimodality treatment strategies, and addressing social determinants of health that impede care delivery across diverse patient populations.

Oncology Nursing News spoke with Amy Schultz, RN, Gynecologic Oncology Nurse Navigator at Allegheny Health Network Cancer Institute. Schultz reflected on her more than 25-year nursing background spanning bedside care, infusion, oncology, and hospice care, offering practical insights into frontline navigation strategies. She discussed empowering patients to recognize non-specific symptoms without delay, supporting individuals through biomarker testing anxiety, and addressing post-treatment survivorship needs, including pelvic floor rehabilitation and reproductive endocrinology care.

Schultz detailed systematic approaches for identifying structural care barriers—such as transportation, financial constraints, housing instability, and food insecurity—while providing actionable advice for clinical staff to screen caregivers proactively for burnout and integrate family support systems into the comprehensive continuum of patient care.

Gynecologic cancers often present with non-specific symptoms such as persistent bloating, pelvic discomfort, or minor changes in bowel habits. From a navigation perspective, how can clinical and community nurses better empower patients to recognize these subtle red flags without causing undue alarm?

We always tell patients you know your body the best, and be persistent. I hear a lot of times from patients, especially patients who were younger, they've been pushed around by the health care system with those symptoms. Maybe they start off with their PCP or even themselves, they'll have a symptom and they'll say, "Oh, well, I was gardening all weekend, so I probably pulled a muscle in my back and that's what's causing my back pain,” or, “I was at a party and I ate foods that I don't normally eat, so that's probably what's causing like my constipation or my bloating.”

But then, when they do go to their PCP, sometimes they are dismissed for those symptoms and it's often, “We'll set you up with a GI doctor,” and the GI doctor may say, “Oh, just monitor it,” or, “Take some medications to help with that,” when really they need imaging studies and they need to get that diagnosis because we don't want to delay care. We want to get things moving. So, it's really important as a navigator once we get that patient in the office, we want to start that process of getting diagnostic testing done and from there it may be biopsies and getting that diagnosis and then getting treatment started.

As precision medicine expands in gynecologic oncology, patients frequently face anxiety regarding genetic implications for themselves and their families. How do you help patients process complex biomarker data during the diagnostic and treatment planning phases?

Our providers are very good to talk with the patients as well as our genetic counselors and explain all of that to them. Myself and a coworker, another navigator who works in the gynecology space with me, we don't have too much to discuss with patients regarding genetic testing but we do help to support them with that anxiety and the emotions depending on what those results are. We can always connect them with our oncology social workers. We can also connect them to our oncology clinical psychology or even outside resources too to help support with whatever that genetic testing results and the diagnosis may be.

Treatment for gynecological malignancies often impacts physical, sexual, and body image health. How can oncology nurses normalize conversations around sexual dysfunction, surgical menopause, and pelvic floor rehab to improve post-treatment survivorship care?

Patients don't just have to deal with just the diagnosis, they have those other issues, the sexual dysfunction or pelvic floor issues. We, of course, refer them to oncology rehab to help with pelvic floor therapy or lymphedema services, things like that, and we can also make referrals to REI, the reproductive endocrinology practice for any postmenopausal changes, any sexual dysfunction issues. We definitely reach out and support them with additional resources that they can connect with.

Gynecological cancer care pathways often require multimodality approaches. What structural barriers like transportation, time off work, most commonly potentially interrupt therapy and how can nurse navigators intervene on behalf of the patients?

That is the function of a navigator, to assess for those barriers to care and those barriers can really impact a patient's treatment journey. Treatment can be surgery, chemo, radiation or a combination of any of those. Our role is to make sure what barriers might a patient have, because we want them to stay on track with treatment, but what might delay them? As you mentioned, transportation is probably the biggest barrier to care. It is not specific to the Pittsburgh area or southwest Pennsylvania, it is a nationwide problem for not only oncology patients, but just any patient trying to seek health care services.

Sometimes food insecurities are a problem. Homelessness can be a problem, too, because those patients deserve care just as much as the next person. Those who don't have insurance or are underinsured, those are also barriers that can impact their care. So, when we meet with a patient, we want to see what those barriers or potential barriers might be. You also mentioned time off of work, especially if it's a patient who might be the breadwinner of the home and now they have to have 6 to 8 weeks off after surgery or now they're going to start chemo and they're not sure how they're going to feel.

So, how do we make sure that they still get insurance to cover their treatments and how do they stay on track with that? In the navigation program I work with social workers, dieticians, financial counselors — and so, we want to make sure that we are connecting that patient to whichever discipline is needed the most. If it is a financial issue, maybe it has to do with rent, or utilities, or their health insurance, then we're connecting them with that financial counselor to help them. If it's a food insecurity issue, we can always make referrals to our healthy food center so that they can receive fresh fruits, vegetables, to get them by for about a month, that referral is good for 12 months, which is wonderful. And then if it is any social issues, housing issues or transportation, we have community navigators that we also work with who have resources to get them set up with different transportation companies.

A cancer diagnosis can impact the entire family unit and support systems can require targeted care of their own. What actionable advice do you offer clinical staff to proactively screen caregivers for burnout and integrate them into the care plan overall?

When I meet with patients and they have their support system with them or support person, I also include them in the conversation. When I'm sitting down with the patient, I'm not only speaking to the patient, but I'm making sure I look at that support person and I'm asking them, "How are you doing? How are you feeling? What can we do to make sure you are supported?” And I always try to be a little light about it and say, “This is 99% about her, the patient. But it's not 100%, because if you don't take care of you as the support person, you're not going to be able to help take care of our patient, your loved one.”

So, we want to make sure that everybody is supported, whether that is a husband, partner, daughter, son, nephew, niece, whoever it may be, we want to make sure that they too are supported. And so sometimes if that person is the breadwinner of the house, how does that impact them? Are they needing to take time off using up their FMLA or their short-term disability? And what resources are out there? Plus, there are support groups out there for caregivers, too.

I don't usually find a lot of caregivers or support people initially will want to accept help, they tend to say, "Oh, I'm good. I'm fine, just take care of my wife” or “Take care of my mom." And we're going to do that, but in the meantime, you need to be taken care of, too, because you're riding right along on the journey. So we want to make sure that they can get connected and we check in with them. We make calls to the patients at different times throughout their journey. If we don't see them in the office, I'll reach out to a patient to talk with them and then I'll even ask, “Hey, how how's your husband doing? How's your daughter doing? Have they had to take time off of work? Has this impacted them?” And sometimes I can ask to talk with that support person on the phone too, a lot of times they'll put on speakerphone and they'll both be on, which is great. It's good to hear the support person too and how well they are or are not dealing with everything that's going on.