National Cancer Survivor’s Day

This blog is written by NPWH Board Member Rachel Gorham, MSN, WHNP-BC, AGN-BC

It was April 2016, when I heard the words, “You have cervical cancer.” I remember finding out the news before heading into a busy day of clinic and seeing my own patients. I quietly walked into my office, closed the door, and broke down. I remember drying my tears, saying a prayer, and from that moment on I never looked back. I was a mother to my only child, Makenzie, and knew what I had to do in order to win the battle ahead of me. I underwent a surgical intervention the following week and required no adjuvant therapy.  May marks my three-year anniversary of celebrating cancer survivorship.

Who Exactly are Cancer Survivors?

Experts from the American Cancer Society and the National Cancer Institute defines a cancer survivor as any individual who has been diagnosed with cancer and remains alive and well. This includes patients who are currently undergoing treatment, as well as those who have finished treatment and are considered cancer-free.

As of January 1, 2014, there are 6,876,600 men and 7,607,230 women who survived cancer. The numbers were based on the Cancer Treatment & Survivorship Facts & Figures 2014-2015 report, which is a collaboration between the American Cancer Society and the National Cancer Institute. Current statistics report that 64% of all cancer survivors have lived at least five years since their diagnosis. That includes the 15% of people who lived at least twenty years since their cancer diagnosis. Nearly half (46%) of cancer survivors are 70 years of age or older.

There are over 15 million cancer survivors in America. National Cancer Survivor’s Day is meant to be cherished around the world on the second day of June. This is a day for reflection and celebration. Whether you are a cancer survivor yourself, supportive family member, or beloved friend to someone who has recently been diagnosed, today provides us with courage and strength to overcome.

A Cancer Survivor’s Journey

There are three phases of cancer survivorship:

  1. Acute survivorship starts at the time a patient is diagnosed with cancer and goes through the end of treatment. The main goal of this phase is cancer treatment.
  2. Extended survivorship starts at the end of cancer treatment and advances through the upcoming months. The main effects of cancer and treatment is the focus during this phase.
  3. Permanent survivorship is the last phase which encompasses years passed since the end of cancer treatment. There is typically less of a chance that the cancer will recur during this phase.

The long-term effects of cancer and treatment is the focus. As patients transition between phases, so do their needs. The patient’s physical, emotional, and psychological needs must be met at each individual phase in order to provide holistic care.

Caring for Cancer Survivors

Long-term cancer survivorship focuses on health, wellness, and the prevention of cancer recurrence. Accomplishing this goal includes a team of medical oncologists, nurse practitioners, nurse navigators, social workers, registered dietitians, and support staff. Providing cancer survivorship care consists of four activities: disease surveillance, recognition of the signs and symptoms of disease recurrence, adhering to the recommended healthcare maintenance, and education on long-term effects from cancer treatment.

The 2005 Institute of Medicine (IOM) report “From Cancer Patient to Cancer Survivor: Lost in Transition” recommends that every cancer survivor receives a survivorship care plan. The goal of this plan is to educate and guide patients through long-term cancer survivorship. The care plan provides specific details on the patient’s diagnosis, treatment, and potential long-term sequelae. The survivorship care plan also addresses recommended follow-ups, adherence to treatment, physical examination, goals of cancer survivorship, and diagnostic testing schedules. The care plan provides a means of communication between all members of the patient’s healthcare team.

As medical research continues to improve survival statistics and the number of cancer survivors grow, its increasingly important to understand the psychological and medical needs of cancer survivorship. Clinicians who care for cancer survivors have the power to help their patients achieve an optimal quality of life.

Systemic Lupus Erythematosus (SLE) Awareness Month

Guest blog by Jennifer Parker Kurkowski, NP and instructor at Baylor College of Medicine

May is Systemic Lupus Erythematosus (SLE) Awareness Month. Building awareness and knowledge of this disease is important for providers who care for women, as it primarily affects women of reproductive age. Here is a brief overview of SLE and the considerations for patients managing the condition.


What is Lupus?

SLE is a chronic autoimmune disease that can affect multiple systems throughout the body,  including blood, kidneys, lungs, nervous system, serous membranes, joints, and skin. The cause of SLE is multifactorial and can include genetic, hormonal, immunologic, and environmental factors. Patients may present with a wide array of symptoms, signs, and laboratory findings. The disease is characterized by periods of remissions and relapses including a variable prognosis.


How common is Lupus?

The reported prevalence of SLE in the United States is 20 to 150 cases per 100,000. The Lupus Foundation estimates 1.5 million Americans have lupus. The female to male preponderance varies with age, emphasizing the estrogen effect. The ratio climbs as high as 15:1 in women of childbearing years. For this reason, it’s important that all providers who care for women in this population are familiar and capable of counseling patients with SLE.


How does Lupus affect pregnancy and contraceptives?

Contraceptive and preconception counseling are important for patients with SLE because it is a disease that is typically diagnosed in women of reproductive age. Here are a few things providers and patients should understand about SLE, pregnancy, or pregnancy prevention:

  • Current research indicates fertility is not altered by the disease, but many medications used to treat SLE have potential teratogenic effects of which the patients should be made aware.
  • Patients with SLE have an increased risk of pregnancy complications, including preterm labor, unplanned cesarean delivery, fetal growth restriction, preeclampsia, eclampsia, thrombosis, infection and transfusion. Also, patients with antiphospholipid antibodies (APL) can be at increased risk for adverse outcomes including pregnancy loss and thrombosis.
  • Possible fetal complications include miscarriage, stillbirth, growth restriction, neonatal lupus and premature birth.
  • Prior to conception, a woman’s SLE should be in good control or inactive for a 6-month period. Active SLE at the time of conception is linked to negative outcomes for mother and child.

Despite the maternal and fetal risks associated with SLE, many patients do not use an effective contraceptive method. The current Center for Disease Control and Prevention (CDC) medical eligibility for contraceptive use provides guidance among different patient populations. The ideal method of birth control for women with SLE depends on their APL status.

What are other health concerns for women with Lupus?

Menstrual Problems

  • Menstrual irregularities can be common in patients with SLE, including heavy menstrual bleeding in those with thrombocytopenia.
  • Premature ovarian failure is a concern in patients receiving alkylating agents such as Cyclophosphamide (CYC). CYC is typically used in severe cases of SLE with renal or central nervous system involvement. This risk is dependent on the patient age at time of exposure and cumulative dose of CYC. It is less in women who received CYC at age 25 or younger and have a cumulative dose of less than 10 grams. Women receiving CYC must be counseled about the importance of avoiding pregnancy. The risk for teratogenicity is greatest if exposure occurs in the first trimester.

Osteoporosis

  • Osteoporosis and osteopenia can be a significant problem in those patients receiving treatment with It is important to be aware of the risk for fractures. Patients should be encouraged to do weight bearing exercises, maintain a healthy weight, and stop smoking. Vitamin D levels should be checked.

Heart Disease

  • Lupus raises the risk of coronary artery disease. This is linked to hypertension and high cholesterol. One study found women with SLE are 50% more likely to have a cardiac event compared to a healthy counterpart.

Renal Involvement

  • Up to half of patients with SLE have some type of renal involvement. Patients with Lupus should have periodic blood pressure checks as well as screening for lupus nephritis.

It is our responsibility as providers to ensure we and our patients understand the nuances of caring for women with Lupus so they can live full and healthy lives.

May is Teen Pregnancy Month

The below is written by Shelagh Larson, DNP, WHNP-BC, NCMP. Dr. Larson is Secretary of the NPWH Board of Directors. 

The month of May might be the time of flowers, butterflies and Mother’s Day.  It is also the month we recognize Teen Pregnancy. Teen pregnancy is a healthcare issue that all providers, parents, teachers, politicians and religious leaders need to come together for.

Good news:

Rates of adolescent pregnancy, birth and abortion in the United States continued to decline and reached historic lows. The teen pregnancy rate is the summation of all live births, abortions, and miscarriages per 1,000 adolescent females in a given year.

  • The rate declined 7% from 2016 to 2017, to 18.8 births per 1,000 females aged 15–19.
  • Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years.
  • The largest decline in the teen birth rate from 2016 to 2017 was for non-Hispanic Asian females, down 15% to 3.3 births per 1,000.

Although reasons for the declines are not totally clearly understood, evidence suggests these declines are due to teens abstaining from sexual activity, and those that are sexually active, are using more birth control, especially long acting reversible contraceptive (LARCs), than in previous years. Kathryn Kost, lead author of the Guttmacher Institute says, “The available evidence suggests that improved contraceptive use continues to be the primary driver of these declines.” Before you throw a party, let’s see the other side to the story.

Bad news:  

Still, the teen birth rate in the U.S. remains significantly higher than in other developed countries, according to the CDC. The U.S. teen pregnancy rate is substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist.

  • About 77 percent of teen pregnancies are unintended, undesired, or occurred “too soon”.
  • Not all teen births are first births, either. In 2017, one in six (16.3 percent) births to 15- to 19-year-olds were to females who already had one or more births.
  • Moreover, teen childbearing costs U.S. taxpayers between $9.4 and $28 billion a year through public assistance payments, lost tax revenue, and greater expenditures for public health care, foster care, and criminal justice services.
  • On a positive note, between 1991 and 2015, the teen birth rate dropped 64%, which resulted in $4.4 billion in public savings in 2015 alone.

The Social Cycle

Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school. While adolescents that are enrolled in school and engaged in learning (including participating in after-school curriculum/programs, having positive attitudes toward school, and performing well educationally) are less likely than are other adolescents to have or to father a baby. The adolescents with mothers who gave birth as teens and/or whose mothers have only a high school degree are more likely to have a baby before age 20 than are teens whose mothers were older at their birth or who attended at least some college. Having lived with both biological parents at age 14 is associated with a lower risk of a teen birth. At the community level, adolescents who live in wealthier neighborhoods with strong levels of employment are less likely to have or to father a baby than are adolescents in neighborhoods in which income and employment opportunities are more limited. Teenage girls who are pregnant — especially if they don’t have support from their parents — are at risk of not getting adequate prenatal care.

The stigma of out-of-wedlock pregnancy may have diminished; however, the risks of serious health consequences remain for babies born to teen mothers. The infants are more likely to have born preterm, lower birth weights, and to suffer the associated health problems. Children born to adolescents realize particular challenges— more likely to have inferior educational, behavioral, and health outcomes throughout their lives, compared with children born to older parents. These children are also more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult. This is a perpetuating cycle.

The Providers Role

As a health care provider, you play a critical role in further reducing teen pregnancy rates through the care you provide to your adolescent patients.

  • Ask both male and female adolescent patients about their past and current sexual and reproductive history.
  • Provide confidential, respectful, and culturally appropriate services that meet the needs of teen clients.
  • Discuss not only pregnancy as a risk, but also acquiring STDs.
  • Support those who are not sexually active to continue to wait.
  • Present sexually active teens the importance of always using dual methods—such as an IUD or hormonal method, and a condom—to prevent pregnancy, and STDs including human immunodeficiency virus (HIV).
  • Discuss the full range of contraceptive methods after birth, especially LARCs. Research indicates that effective contraception helps prevent poor birth spacing, thereby reducing the risk of low-weight and/or premature birth. Most states’ Medicaid program cover the cost of contraceptives, especially the LARCs.

 

Fighting Misinformation

Abstinence-only programs are a classic case of “information manipulation”—an attempt to misuse information to influence individual choice. This is why leading medical organizations have taken strong stances against abstinence-only programs. These programs often promote harmful gender stereotypes, and they marginalize and systematically ignore the needs of marginalized groups, including LGBTQ young people. Ultimately, young people have a need and right to complete and accurate information to support their healthy sexual development as adolescents, and throughout their lives.

We Can Make a Difference

We are making a difference in teen pregnancy rates, but our job is not over. Having the power to decide if, when, and under what circumstances to get pregnant and have a child increases young people’s opportunities to be healthy, to complete their education, and to pursue the future they want. But they can’t make that decision if they lack information and access to contraception. It is our calling to make that difference.

An Open Letter to WHNP Students

An open letter to WHNP students by NPWH Chair Elect, Diana Drake DNP, APRN, WHNP-BC and Clinical Associate Professor

Dear WHNP Students,

To the students who graduated this semester in the Class of 2019, and the future graduates in the Class of 2020 and 2021, I strongly urge you to pay very close attention to the current bans, discussions and political debates regarding abortion, contraception and the control of women’s bodies that is happening right now. With all due respect to your individual values and beliefs, please know that the issues at stake will have a direct impact on you career as WHNPs and the young girls and women you are seeing as patients.

The WHNP faculty work hard to instill the values of compassionate individualized care, health care rights, safe choices and equal access. What we teach is based on sound science and it is implemented through models of evidence-based practice. As WHNPs, we follow and align closely with highly regarded national organizations in our specific field that promote and protect the health and wellbeing of girls and women. You can read NPWH’s statement below.

Please read, please stay current and please stay engaged as activists and advocates for women and girls. We are at the frontlines of women’s health care and we have a professional obligation and responsibility to the populations we serve. 

Sincerely,

Diana Drake DNP MSN APRN, WHNP-BC
Clinical Associate Professor, School of Nursing, University of Minnesota

NPWH Statement on Abortion Bans

The National Association of Nurse Practitioners in Women’s Health (NPWH) is alarmed that lawmakers are working to pass new laws banning and restricting abortion access – imposing professional, civil, and criminal penalties on clinicians who provide safe, high-quality abortion care to their patients. We are also troubled and paying close attention to new discussions and political debates regarding contraception and the autonomy of women’s bodies.

As these disturbing events continue to unfold, NPWH re-asserts our mission statement, which values “protecting and promoting a woman’s right to make her own choices regarding her health within the context of her personal, religious, cultural, and family beliefs.”

Nurse practitioners understand that it is crucial to have the ability to provide women with compassionate, individualized healthcare built on sound science and evidence-based practice. We are committed to offering safe choices and equal access to all women.