Email this article 
Cervical cancer treatment and nursing considerations: Best practices for effective care
Abstract
Over the past several decades, there has been excellent progress in cervical cancer prevention and early detection. However, there are still many Canadian woman who will be diagnosed with cervical cancer and will require active treatment. Advancements in personalizing treatment options based on specific staging and fertility-sparing preferences have helped decrease morbidities for some while ensuring well-needed aggressive treatment for others. Surgical procedures, for example, offer a variety of options with curative intent, particularly for those with earlier stage disease. Once the cancer has spread beyond the cervix to locally advanced stages 2 and 3, the combination of chemotherapy and radiation tends to be the mainstay treatment option. Finally, as cancer becomes more advanced into later stages 3 and 4 disease, utilizing traditional chemotherapy with the addition of novel drugs, such as monoclonal antibodies and immune check point inhibitors, offers hope where it was once lacking. This article focuses on these varying treatment options and identifies how nurses are in the prime position to help patients improve overall understanding, tolerance, and continuity of their treatment plan.
Full Text:
PDFReferences
Altman, A. D., Helpman, L., McGee, J., Samouëlian, V., Auclair, M.-H., Brar, H., & Nelson, G. S. (2019). Enhanced recovery after surgery: Implementing a new standard of surgical care. Canadian Medical Association Journal (CMAJ), 191(17), E469–E475. https://doi.org/10.1503/cmaj.180635
Barber, F. (2019). Adverse events of oncologic immunotherapy and their management. Asia-Pacific Journal of Oncology Nursing, 6(3), 212–226. https://doi.org/10.4103/apjon.apjon_6_19
Benedict, C., Thom, B., Friedman, D., Diotallevi, D., Pottenger, E., Raghunathan, N., & Kelvin, J. F. (2016). Young adult female cancer survivors’ unmet information needs and reproductive concerns contribute to decisional conflict about post-treatment fertility preservation. Cancer, 122(13), 2101–2109. https://doi.org/10.1002/cncr.29917
Brahmer, J. R., Lacchetti, C., Schneider, B. J., Atkins, M. B., Brassil, K. J., Caterino, J. M., … Thompson, J. A. (2018). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 36, 1714–1768. https://doi.org/10.1200/ jco.2017.77.6385
Caird, H., Simkin, J., Smith, L., Van Niekerk, D., & Ogilvie, G. (2022) The path to eliminating cervical cancer in Canada: Past, present and future directions. Current Oncology. 29, 1117–1122. https://doi.org/10.3390/curroncol29020095
Canadian Association of Nurses in Oncology, Oncology Nurses Society, & American Pediatric Hematology/Oncology Nurses. (2024). Fertility preservation in individuals with cancer: A joint position statement from APHON, CANO/ACIO and ONS. Canadian Oncology Nursing Journal, 34(3), 421–423.
Canadian Cancer Society (2024). Cancer Statistics at a Glance. https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance?gad_source=1&gclid=CjwKCAjwnv-vBhBdEiwABCYQAyp6n4HhqoE3-%09Canadian%20Cancer%20Society%20(2024).%20Cancer%20Statistics%20at%20a%20Glance.%20Cancer%20statistics%20at%20a%20glance%20%7C%20Canadian%20Cancer%20Society
Canadian Partnership Against Cancer (2021). HPV immunization for the prevention of cervical cancer. https://s22457.pcdn.co/wp-content/uploads/2020/11/Elimination-cervical-cancer-action-plan-EN.pdf
Champiat, S., Lambotte, O., Barreau, E., Belkhir, R., Berdelou, A., Carbonnel, F., Cauquil, C., Chanson, P., Collins, M., Durrbach, A., Ederhy, S., Feuillet, S., François, H., Lazarovici, J., Le Pavec, J., De Martin, E., Mateus, C., Michot, J.-M., Samuel, D., … Marabelle, A. (2016). Management of immune checkpoint blockade dysimmune toxicities: A collaborative position paper. Annals of Oncology, 27(4), 559–574. https://doi.org/10.1093/annonc/mdv623
Christiansen, M. G., Piil, K., & Jarden, M. (2022). The symptom experience and self-management strategies of women undergoing cervical cancer treatment: A qualitative study. Cancer Nursing, 45(1), 12–20. https://doi.org/10.1097/NCC.0000000000000843
Chuang, L. T., Temin, S., Camacho, R., Dueñas-Gonzalez, A., Feldman, S., Gultekin, M., Gupta, V., Horton, S., Jacob, G., Kidd, E. A., Lishimpi, K., Nakisige, C., Nam, J.-H., Ngan, H. Y. S., Small, W., Thomas, G., & Berek, J. S. (2016). Management and care of women with invasive cervical cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline. Journal of Global Oncology, 2(5), 311–340. https://doi.org/10.1200/JGO.2016.003954
Colombo, N., Dubot, C., Lorusso, D., Caceres, M. V., Hasegawa, K., Shapira-Frommer, R., Tewari, K. S., Salman, P., Hoyos Usta, E., Yañez, E., Gümü?, M., Olivera Hurtado de Mendoza, M., Samouëlian, V., Castonguay, V., Arkhipov, A., Toker, S., Li, K., Keefe, S. M., & Monk, B. J. (2021). Pembrolizumab for persistent, recurrent, or metastatic cervical cancer. The New England Journal of Medicine, 385(20), 1856–1867. https://doi.org/10.1056/NEJMoa2112435
Drug Formulary. (2023). Pembrolizumab – Provider Monograph. Cancer Care Ontario. https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44411
Gatti-Mays, M., & Kress, E. (2022). Checkpoint inhibitors: Updated ASCO guidelines of immune-related adverse events in cancer patients. https://www.medpagetoday.com/reading-room/asco/immunotherapy/96644
Gennigens, C., De Cuypere, M., Hermesse, J., Kridelka, F., & Jerusalem, G. (2021). Optimal treatment in locally advanced cervical cancer. Expert Review of Anticancer Therapy, 21(6), 657–671. https://doi.org/10.1080/14737140.2021.1879646
Gopu, P., Antony, F., Cyriac, S., Karakasis, K., & Oza, A. (2021). Updates on systemic therapy for cervical cancer. Indian Journal of Medical Research (New Delhi, India: 1994), 154(2), 293–302. https://doi.org/10.4103/ijmr.IJMR_4454_20
Herter, J. M., Kiljan, M., Kunze, S., Reinscheid, M., Ibruli, O., Cai, J., Niu, L., Heßelmann, I., Trommer, M., Herter-Sprie, G. S., Köhler, C., & Marnitz, S. (2023). Influence of chemoradiation on the immune microenvironment of cervical cancer patients. Strahlentherapie Und Onkologie, 199(2), 121–130. https://doi.org/10.1007/s00066-022-02007-z
Hickey, M. (2024). Managing menopause after cancer. The Lancet, 403(10430), 984–996.
Landoni, F., Maneo, A., Colombo, A., Placa, F., Milani, R., Perego, P., Favini, G., Ferri, L., & Mangioni, C. (1997). Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. The Lancet (British Edition), 350(9077), 535–540. https://doi.org/10.1016/S0140-6736(97)02250-2
Lin, L. L., Lakomy, D. S., Ning, M. S., Simpkins, F., & Jhingran, A. (2020). Combining novel agents with radiotherapy for gynecologic malignancies: Beyond the era of cisplatin. International Journal of Gynecological Cancer, 30(4), 409–423. https://doi.org/10.1136/ijgc-2020-001227
Ma, F., Zhu, Y., & Liu, Y. (2024). The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: A cross-sectional study. BMC Nursing, 23(1), 26–26. https://doi.org/10.1186/s12912-024-01704-7
Matsuo, K., Machida, H., Mandelbaum, R. S., Konishi, I., & Mikami, M. (2019). Validation of the 2018 FIGO cervical cancer staging system. Gynecologic Oncology, 152(1), 87–93. https://doi.org/10.1016/j.ygyno.2018.10.026
McCormack, M., Eminowicz, G., Gallardo, D., Diez, P., Farrelly, L., Kent, C., Hudson, E., Panades, M., Mathew, T., Anand, A., Persic, M., Forrest, J., Bhana, R., Reed, N., Drake, A., Adusumalli, M., Mukhopadhyay, A., King, M., Whitmarsh, K., … Mathew, T. (2024). Induction chemotherapy followed by standard chemoradiotherapy versus standard chemoradiotherapy alone in patients with locally advanced cervical cancer (GCIG INTERLACE): An international, multicentre, randomised phase 3 trial. The Lancet (British Edition), 404(10462), 1525–1535. https://doi.org/10.1016/S0140-6736(24)01438-7
Monk, B. J., Colombo, N., Tewari, K. S., Dubot, C., Caceres, M. V., Hasegawa, K., Shapira-Frommer, R., Salman, P., Yañez, E., Gumus, M., Olivera Hurtado de Mendoza, M., Samouëlian, V., Castonguay, V., Arkhipov, A., Tekin, C., Li, K., Keefe, S. M., & Lorusso, D. (2023). KEYNOTE-826: Final overall survival results from a randomized, double-blind, phase 3 study of pembrolizumab + chemotherapy vs placebo + chemotherapy for first-line treatment of persistent, recurrent, or metastatic cervical cancer. Journal of Clinical Oncology, 41(16_suppl), 5500–5500. https://doi.org/10.1200/JCO.2023.41.16_suppl.5500
National Comprehensive Cancer Network (2023). Management of immunotherapy-related toxicities. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf
National Institutes of Health (NIH). (2022). Update knowledge of cervical cancer (exploration of biomarkers for the diagnosis, treatment, and prognosis of cervical cancer: A review). Women’s Health Weekly, 5350. https://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq
Nelson, G., Fotopoulou, C., Taylor, J., Glaser, G., Bakkum-Gamez, J., Meyer, L. A., Stone, R., Mena, G., Elias, K. M., Altman, A. D., Bisch, S. P., Ramirez, P. T., & Dowdy, S. C. (2023). Enhanced Recovery After Surgery (ERAS®) Society Guidelines for gynecologic oncology: Addressing implementation challenges – 2023 update. Obstetrical & Gynecological Survey, 78(8), 476–477. https://doi.org/10.1097/01.ogx.0000967024.88312.e0
Pang, S. S., Murphy, M., & Markham, M. J. (2022). Current management of locally advanced and metastatic cervical cancer in the United States. JCO Oncology Practice, 18(6), 417–422. https://doi.org/10.1200/OP.21.00795
Plante, M., Kwon, J. S., Ferguson, S., Samouëlian, V., Ferron, G., Maulard, A., de Kroon, C., Van Driel, W., Tidy, J., Williamson, K., Mahner, S., Kommoss, S., Goffin, F., Tamussino, K., Eyjólfsdóttir, B., Kim, J.-W., Gleeson, N., Brotto, L., Tu, D., & Shepherd, L. E. (2024). Simple versus radical hysterectomy in women with low-risk cervical cancer. The New England Journal of Medicine, 390(9), 819–829. https://doi.org/10.1056/NEJMoa2308900
Ramirez, P. T., Frumovitz, M., Pareja, R., Lopez, A., Vieira, M., Ribeiro, R., Buda, A., Yan, X., Shuzhong, Y., Chetty, N., Isla, D., Tamura, M., Zhu, T., Robledo, K. P., Gebski, V., Asher, R., Behan, V., Nicklin, J. L., Coleman, R. L., & Obermair, A. (2018). Minimally invasive versus abdominal radical hysterectomy for cervical cancer. The New England Journal of Medicine, 379(20), 1895–1904. https://doi.org/10.1056/NEJMoa1806395
Rose, P. G., Bundy, B. N., Watkins, E. B., Thigpen, J. T., Deppe, G., Maiman, M. A., Clarke-Pearson, D. L., & Insalaco, S. (1999). Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. The New England Journal of Medicine, 340(15), 1144–1153. https://doi.org/10.1056/NEJM199904153401502
Salib, M. Y., Russell, J. H. B., Stewart, V. R., Sudderuddin, S. A., Barwick, T. D., Rockall, A. G., & Bharwani, N. (2020). 2018 FIGO staging classification for cervical cancer: Added benefits of imaging. Radiographics, 40(6), 1807–1822. https://doi.org/10.1148/rg.2020200013
Santana, E. de O., Silva, L. dos S., Silva, L. A. A. da, Lemos, J. L. de A., Marcondes, L., Guimarães, P. R. B., & Kalinke, L. P. (2023). Effect of guided imagery relaxation on anxiety in cervical cancer: Randomized clinical trial. Revista Brasileira de Enfermagem, 76(5), 1–7. https://doi.org/10.1590/0034-7167-2021-0874
Schmeler, K. M., Pareja, R., Lopez Blanco, A., Humberto Fregnani, J., Lopes, A., Perrotta, M., Tsunoda, A. T., Cantú-de-León, D. F., Ramondetta, L. M., Manchana, T., Crotzer, D. R., McNally, O. M., Riege, M., Scambia, G., Carvajal, J. M., Di Guilmi, J., Rendon, G. J., Ramalingam, P., Fellman, B. M., … Ramirez, P. T. (2021). ConCerv: A prospective trial of conservative surgery for low-risk early-stage cervical cancer. International Journal of Gynecological Cancer, 31(10), 1317–1325. https://doi.org/10.1136/ijgc-2021-002921
Schneider, B. J., Naidoo, J., Santomasso, B. D., Lacchetti, C., Adkins, S., Anadkat, M., Atkins, M. B., Brassil, K. J., Caterino, J. M., Chau, I., Davies, M. J., Ernstoff, M. S., Fecher, L., Ghosh, M., Jaiyesimi, I., Mammen, J. S., Naing, A., Nastoupil, L. J., Phillips, T., … Bollin, K. (2021). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. Journal of Clinical Oncology, 39(36), 4073–4126. https://doi.org/10.1200/JCO.21.01440
Shimada, M., Kigawa, J., Nishimura, R., Yamaguchi, S., Kuzuya, K., Nakanishi, T., Suzuki, M., Kita, T., Iwasaka, T., & Terakawa, N. (2006). Ovarian metastasis in carcinoma of the uterine cervix. Gynecologic Oncology, 101(2), 234–237. https://doi.org/10.1016/j.ygyno.2005.10.004
Shiravand, Y., Khodadadi, F., Kashani, S. M. A., Hosseini-Fard, S. R., Hosseini, S., Sadeghirad, H., Ladwa, R., O’Byrne, K., & Kulasinghe, A. (2022). Immune checkpoint inhibitors in cancer therapy. Current Oncology, 29(5), 3044–3060. https://doi.org/10.3390/curroncol29050247
Singh, P., & Oehler, M. K. (2010). Hormone replacement after gynaecological cancer. Maturitas, 65(3), 190–197. https://doi.org/10.1016/j.maturitas.2009.11.017
Tang, S.-Q., Tang, L.-L., Mao, Y.-P., Li, W.-F., Chen, L., Zhang, Y., Guo, Y., Liu, Q., Sun, Y., Xu, C., & Ma, J. (2021). The pattern of time to onset and resolution of immune-related adverse events caused by immune checkpoint inhibitors in cancer: A pooled analysis of 23 clinical trials and 8,436 patients. Cancer Research and Treatment, 53(2), 339–354. https://doi.org/10.4143/crt.2020.790
Teixeira-Poit, S. M., Sawicki, K., O’Kelley, W., Hardin, M., Jenkins, M., & Gudena, V. (2023). Efficacy of a patient education session for cancer patients receiving immunotherapy. Seminars in Oncology Nursing, 39(4), 151445–151445. https://doi.org/10.1016/j.soncn.2023.151445
Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PloS one, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350
Tewari, K. S., Sill, M. W., Long, H. J., Penson, R. T., Huang, H., Ramondetta, L. M., Landrum, L. M., Oaknin, A., Reid, T. J., Leitao, M. M., Michael, H. E., & Monk, B. J. (2014). Improved survival with bevacizumab in advanced cervical cancer. The New England Journal of Medicine, 370(8), 734–743. https://doi.org/10.1056/NEJMoa1309748
Wang, H., Ni, C., Xiao, W., Yang, T., & Sun, W. (2021). Comparison of radical surgery and radiotherapy for the treatment of early-stage cervical carcinoma: A meta-analysis. Oncology Research and Treatment, 44(4), 176–183. https://doi.org/10.1159/000509149
Wang, Y., Lo, T.-T., Wang, L., Hsu, S.-T., Hwang, S.-F., Lu, C.-H., & Sun, L. (2023). Long-term efficacy and toxicity of intensity-modulated radiotherapy in bulky cervical cancer. International Journal of Environmental Research and Public Health, 20(2), 1161-. https://doi.org/10.3390/ijerph20021161
Weber, J. S., Postow, M., Lao, C. D., & Schadendorf, D. (2016). Management of adverse events following treatment with anti-programmed death-1 agents. The Oncologist (Dayton, Ohio), 21(10), 1230–1240. https://doi.org/10.1634/theoncologist.2016-0055
Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 36(6), 284–289
Zhang, L., & Lu, Y. (2021). Follow-up care for patients receiving immune checkpoint inhibitors. Asia-Pacific Journal of Oncology Nursing, 8(6), 596–603. https://doi.org/10.4103/apjon.apjon-212
Refbacks
- There are currently no refbacks.
