Addressing Gynecologic Cancer Care in Rural Communities | David Shalowitz, MD, MSHP
David Shalowitz, MD, MSHP
David Shalowitz, MD, MSHP, a Michigan-based gynecologic oncologist and past recipient of a Foundation for Women’s Cancer (FWC) grant (2021-2022), is a health equity researcher who is particularly committed to bridging the gynecologic cancer care gap in rural communities. In advance of National Rural Health Day (November 21), we had a chance to visit with Dr. Shalowitz about the unique challenges faced by rural communities in accessing gynecologic cancer diagnosis, treatment, and care, alongside possible opportunities to better outcomes via technology.
Research has shown that rural residents often face challenges in accessing timely and comprehensive healthcare. Limited availability of specialized services, long travel distances, and fewer healthcare providers contribute to disparities, impacting early detection and treatment outcomes for gynecologic cancers.
As an example, in a study by Morgan F. Gruner, MD presented at the Society of Gynecologic Oncology’s 2024 Annual Meeting on Women’s Cancer, researchers found poorer overall survival in vulvar cancer patients who live in rural communities. “Rural patients are at higher risk for being diagnosed with advanced, preventable diseases like cervical and vulvar cancers due to lack of vaccination and routine screening,” Dr. Shalowitz shares. While travel, financial strain, and limited preventive care affect both rural and urban populations, rural patients are disproportionately impacted by the logistical difficulties of accessing care. The need for support systems that assist with transportation, housing, and social needs is essential to ensure patients can complete their treatment regimens.
According to Dr. Shalowitz, specialists should not be the primary providers of screening and early detection for gynecologic cancers. “These interventions, including cervical cytology and human papillomavirus (HPV) testing, endometrial sampling, and identification of patients at risk for hereditary ovarian cancer syndromes, should be part of the repertoire of general gynecologists and primary care clinicians irrespective of distance to referral centers,” he explains.
When cancer is diagnosed, rural patients may need to navigate a combination of in-person care from specialists and co-management with local clinicians. Dr. Shalowitz notes that while surgical procedures can often be managed with a single trip, daily radiation therapy can be especially burdensome, and ongoing chemotherapy presents intermediate challenges.
Telemedicine presents a promising solution to the geographical barriers rural patients face. Dr. Shalowitz highlights its potential: “Telemedicine can improve access whenever distance is identified as a barrier to care. Virtual clinic visits can decrease patients’ travel burden, and remote patient monitoring can reduce complications from disease or treatment.” Additionally, virtual tumor boards allow specialists to collaborate on treatment planning without requiring patients to travel for consultations.
Dr. Shalowitz emphasizes the importance of developing a strong relationship with a primary care clinician for routine screenings and early interventions. He also encourages patients to become advocates for their own care by utilizing trusted sources like the Foundation for Women’s Cancer to stay informed and seek consultations with specialists when necessary.
Dr. Shalowitz stresses the importance of not separating gynecologic cancer care from general women’s health. “Commitment to screening and prevention requires ensuring that clinicians are able to provide evidence-based healthcare without personal or professional risk,” he says. Restrictive state laws in some rural areas have made it difficult for clinicians to practice, exacerbating existing disparities. Organizations dedicated to gynecologic health, like the Society of Gynecologic Oncology, have a responsibility to support frontline clinicians and advocate for policies that protect women’s access to high-quality care.
Looking ahead, Dr. Shalowitz envisions a healthcare system that better integrates prevention, screening, and treatment at all levels. “Obstetrician-gynecologists and primary care clinicians play a critical role in preventing and identifying diseases that need subspecialty care,” he notes. Collaboration amongst healthcare professionals, increased gynecologic health advocacy, and technology integration are tangible solutions for reducing rural health disparities in gynecologic cancer care.
