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The ONS Podcast

The ONS Podcast

Oncology Nursing Society

Health & Fitness
Education

Frequency: 1 episode/8d. Total Eps: 420

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Where ONS Voices Talk Cancer Join oncology nurses on the Oncology Nursing Society's award-winning podcast as they sit down to discuss the topics important to nursing practice and treating patients with cancer. ISSN 2998-2308
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Episode 388: ONS 50th Anniversary: Milestones in Oncology Advocacy and Health Policy

Season 1 · Episode 388

vendredi 7 novembre 2025 • Duration 33:51

"I think we really need to push more of our oncology nurses to get into elected and appointed positions. So often we're looking at health positions to get involved in, and those are wonderful. We need nurses as secretaries of health, but there are others. We as nurses understand higher education. We understand environment. We understand energy. So I think we look broadly at, what are positions we can get in? Let's have more nurses run for state legislative offices, for our House of Representatives, for the U.S. Senate," ONS member Barbara Damron, PhD, LHD, RN, FAAN, told Ryne Wilson, DNP, RN, OCN®, CNE, ONS member and member of the ONS 50th anniversary committee, during a conversation about the future of oncology nursing advocacy and health policy. Wilson spoke with Damron and ONS member Janice Phillips, PhD, RN, CENP, FADLN, FAAN, about how ONS has advanced advocacy and policy efforts over the past 50 years and its approaches for the future.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Episode Notes 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From This Episode

Phillips: "I think that there are so many pressing issues, but I'm going to start with any kind of threats or legislation that's poised to take away safety-net resources. It's really going to set us back because we all know that, particularly for minorities and certain other underserved populations, they have experienced poor cancer outcomes for a variety of reasons, variety of socioeconomic reasons, lack of access to quality screening resources—you name it. When you take away those safety net resources and take away resources for people who are already underserved, uninsured, or underinsured, it also jeopardizes their ability to get proper screening, get proper follow-up, have access to state of the art cancer services. I think the lack of affordability of health care is a problem that continues to challenge us, whether you on Medicaid or whether you have limited insurance." TS 10:16

Damron: "Because ONS is so grounded in science and research—we're not just a clinical organization; we're grounded in scholarship, science, research, and publication—we're able to take this vast network of strong clinicians [and combine it] with amazing scientists. … We've had some amazing scientists come out of ONS; some of the leading nurse scientists of all time were also oncology nurses. So by combining this, we're able to make a difference at the state and federal level. So the advocacy work that I've been involved in, state and federal levels, really involved working with the ONS staff involved with advocacy and those scientists and clinicians who brought that expertise." TS 18:19

Phillips: "I think expanding the work around multiculturalism in oncology will always be important. Are there any new partnerships or avenues that ONS can reach out to or explore? Maybe there are other specialty organizations or groups—and not always necessarily nursing— because as we think about the determinants of health, we think about things like health and all policies. Maybe there are other disciplines or other specialties that we need to embrace as we launch our agendas." TS 23:28

Damron: "As nurses, just our basic nursing training, we get these skills—we see a problem, we identify the problem, we assess what we're going to do about it, we do it, and then we evaluate what we did. Does that work or not? That's how you make policy. So we were all trained in this. Then what you bring on top of that are oncology nursing experience, whether it's clinical, whether it's research, whether it's teaching, practice, etc. Those continue to refine those skills that are basic to us as nurses. We have this built-in skill set, and we need to own it and understand it." TS 30:25

Episode 387: Prostate Cancer Screening, Early Detection, and Disparities

Season 1 · Episode 387

vendredi 31 octobre 2025 • Duration 16:28

"[When] a lot of men think about prostate exams, they immediately think of the glove going on the hand of the physician, and they immediately clench. But really try to talk with them and discuss with them what some of the benefits are of understanding early detection. Even just having those conversations with their providers so that they understand what the risk and benefits are of having screening. And then educate patients on what a prostate-specific antigen (PSA) and digital rectal exam (DRE) actually are—how it happens, what it shows, and what the necessary benefits of those are," ONS member Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, manager of clinical education and clinical nurse specialist at Karmanos Cancer Institute in Detroit, MI, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about prostate cancer screening, early detection, and disparities.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by October 31, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to prostate screening, early detection, and disparities.

Episode Notes 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From This Episode

"The recommendations are men [aged] 45 who are at high risk, including African American men and men who have a first-degree relative who has been diagnosed with prostate cancer younger than 65 should go through screening. And men aged 40 at an even higher risk, these are the men that have that one first-degree relative who has had prostate cancer before 65. Screening includes the PSA blood test and a digital exam. Those are the screening recommendations, although they are a little bit controversial." TS 3:42

"You still see PSAs and DREs as the first line because they're easier for primary care providers to perform. ... Those are typically covered by insurance, so they still play that role in screening. But with the advent of MRIs and biomarkers, these have really helped refine that screening process and determine treatment options for our patients. Again, those patients who may be at a bit of a higher risk could go for an MRI or have biomarkers completed. Or if they're on that verge with their Gleason score, instead of doing a biopsy, they may send the patient for an MRI or do biomarkers for that patient. ... These updated technologies put [patients] a little bit more at ease that someone's watching what's going on, and they don't have to have anything invasive done to see where they're at with their staging." TS 4:35

"Disparities in screening access exist based on race, socioeconomic status, gender identity, education, and geography. It's really hard in rural areas to get primary care providers or urologists who can actually see these patients, [and] sometimes in urban areas. So socioeconomic status can affect that, but also where a person lives. African American men with lower incomes and people in rural areas face the greatest barriers to receiving screening. It's also important to encourage anyone with a prostate to be screened and offer gender-neutral settings for patients to feel comfortable." TS 7:50

"I think a lot of men feel like if they have no symptoms, they don't have prostate cancer ... so a lot of patients may put off screening because they feel fine, [they] haven't had any urinary symptoms, it doesn't run in their family. ...With prostate cancer, there usually are not symptoms that a patient's having—they may have some urinary issues or some pain—but it's not very frequent that they have that. So, just making sure our patients understand that even though they're not feeling something, it doesn't mean there's not something else going on there." TS 12:53

"Prostate cancer found at an early age can be very curable, so it's really important for men to have those conversations with their providers about the risk and benefits of screening. And anyone that we can help along the way to be able to have those conversations, I think is a great thing for oncology nurses to do." TS 15:44

Episode 378: Considerations for Adolescent and Young Adult Patients With Metastatic Breast Cancer

Season 1 · Episode 378

vendredi 29 août 2025 • Duration 36:49

"She's triple negative and has a very, very aggressive tumor. Instead of going on spring break that year, she sat in our chemo room and got chemo. Her friends from college are good to try to keep her involved and try to surround her and encourage her, but they're right now in very, very different spots in their lives. She's fighting for her life; her friends are fighting for the grade they get in a class—and that's different," ONS member Kristi Orbaugh, MSN, NP, AOCN®, AOCNP®, nurse practitioner at Community Hospital North Cancer Center in Indianapolis, IN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about metastatic breast cancer in adolescent and young adult patients.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

This podcast is sponsored by Lilly and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Episode Notes

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From This Episode

"When we use 'adolescent and young adult,' we're really talking about age 19–35. Some groups will say 15–39, but right around that age. When we think about that age, think about what all could be going on during those ages. Late teenagers, they may be going off to college, they may be graduating high school, trying to set up their own life, trying to become independent from mom and dad. If you're talking about early to mid 30s, you could be talking about young parents, young career folks. So, just setting that into place makes you realize this can be a very tumultuous time for folks." TS 2:06

"Unfortunately, this group tends to have more aggressive subtypes. We see more triple-negative in this group. We see more hormone-negative, HER2-positive in this group. Normal breast cancer cells should be stimulated by hormone. They are stimulated by hormones. So when you have a breast cancer cell that is not driven by hormones, it's much more difficult to treat. We tend to see more aggressiveness in these tumors. We also see a higher incidence in non-Caucasian folks in this age group compared to the older age groups." TS 4:53

"I think we have gotten much better about understanding the importance of fertility preservation and getting reproductive endocrinologists in, sooner rather than later. If we have earlier-stage cancers and we have patients that want to try to preserve eggs, preserve fertility, sperm banking. … If you have that time to talk to them—maybe a 21-year-old—the primary thing on her mind is not how many children she wants to have one day. Maybe she's not even thought about having kids yet. It's still a question you need to [ask]. Do you want to try to preserve fertility? Do you want to try to harvest some eggs? That's a conversation that needs to be had and is very, very important for that age group." TS 10:35

"One thing that helps is if you can get them [into] reputable support groups with people their own age that are going through what they're going through. Someone else that doesn't have hair, someone else that isn't going to make it to the big board meeting or isn't going to get the promotion this year because they've had to take a medical leave. Someone else that understands it differently." TS 16:47

"In breast cancer, many of those biomarkers just get reflexed. And what I mean by reflexed is a breast cancer pathology comes through, or a breast cancer specimen comes through, and it just automatically gets tested for X, Y, Z. HER2 and of course ER/PR. Now we understand that we don't just need to know whether they're HER2 positive or HER2 negative. We need to know: What is the IHC score? And even if the IHC score is zero, is there any membrane staining? And then we need to know what's their ESR1, their PTEN, their AKT, their PIK3CA. Those are so important to know." TS 18:11

"I think it's important to try to remember what our priorities were when we were in our 20s—what our priorities were when we were starting out as young mothers or starting out our career. Because that's where these folks are. … I can't imagine in the midst of college, when I'm trying to be independent, to suddenly have to be at home and rely on my mom to take me to my chemo appointment. … So I think one really important bias is to remember where they are in the developmental stages of life. They're not 40-something. They haven't lived X amount of life, and we need to take a step back and try to remember when we were their age, what was important to us? Where were our priorities at that point? And then hear them when they're telling us what's important to them." TS 29:22

"From a female standpoint … we frequently throw these patients into menopause or have early menopausal symptoms, and I think we forget how devastating that can be. … They now are at higher risk for osteopenia or osteoporosis. … And then we tell people, 'Be as normal as possible, get back and do those normal things.' Well, they're in a relationship, and they want to be intimate [but] suddenly having sexual intercourse is incredibly painful. Or if it's not painful, sometimes they've just lost pure interest in that. They don't feel confident about their body. All of those things need to be addressed because patients are trying to live each day as normally as possible." TS 31:55 

Episode 288: Pharmacology 101: Antimetabolites

Season 1 · Episode 288

vendredi 1 décembre 2023 • Duration 27:22

"I think that there are certain agents that are so foundational in some diseases that they will remain. Whether they remain first-line, maybe not; maybe they'll go to second line as we see things evolve with new agents. Some of these drugs have been very effective in the diseases in which they are used to treat patients. There's a long term place in therapy for these, and I think that will still be using these," Rowena Schwartz, PharmD, BCOP, FHOPA, known to many as "Moe," professor of pharmacy practice at James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about what oncology nurses need to know about antimetabolites. This episode is part of a series about drug classes, which we'll include a link to in the episode notes. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to antimetabolites. 

Episode Notes

  • ONS courses: 

  • Patient education guides created as a collaboration between ONS, HOPA, NCODA, and the Association of Community Cancer Centers: 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"Antimetabolites are relatively old agents. They are some of the oldest anti-cancer drugs that we have. They were developed to be similar to naturally occurring compounds that are important in cellular production. They are similar but not the same. So, they sometimes will bind to an enzyme important for cell proliferation. And because it binds to an enzyme, does it mean that it helps the enzyme? It may block it and that may cause cell death. And so, they've been used for a long time in oncology." TS 1:44 

"There's different classes of antimetabolites in oncology. If you think of the structure of DNA, there is purines, that's adenine and guanine, there are pyrimidines, which are things like cytosine and limonene, and then in RNA there's uracil. So, some of the antimetabolites are either purine analogues or pyrimidine analogues, meaning they look very much like the natural parts of DNA, and by being incorporated into the DNA they cause cell death. There's also a class of antimetabolites that interfere with how we use folate in the body, such as methotrexate is an obvious one, and these are called folate antagonists." TS 2:43 

"The purine analogs—and those are things like fludarabine or clofarabine—those drugs are very toxic to lymphocytes. And because they're very toxic to lymphocytes, these are drugs that we use in lymphocytic diseases. But that also means that these are drugs that we get immunosuppression because of the toxicity to lymphocytes. So, these patients have risk of infections because of their decreased lymphocyte activity after receiving these drugs." TS 6:37 

"Methotrexate works by blocking an enzyme that decreases the ability to make the folate that we need in our body to make cells. So, one of the things that we do when we use really high doses of methotrexate is we let it work for 24 hours and then we come in and we give leucovorin, which is the thing that we blocked. So, you're coming into rescue cells. And you're rescuing cells because the cancers we use high-dose methotrexate, we know that 24-hour exposure is going to be a really good effect on those cancer cells. So that's why we use leucovorin after methotrexate. We use it to minimize the toxicities that you would see with methotrexate. You decrease GI mucositis; you decrease the bone marrow suppression when you come in and adequately rescue with leucovorin." TS 12:22  

"I think [that's] one of the biggest challenges. I just had a situation that was an antimetabolites drug I'd never used before. I couldn't find in the literature and through resources I normally use, how to manage, so I actually reached out to colleagues to find out, who have used the medications to say, 'What's your experience? What's worked for you?' It's one of the reasons I really love ONS, because I think it gives a forum for people to ask those questions together." TS 15:23 

"I think developing good patient education tools that people can take home that highlight the most important things about the regimen, including the antimetabolite aspects, making sure patients know what to monitor for so that they can contact their team if they need them. Diarrhea is something I always talk about with patients getting 5-fluorouracil. I do it because otherwise people self-manage and don't actually know what to do, and we really want to make sure that they contact us if they're having problems with diarrhea." TS 17:14 

"I think one of the best things that people can do is work together in the development of the order sets, whether they be electronic or not. And, so, that within the order sets there is clear indications of those things that highlight to patients the strategies to take, to manage. I think that's really helpful, and I think it's best done by a team. And to modify those order sets as things are learned that are helpful so that, you know, the strategy is dose reduction that's clear that that's going to be the strategy. So, I think that in this day and age it's really important that there is collaboration in developing whatever resources that we have." TS 18:55 

"Because gemcitabine is such a good radio sensitizer, when we use it with radiation, we use a very small dose. Very small. We're not talking anything near what we use when we use it in combination chemotherapy. So, when you have a patient getting gemcitabine, if somebody decides that they're going to do radiation, you have to make sure everybody knows they're on gemcitabine because you may hold the drug while they're getting radiation because you don't want to increase in toxicity." TS 22:31 

"I think that there are so many new, exciting agents and there are so many older agents that are still used in practice, that it's becoming very difficult for people to understand the mechanisms of the drugs that we're using and the agent-specific toxicities. So, I think that the education that's needed is the foundation and fundamentals of chemotherapy, because they still are used so much in practice. And I would hate to lose the knowledge that practitioners have because we're excited about the new, exciting therapies that are new and exciting." TS 25:09 

Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care

Season 1 · Episode 287

vendredi 24 novembre 2023 • Duration 34:24

"I think the key in effective communication is building trust, because without trust, patients are not likely to engage in their care as effectively, which can influence patient well-being and their overall health outcomes. Building trust is, I think, crucial," Deb Christensen, MSN, APRN, AGCNS-BC, AOCNS®, founder and chief patient officer at the Cancer Help Desk, a nonprofit that provides personalized cancer treatment resources, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about strategies oncology nurses can use when approaching difficult conversations with patients across all populations.  

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to difficult conversations in cancer care. 

Episode Notes 

  • Clinical Journal of Oncology Nursing articles: 

  • ONS Resources: 

 To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"Patients tend to be less anxious when they have a trusting relationship with their providers, with their oncology team on a whole, and they tend to follow through better on their treatment plan because they trust what you're saying. It's not easy to establish a trusting relationship when you first meet someone. But what I found in my practice is that anticipating their needs and really listening to their story has made a world of difference in establishing that trusting relationship—and admitting if I don't know the answer to something or if perhaps I've gotten something wrong." TS 2:32 

"Intellectual empathy asks you to imagine yourself in that person's place. And we've all had challenging experiences; we just don't get through life without them. And as a result, we can generally think of a time when we might have been in a similar situation, maybe not exactly the same, but a similar situation, and garner that empathy for the patient and, importantly, for the caregiver, too. Because we genuinely, genuinely want to understand somebody. Intellectual empathy really comes from listening carefully to what's being said and what's not being said, analyzing different people's perspective, knowing your own bias, and asking open-ended questions." TS 4:41 

"I think that the first thing that an oncology nurse needs to do is recognize that patients have their own autonomy to make their own decisions and not go into a conversation expecting a specific outcome. So going in with the intention to do your best, but also be open to what the patient wants to do." TS 8:30 

"Our biggest foe in all of this communication, these communication strategies, really is time. We just do not have the amount of time. I mean, we love the luxury of time to be able to sit and really get into these kind of deeper conversations with people, but we may only have 30 minutes. We may only have 15. So, how do we do that? That is still a question that's out there that there's a lot of investigating. Are there techniques that can help? And there are." TS 13:47 

"All of these points in the continuum have one thing in common, and that's uncertainty. That's really a whirlpool—uncertainty—for people. One of the communication strategies that I've used with people is letting them know that this is a very common emotion to experience—a sense of loss of control, uncertainty—and that in my experience, that people generally, once they have a plan, the anxiety settles. So, giving them kind of a guidepost, hope in the future, that the anxiety will settle. Because I would say 98% of the time it does, once people gain a sense of control, because they have a plan of action to move forward." TS 16:10 

"The setting is really, really important, especially when you're having these challenging conversations. Always checking for understanding: What is that perception? What is the patient perceiving? What is the caregiver family perceiving? Are they understanding you correctly? And being respectful of what people want to know, because sometimes they don't want to know specific things." TS 21:57 

"Oncology nurses need to be aware of their own biases and their own emotional state when they're going into these emotional conversations, these difficult conversations they really need to be in. You might not always be the right one for the conversation. I think that's an important thing to note too, and be able to admit that you may have had a personal life experience that just is not going to allow you to get around a bias or an emotional reaction to the conversation, and so you might not be the right one." TS 23:11 

"I've always felt like if you can help someone find joy and peace in the moment, then that moment was made better. Life is a series of moments. That's kind of how I get through that piece of it." TS 26:20 

Episode 286: Pharmacology 101: Alkylating Agents

Season 1 · Episode 1

vendredi 17 novembre 2023 • Duration 34:52

"When I meet with patients, I try and remind them, 'Yes, you do have these side effects that can happen' and make sure that they're informed, but also try and reassure them that not everyone gets it as severe as maybe the movies and TV shows portray," Dane Fritzsche, PharmD, BCOP, informatics pharmacist from the Fred Hutchinson Cancer Center at the University of Washington Medicine in Seattle, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what oncology nurses need to know about alkylating agents for patients with cancer. This episode is the first in a series about drug classes, which we'll include a link to in the episode notes. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to alkylating agents.  

Episode Notes 

 To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"Alkylating agents are a very interesting class of chemotherapy agents, both mechanistically as well as historically. I remember back in pharmacy school learning this was actually the first class of medicines used to treat cancer, and it actually starts way back in World War I with the use of sulfur mustard gas, in kind of a military fashion, and then noticing some of the responses that soldiers as well as civilians who were actually exposed to that. They would develop things like bone marrow suppression, as well as other antitumor effects. Sadly, it's rough to see mustard gas as being the first agent to lead to something so remarkable, because it was a weapon of devastation, but it did lead to some breakthroughs." TS 1:43 

"The first thing that jumps to my mind when thinking about alkylating agents is their toxicities and then their supportive care agents that we use to make sure that we're treating our patients well and making their care optimum. So, when I, as an oncology pharmacist, would look at these orders, I immediately am jumping to, are we giving them appropriate antiemetics? Because a lot of these agents are highly emetogenic or moderately emetogenic by NCCN. A lot of them have other organ toxicities, like are really harsh on the kidneys. Are they getting their pre- and post-hydration? And then also many of these agents are very bone marrow suppressing, meaning they're targeting the red blood cells, they're hitting platelets, they're reducing our ANCs and making patients at higher risk for infection, you know, so do we need growth factor support here? Are the patients—their current labs—are they able to take another dose at this time or do we need to dose reduce or delay therapy because their platelets are just too low now?" TS 09:54 

"Honestly, it's probably one of the most important things is collaborating together to help provide optimal patient care. And to me, kind of the biggest thing that jumps out is just good communication between the various team members. I can't tell you how many times I would learn crucial information either from an infusion nurse chatting with the patient or walking down the hall or giving a call to one of our lovely clinical nurse coordinators here at Fred Hutch. You know, I always wanted to make sure that I go in and have the full picture of where the patient's at, what, if any, challenges there have been with this patient's particular case, just to make sure that I'm up to date about them and able to provide as good of care as I can." TS 14:55 

"Unfortunately, this class of drugs does come with kind of those generic chemotherapy side effects that we think of: hair loss, nausea and vomiting, and bone marrow suppression. That just comes as a function of how these work. These agents are not selective for just cancer. They're more selective for rapidly dividing cells. So, that leaves our normal cells that rapidly divide like our hair, our GI tract, our bone marrow, you know, to get hit by these." TS 17:50 

"The next thing I always drill my residents on, when I'm teaching them how to provide actionable and helpful information about their regimens that they're getting, is kind of like you're saying, outlining those expectations. How do you prevent these side effects? When do these side effects even start to show up? Like, am I going to immediately be nauseous right when the cisplatin gets turned on? Well, maybe, not super common, but it's more common that we'll see it in, you know, at the end, in the next couple of days and within the next 72 hours or going into the nuances between acute versus chronic nausea and things like that. So, it's really trying to empower the patients with information. How do they prevent this? What are we doing to help prevent it? And then when should they call us? When is the stuff that we're preventing didn't help? When should they call us to get more help?" TS 24:04 

"I think that's a misconception that we as healthcare professionals can really help alleviate with our patients, reminding them that, yes, they do carry risks, but we also have a lot of supportive care agents to kind of help minimize that toxicity. And then we have this whole team of professionals behind you to help carry you through the treatment." TS 29:34 
 

Episode 285: Transarterial Chemoembolization: The Oncology Nurse's Role

Season 1 · Episode 285

vendredi 10 novembre 2023 • Duration 36:41

"I think oftentimes people think this is just a radiology procedure that is rather benign. That's really the role of the oncology nurse, just to be [an educator], support, emotional support, and a coach," Lisa Parks, MS, APRN-CNP, ANP-BC, nurse practitioner in hepatobiliary surgery at The James Cancer Hospital and Solove Research Institute at The Ohio State University Comprehensive Cancer Center in Columbus, Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what oncology nurses should know about transarterial chemoembolization administration and their role surrounding that procedure. This episode is part of a series about non-IV chemotherapy administration; the others are linked below. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to transarterial chemoembolization.  

Episode Notes 

  • The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.

  • Oncology Nursing Podcast episodes about non-IV chemotherapy administration: 

  • Oncology Nursing Forum articles: 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"So, TACE was commonly used to treat liver metastatic cancers, primarily metastatic colon cancer, until research showed that some of these cancers were not responding to TACE. Therefore, it is no longer really used in metastatic colon cancer. TACE is used in hepatocellular cancer. It also was used more than 10 years ago to treat metastatic neuroendocrine cancers. But recent research has showed that neuroendocrine cancers respond to this embolization without the use of chemotherapy. By eliminating chemotherapy, we also eliminate the potential for side effects." TS 3:29 

"TACE, or TAE, is usually completed more than once in the course of a patient's treatment. Depending on the tumor burden of the liver, the procedure can be segmentally completed on a liver lobe, or you can do the procedure on the right lobe and then follow-up treatment in about six weeks in the left lobe." TS 5:45 

"This is something that isn't even really taught in medical school. So it's really important to understand that even though this is a postprocedural side effect, there are certain things that you have to be aware of. So, the most common side effect that you will see is right upper-quadrant pain, and this is very common. And if the left side of the liver has received the therapy, this pain can radiate to the epigastric area and the patient will describe it as chest pain. And when you have the patient point to that area where he's having pain, it's often epigastric and it's just a referred pain, it's not cardiac pain, typically. You can get a EKG and troponin, but those are almost always negative and it's just really part of this embolization syndrome." TS 14:30 

"As far as what the oncology nurse needs to really be aware of pre-TACE or pre-TAE, I just want to emphasize the importance of patient education. The patient and their family need to understand again, it's not a surgery, it's a radiology procedure, and that the patient is going to have abdominal pain and nausea and vomiting that will last for several weeks and that is why they are not kept in the hospital for three weeks until these symptoms dissipate. Oftentimes these symptoms will be present until they get reimaged at the medical oncologist and then it's time for them to come back and maybe get another phase of their procedure that they are supposed to have as part of their treatment plan." TS 17:44 

"I do want to let you know, though, that patients that have a significant spike of their transaminases over 1,000, those patients are of great concern of going into liver failure. So, the nurses need to let the patient know that they will be monitored and kept in the hospital until we start to see a downtrend in those transaminases before they will be discharged." TS 19:48 

"As an oncology nurse and medical oncology, [it's] education, education, education. Also being able to triage these patients on the phone, talking them through how to keep themselves hydrated. . . . So I just think it's really a coaching job of the oncology nurse. A lot of reassurance, a lot of suggestions on how to get through this very uncomfortable difficult procedure." TS 21:16 

"I want it to be clear that if you're doing local regional therapy, TACE or TAE, this is considered a palliative procedure. You are not going to get a cure with this treatment. In this situation, neuroendocrine carcinoma, it's already metastatic if you're treating the liver. And with hepatocellular, again, it's still palliative because you're not doing a surgical resection on this patient. And every TACE experience for every patient, I've had patients that've and I've had six of these procedures, every experience they get is different." TS 28:11 

"When the patient comes back to our floor after having the treatment, it's just very important for those nurses to know the 'abnormal normal,' to know that some of the things that they're seeing, the hypertension, the severe pain, the severe nausea, is actually normal and the provider will work with them to try to come up with a regimen that will make the patient as comfortable as possible." TS 33:22

Episode 284: How AI Is Influencing Cancer Care and Oncology Nursing

Season 1 · Episode 284

vendredi 3 novembre 2023 • Duration 40:31

"We incorporate nurses and clinicians and users for any tool from the very beginning. They say, 'You know, we need help with this.' And then we start ideation: We start understanding the problem, we meet with them, we try to see what is it that they're trying to do, is it feasible given the data we have? We go back, we do some research, feasibility study. We say we think this is something we can predict with decent performance. Now let's do it," Nasim Eftekhari, MS, executive director of applied artificial intelligence (AI) and data science at the City of Hope National Medical Center in Duarte, CA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about how the use of AI in cancer care affects an oncology nurse's daily work. 

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The advertising messages in this episode are brought to you by LUNGevity. 

Episode Notes 

  • This episode is not eligible for NCPD.

  • Oncology Nursing Podcast: 

  • ONS Voice articles: 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"So, there is a lot of applications of AI in cancer care, so I can't possibly give you an exhaustive list. But the ones that come to my mind, at least the ones that we are actively working on are early detection and diagnosis, treatment planning, predictive modeling for predicting unwanted outcomes, remote monitoring, radiology applications, pathology applications, improving operations and helping the resource allocation, precision medicine, and research. And we also started a year or so incorporating AI and helping with drug discovery." TS 2:13 

"We've been using AI for a very, very long time. Recently, we just hear more about AI, but AI is in our lives, in health care or not, all day, every day. Google Maps, Google search, all of this is enabled by AI, but we may not realize even that we're using it." TS 8:27 

"So, for technical challenges, you have to always consider: Is this model performing in a decent manner for this application? And depending on the use case, that's different. If you're providing a decision support to someone that is impacting patient care, then you have to be very careful about model performance. So, model performance is one technical consideration, then how do you really technically integrate with the EMR system? It's not easy, EMR systems are not usually very open, and that's a whole challenge in itself to be able to read from any EMR system in real time and feed data back into it in real time." TS 10:16 

"For nurses to successfully approach and adopt this work, I think the most important thing is to keep an open mind to really realize that these technologies can, at best, take the mundane part of their work away so they can operate at the top of their license, but what AI does best is to do things that are repetitive and doesn't require a ton of human intelligence. I think that would be very helpful. Just that mindset could make things more collaborative and cooperative, and that's the only way that we can make these successful." TS 12:37 

"What could help is for nurses to learn the basic concepts that are involved in the development and deployment and testing of these models, so that they can really understand the limitations and capabilities and they can take an active part in the development as well. So, it's not like we build something for you and then we're trying to convince you this is good for you. We try to build together. As an AI and computer scientist, I'm always learning the medical language. I try to educate myself about the clinicians' workflows and language, and I think the same needs to happen on the clinician side for us to be able to build tools that really work in their workflows for their everyday life." TS 13:58 

"We incorporate nurses and clinicians and users for any tool that will be developed from the very beginning. So, usually, the need for something, like a predictive model, comes from nurses and doctors. They say, 'You know, we need help with this.' And then we start ideation: We start understanding the problem, we meet with them, we try to see what is it that they're trying to do, and is it feasible given the data we have? We go back, we do some research, feasibility study. We come back and say we think this is something we can predict, you know, with decent performance. Now let's do it." TS 14:30 

"All of our models, even the ones that have been in production for the longest, we're still getting feedback, we're still improving, and we're still retraining models, not only with new data that becomes available but also with the feedback that we get from our users." TS 17:43 

"For example, after going live, we've had less ICU admissions because of sepsis or septic shock, or after going live had less sepsis mortality, which is very reassuring. So that seems like we're doing the right thing, and our model is working, but if you want to put your scientist hat on, you cannot say 100% this is the impact of the model because there is a lot of different workstreams that are trying to improve those same metrics. And unless you do a clinical trial or what we call in industry A/B testing, where you control for everything else and it's only the model intervention that is the variable, you cannot say for 100% that this is the impact of the model. That's why we combine our qualitative metrics that seem to be right in the right direction with the quantitative metrics." TS 22:17 

"I think for the first time, something has come up that can really make a big change in health care. I could not say this before generative AI. AI has always been helpful, but now I think it's the time to see real change. We're still experimenting. It's really new technology. We are experimenting with in-house development as well as third-party tools that we are testing and evaluating. Again, there's a huge potential in reducing manual labor and documentation, note taking, there are implications in billing and finance, data abstraction for research or whatever other purposes that we need them, tumor boards, predictive modeling, clinical trial matching is one big use case in oncology, and finding similar patients—something that we've been aspiring to for a really long time—seems to be very possible now with these technologies." TS 25:30 

"The users also weigh in. So, if you're considering it to improve clinical operations, the people who will be using the tool will have a say in, 'Yes, we think this tool will be helpful.' So, it's not just looking at the technical and cybersecurity and ethical and legal aspects, but also is this something that our users will use because that's the ultimate goal. If they don't use it, it doesn't matter how good the tool is. It won't work." TS 31:13 

"Making it successful is not about the technology, but mostly about people and processes and operational support." TS 33:33 

"Helping people, helping clinicians, nurses to be more free of mundane tasks and be able to interact with patients, do patient care, which is what they should be doing, rather than the things that I know a lot of nurses hate. I think we have a very exciting time ahead of us." TS 38:47 

Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction

Season 1 · Episode 283

vendredi 27 octobre 2023 • Duration 38:48

"Having a nurse-driven protocol, at my facility we call them clinical practice guidelines, allows for that immediate action and swift intervention for the patient," Maura Price, MSN, RN, AOCNS®, oncology clinical nurse specialist at the Lehigh Valley Topper Cancer Institute in Bethlehem, PA, told Jaime Weimer, manager of oncology nursing practice at ONS, during a discussion about what oncology nurses should know about desensitization strategies. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. 

Learning outcome: The learner will report an increase in knowledge related to desensitization strategies after an infusion-related reaction.  

Episode Notes 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"An allergic reaction is kind of a more general term that's used when someone has an allergy, whether that be to a medication, an environmental allergy. But an allergic reaction can really range in symptoms, anywhere from mild to severe. So, if a patient tells me 'I'm allergic to amoxicillin' or 'I had an allergic reaction, when I take this drug,' definitely ask them to elaborate." TS 4:40 

"Your assessment in grading is really going to be based on the symptoms that the patient is experiencing during the reaction. So, just personally knowing the CTCAE grading so well, this really helps us to identify those next steps for the patient. So, if the reaction was mild and more of a grade one or two, then we can consider rechallenging the patient after additional meds we're always giving and intervening at that point. So, the patient may already have taken premeds prior to starting the infusion. And then we're giving rescue meds to help them through this reaction. So we could potentially rechallenge at that point and either continue them but at the same rate that we were using it at or, per the prescribing information, maybe slow the rate down." TS 13:58 

"I always like to use the example of a GYN-onc patient that's receiving either typically taxol carbo for either their diagnosis of ovarian cancer or endometrial cancer. So that taxane-platinum doublet is really the gold standard for these patients. We know that that is standard of care for them to receive that doublet chemotherapy. So, if the patient has a reaction to the carboplatin but is willing to continue receiving the drug if they pursue that desensitization, they're still getting that gold-standard treatment. So alternatively, completely fine for the patient if they would not like to pursue that and they tell you 'I'm scared' or for whatever reason they don't, that's why it's just very important to have these conversations up front and educate the patients on the risk versus benefits of all of their treatment options." TS 16:13 

"A great example that I typically use is that patient again with ovarian cancer that had six cycles of taxol carbo. Maybe they then went on to maintenance PARP inhibitor and then several months or years later, they unfortunately have recurrence. That, like you said, it kind of looking back at their treatment history to say, 'Oh my goodness, this patient already had six doses of the taxol carbo.' So even though it looks like it's fresh taxol carbo—maybe in the treatment plan—they've already been sensitized to that, so as you said, making sure that you're looking back and you know their treatment history." TS 24:54 

"Just remembering that with a desens, this is never a permanent tolerance; it's only temporary. So, making sure that we are closely observing the patient, getting their vital signs, educating them, making sure that they know, 'Hey, you've reacted to this drug previously. We of course want to keep you on this drug. That's why we're going this route with desensitization. So, if you are feeling anything out of the ordinary, you want to let us know right away." Making sure that we have our emergency equipment and medications available and right at the bedside or chair side, making sure that there's no contraindications for the desensitization." TS 27:35 

"I think explaining the rationale behind the desensitization and why we're doing it is really key, explaining to them we want to keep you on this drug that you're currently getting, explaining that whole process. None of us like to go into anything without knowing a plan, so it's even just as simple as giving the patient the plan and explaining the process." TS 30:59 

"I'd say the most common misconception that I hear, or get the question about, is this is once and done. So, definitely not the case, it's not once and done. When we do desensitize, just keeping in mind that is a temporary tolerance to the drug. So every time that the patient is going to receive this drug in the future, that is going to require the desensitization. So definitely get that question from nurses that are unfamiliar with it and then also patients thinking like, 'Oh, I'll be good after I get this one time over a long day, then I'll be okay,' but just reiterating, this is for every single subsequent administration with this medication." TS 33:55 

"It's very scary for patients, and as we said earlier, if they have a friend or a family member with them, it's really a scary time for them. So, reassuring all of them, everyone that's there that day, definitely encouraging them. Another thing that I think gets forgotten is just the financial implications of it. So, if we have a younger patient or even a middle-aged patient that's still working full-time, this is not a short infusion that they were used to prior before they had the reaction. This is a long day. So if they are working full-time, making sure that they understand, 'You are going to need to miss a day of work each time that you get this going forward.' So, I would say some of those psychosocial things are things that are not often discussed, but definitely important to have that conversation with your patient." TS 34:40 

Episode 282: Telehealth-Based Oncology Palliative Care

Season 1 · Episode 282

vendredi 20 octobre 2023 • Duration 33:37

"We really need to do our best to reach people who don't have access to palliative care in their communities, and this is an innovative way for us to do that," Carey Ramirez, ANP-C, ACHPN, nurse practitioner and manager of advanced practice and supportive care medicine at the City of Hope National Medical Center in Duarte, CA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about how telehealth is overcoming barriers and disparities that previously limited patients' access to timely oncology palliative care. 

You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.  

Music Credit: "Fireflies and Stardust" by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: The learner will report an increase in knowledge related to telehealth-based oncology palliative care. 

Episode Notes 

  • Oncology Nursing Podcast: 

  • ONS Voice articles: 

  • Clinical Journal of Oncology Nursing articles: 

 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Highlights From Today's Episode 

"If a person is uncertain of their prognosis or if a provider is uncertain of the goals that the patient has for themselves, that might be an appropriate time to consider palliative consultation. These are all important considerations for triggers that might make palliative a possibility for patients in those scenarios. The take-home message, though, is that the sooner that palliative care is involved, the more likely the patient and family are to benefit." TS 2:51 

"From a patient and family perspective, we frequently find that there are misperceptions regarding palliative care. Oftentimes, they'll conflate the word palliative with either hospice or end-of-life care. They unfortunately sometimes believe that they're one and the same. They demonstrate a lack of knowledge regarding the benefits, including the fact that palliative care can and should be provided alongside life-prolonging care." TS 3:53 

"Palliative providers do their best to help patients maintain hope throughout their disease trajectory, regardless of how well or how poorly things are going. I tend to view things in terms of climbing a sand dune: Living with cancer can sometimes feel like you're walking up a sand dune, either at the beach or at the desert, and there will be days where you take two steps forward and you might slide only one step back. There may also be days where you take two steps forward and slide three steps back. And you find, for example, that if you keep trudging toward the top, that because the winds are constantly blowing those dunes, the top you eventually reach might be different than the one you initially set out to reach. And I think that speaks to the changing nature of hope." TS 6:08 

"It's important to ensure that providers are aware of the local services available to them in their respective communities. [And] we often find that from an organizational or a structural barrier perspective, there are lack of access to palliative care in the community. We often find that outpatient programs may not be as robust, or you may find that there is great variation between outpatient programs with regard to quality." TS 10:10 

"We have multiple patient populations who unfortunately do not have equal access to palliative care. They include rural populations, those who come from low socioeconomic backgrounds. We find that male patients and/or patients who are older adults have lower access to palliative care. We find that those who might be either single or live alone, those who might have an immigrant status, those who don't speak English, those who might have certain cancer diagnoses. It may surprise some of you to know that those with hematologic malignancies actually have much lower rates of palliative referral than those with solid tumors." TS 11:23 

"There's a maldistribution of palliative care resources nationwide. We tend to see that many of the resources are in urban areas, and as a result, we find that a great many rural areas are left untouched. I think it's important for us to recognize that these social determinants of health exist. It's important for us to look intentionally at them and whether they affect some of our patient populations and to work together to overcome them." TS 14:03 

"Anecdotally, I've been doing telehealth for about five years and it's been quite well received. It decreases my no-show rates. It improves my ability to monitor patients over time, and it can be carried out safely." TS 16:12 

"It's important to recognize that telehealth can be utilized not only for a planned appointment that might be scheduled to surveil someone every two weeks or every month from a pain and symptom management perspective, it can also be utilized as a same-day possibility. So if, for example, we have a patient who's due to have an MRI tomorrow and their last MRI was stopped in part because they couldn't tolerate it due to pain or symptoms, we might have a primary team reach out to us and ask whether we can see that patient the day prior to their MRI and devise a plan with that patient so that they can tolerate the MRI more easily the next day." TS 22:26 

"Many of our patients no longer have the ability to get to and from their place of worship, and we can sometimes bring their clergy people to them via telehealth video. We also offer psychology services, psychiatry services, child life services, all via telehealth. And I think it's important to recognize that palliative care is actually made up of an interdisciplinary team, including all of the aforementioned specialists who can basically work together to improve the experience of the patient who is living with cancer and being treated for it." TS 26:41 

"Accept the inevitability of ups and downs. Learn from the downs and persevere. The outcomes are definitely worth it." TS 28:11 

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