The ONS Podcast

"The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we're trying to set up, is a way to make what is currently an invisible risk, visible," ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public health director of the division of occupational and environmental medicine at the University of Maryland School of Medicine in Baltimore, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 23, 2027. 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 in the incidence of hazardous drug exposure and the tracking and reporting of healthcare worker exposures. Episode Notes  Complete this evaluation for free NCPD. University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry information sheet ONS Podcast™ episodes: Episode 330: Stay Up to Date on Safe Handling of Hazardous Drugs Episode 308: Hazardous Drugs and Hazardous Waste: Personal, Patient, and Environmental Safety Episode 209: Updates in Chemo PPE and Safe Handling ONS Voice articles: Hazardous Drug Surface Contamination Prevails, Despite More Diligent PPE National Hazardous Drug Exposure Registry Safeguards Oncology Professionals NIOSH Releases Its 2024 List of Hazardous Drugs Safe Handling—We've Come a Long Way, Baby! Strategies to Promote Safe Medication Administration Practices Surfaces in Patient Bathrooms Often Contaminated With HDs, Despite Use of Plastic-Backed Pads ONS books: Safe Handling of Hazardous Drugs (fourth edition) Safe Handling of Hazardous Drugs Quick Guide™ ONS course: Safe Handling Basics Clinical Journal of Oncology Nursing articles: Hazardous Drug Exposure: Case Report Analysis From a Prospective, Multisite Study of Oncology Nurses' Exposure in Ambulatory Settings Personal Protective Equipment Use and Surface Contamination With Antineoplastic Drugs: The Impact of the COVID-19 Pandemic Sequential Wipe Testing for Hazardous Drugs: A Quality Improvement Project The Use of Plastic-Backed Pads to Reduce Hazardous Drug Contamination Oncology Nursing Forum articles: Ensuring Healthcare Worker Safety When Handling Hazardous Drugs Factors Influencing Nurses' Use of Hazardous Drug Safe Handling Precautions Other ONS resources: ONS Safe Handling of Hazardous Drugs Quick Guide Introduction to Safe Handling Huddle Card Safe Handling of Hazardous Drugs Learning Library Hematology/Oncology Pharmacy Association (HOPA) course: Safe Handling of Hazardous Drugs National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs in Healthcare Settings, 2024 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 "We thought that in order to answer some of the unclear questions about health risk, we would set up an exposure registry, in this case, for oncology personnel who handle the drugs. This would then create a cohort that we could ask questions to. For example, we could try to characterize whether there is a cancer excess in this group. Or characterize the reproductive abnormalities in excess that people are experiencing." TS 6:21 "It's sort of counterintuitive that the healthcare industry, whose mission itself is care of the sick, is a high-hazard industry. We typically think about the risk as being from infectious diseases, and certainly we've all lived in our practice lifetime through some examples of that. Even before COVID-19, some of us were doing preparation for Ebola and that sort of thing. So, we're kind of used to that. But the hazards that you kind of grew up with, we've routinized or normalized handling group one, human carcinogens, which a number of these drugs are—it's just something we do every day. Well, it is, but we have to do it with respect and with care every day. And I think sometimes in that routineness of it, we have sort of lost sight of the vigilance that we need to maintain." TS 11:19 "It's very easy in the life cycle of a drug in an organization to do something that doesn't just impact you, but unknowingly, you've contaminated a surface for somebody who comes behind you. Who maybe doesn't have plastic protective equipment on because something that got contaminated shouldn't have been contaminated in the first place. If we could all be thinking of it as more of a team sport, especially in terms of safe handling, that our disposition and drug handling affects not just us and our health, but those of our colleagues." TS 24:47 "For the job history pieces, we ask what year you started, what year you stopped, and we ask about estimations of handling. So we'll be able to come up with either a duration or some kind of metric for the intensity and duration of your handling history, which will then permit us to sort the population who completed the survey into sort of low, medium, high. And we'll see whether the health outcomes that are being reported are influenced by that drug handling history." TS 27:45 "The idea that we aren't exposed to the same therapeutic dose we give to our patients is absolutely true. However, the dosing schedule to them versus us is very different, and we are exposed frequently, if not daily, to very small concentrations. They don't reach a cytotoxic dose necessarily, but we do know from a lot of studies that either ourselves or our colleagues are taking up drug from contaminated work environments. And you've probably seen there is an awful lot of intermediate evidence looking at genotoxic insult in pharmacists and nurses who handle the drugs. So clearly we're showing uptake and we're showing that there are biologically plausible, concerning measures that are taking place in us. So, I think that we need to come back and circle around the idea that we need to have deep respect for the toxicity of these agents." TS 35:03

"[Multiple myeloma] is very treatable, very manageable, but right now it is still considered an incurable disease. So, patients are on this journey with myeloma for the long term. It's very important for us to realize that during their journey, we will see them repeatedly. They are going to be part of our work family. They will be with us for a while. I think it's our job to be their advocate. To be really focused on not just the disease, but periodically assessing that financial burden and psychosocial aspect," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 16, 2027. 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 the pathophysiology and diagnosis of multiple myeloma. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 332: Best Nursing Practices for Pain Management in Patients With Cancer Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 192: Oncologic Emergencies 101: Hypercalcemia of Malignancy ONS Voice articles: AI Multiple Myeloma Model Predicts Individual Risk, Outcomes, and Genomic Implications Cancer Mortality Declines Among Black Patients but Remains Disproportionately High Financial Navigation During Hematologic Cancer Saves Patients and Caregivers $2,500 Multiple Myeloma: Detecting Genetic Changes Through Bone Marrow Biopsy and the Influence on Care Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations Nurse-Led Bone Marrow Biopsy Clinics Truncate Time for Testing, Treatment Diagnose and Treat Hypercalcemia of Malignancy ONS books: BMTCN® Certification Review Manual (second edition) Multiple Myeloma: A Textbook for Nurses (third edition) Clinical Journal of Oncology Nursing articles: African American Patients With Multiple Myeloma: Optimizing Care to Decrease Racial Disparities Music Intervention: Nonpharmacologic Method to Reduce Pain and Anxiety in Adult Patients Undergoing Bone Marrow Procedures Other ONS resources: Financial Toxicity Huddle Card Hypercalcemia of Malignancy Huddle Card Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library American Cancer Society article: What Is Multiple Myeloma? Blood Cancer United educational resources page International Myeloma Foundation homepage Myeloma University homepage Multiple Myeloma Research Foundation (MMRF) article: Understanding Multiple Myeloma 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 "Epidemiologically, myeloma is a cancer of older adults. The median age is about 69. It is more common in men than women. It's a ratio of about three men to two women that are diagnosed. It is much more common in people of African American descent with increasing global incidence linked to aging populations. Although, the highest rates are in high-income countries. So, if we look at some of the risk factors, and several have been identified, including MGUS. MGUS is a benign precursor of myeloma, and it stands for monoclonal gammopathy of undetermined significance. Older age is also a risk factor, although we do see patients that are younger who are diagnosed with myeloma." TS 1:54 "Bone pain, specifically in the back, and fatigue, are very common symptoms that relate to things that are going on behind the scenes with myeloma. But also, patients can be bothered by frequent and long-lasting infections. So, they find that they get sick more frequently than their family and friends, and they take a longer time to recover. That could also be a presenting sign. I think there can be some presenting signs and symptoms related to electrolyte abnormalities, especially in later stages. They might be nauseated, vomiting, or constipated. Also, signs and symptoms related to cytopenias. You have to remember that this is a bone marrow cancer. So, we do have some problem with development of normal blood cells. So, we can see not only infections, but bleeding issues related to thrombocytopenia and factors related to anemia from low red blood cell counts." TS 7:15 "About 20%–25% of our patients who are diagnosed are asymptomatic. They have no symptoms. They're living their lives, they're going to work or they're traveling, playing golf on the weekends, taking care of their children or grandchildren. They are just living their lives. And at times, they go to the primary care physician and then they're referred to a hematologist-oncologist, and they're pretty surprised when they're sent to a cancer center. The way they are diagnosed in this matter is that their routine lab work, the complete blood cell count may be normal, there may be some slight differences in their hemoglobin. But what we see in the chemistry, the complete metabolic panel, is an elevation in their total protein and or an elevation of the total globulins." TS 9:22 "The bone marrow biopsy serves many purposes. You want to determine the percentage of bone marrow plasma cells. So, you want to get the degree of plasmacytosis. And then you want to do really specific tests on those plasma cells. So, you want to isolate the malignant plasma cells and determine, via analysis. So, we do the karyotype, chromosomal studies, fluorescence in situ hybridization (FISH) studies, immunohistochemistry studies, and molecular studies. All of these studies are looking for specific genetic changes in the myeloma cells—looking for translocations or deletions. And it's very important to get that information because we can put patients in a category of having standard-risk disease versus high-risk disease. And that can give us a better picture of what this patient's journey with myeloma may look like." TS 13:41 "When I used to work in lymphoma, I spoke with the physicians who were lymphoma specialists, and they said that they foresee a future in having these assays that detect circulating tumor cells actually take the place of imaging studies like restaging positron-emission tomography (PET), computed tomography (CT) scans. So, it's really amazing, these tests that are on the market now and maybe not as widespread as we'd like, but there's a lot of nice assays out there that will become more popular and used more commonplace in the future that I think are going to help identify myeloma more precisely. ... If you think about myeloma, even with measurable residual disease (MRD), MRD for leukemia, for lymphoma, you take a blood sample, you test it for MRD. For myeloma, you need a bone marrow biopsy. You need a bone marrow sample. You can't do MRD on a blood sample for myeloma. Not yet. But if we perfect these assays and we can eventually detect this, then you're looking at a whole new ballgame. You can even perfect your MRD testing as well. So, it's a very exciting time for some of these heme malignancies." TS 28:09

"Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it's really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the 'so what': We are the first line of defense," ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer Institute in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ototoxicity in cancer care. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 9, 2027. 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 the management of ototoxicity after chemotherapy treatment. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ Cancer Symptom Management Basics series ONS Voice articles: Oncology Drug Reference Sheet: Cisplatin Oncology Drug Reference Sheet: Carboplatin Oncology Drug Reference Sheet: Oxaliplatin FDA Approves Sodium Thiosulfate for Cisplatin-Associated Ototoxicity in Pediatric Patients ONS book: Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition) American Cancer Society resources: 4 Causes of Hearing Problems for Cancer Survivors Cancer Survivors Network American Speech-Language-Hearing Association (ASHA) Hearing Loss: An Under-Recognized Side Effect of Cancer Treatment Embedded Ear Care: Audiology on the Cancer Treatment Team American Society of Clinical Oncology (ASCO) Annual Meeting abstract: Innovative Infusion Center Assessments of Chemotherapy-Induced Neurotoxicities: A Pilot Study Supporting Early and Routine Screenings as Part of Survivorship Programs Children's Oncology Group supportive care endorsed guideline: Prevention of Cisplatin-Induced Ototoxicity in Children and Adolescents With Cancer: A Clinical Practice Guideline Ear and Hearing article: Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment International Ototoxicity Management Group (IOMG) IOMG Wikiversity page Shoebox hearing assessments World Health Organization initiative: Make Listening Safe 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 "At different pitches, the eardrums move faster or slower, signaling the inner ear, or the cochlea—the thing that looks like a snail in the pictures. The cochlea has fluid and hair cells inside of it that receive movements from the eardrum. The hair cells change the movement into electrical signals that actually go to the auditory nerves or the cranial nerve VIII." TS 2:15 "Ototoxicity is an umbrella term for some sort of exposure to a toxin that causes damage to the inner ear. These toxins can be in the environment, such as loud or different noises, or they can be from medications, including antibiotics or commonly cancer treatments, such as radiation chemotherapy. Some common chemotherapies can be platinum-based chemotherapies like cisplatin or carboplatin. And then what patients are experiencing if they have ototoxicity can be hearing loss." TS 3:15 "The hypothesized mechanism of action is that the chemicals like the platinum compound in cisplatin … that platinum compound travels through our bloodstream. Since chemotherapy is systemic, it'll go to the inner ear, and it gets stuck there by binding to the cellular DNA in that cochlea, or that snail-looking image. That initiates the release of the reactive oxygen species, which are really trying to help clean it out, but releases such high levels that it ends up causing damage to those inner ear hairs. These inner ear hairs cannot regenerate themselves, so then they're permanently damaged. And remember we said that those hairs send electrical signals to the brain that recognize sound. So that function is permanently gone once those hair cells are damaged." TS 7:10 "I definitely think this is a huge interdisciplinary collaborative effort. As nurses and advanced providers, we're assessing and providing education. Our medical oncologists are doing those dose modifications and submitting those audiology referrals. The radiation oncologists are very important to know about this—maybe dose localization awareness. Maybe they do some changes with the doses. And then our audiologists and [ear, nose, and throat physicians], they can do that diagnostic confirmation and any rehabilitation measurements and really monitor them throughout their journey as well. And nurse navigators play a huge part in making sure those patients get those referrals, because a lot of the time the audiologists aren't in the cancer clinic, so they may have to go to another location or may need help coordinating with all their appointments that they have." TS 22:28 "We had a really innovative way of monitoring the hearing that a couple other studies have also tested. It's a remote point-of-care hearing screen. It was on [a tablet] with calibrated headphones. And then it's a paid-for subscription to an audiology testing platform. … Myself, along with a couple of other nurses, were trained how to use this testing device with the tablet and the headphones and the software program. And it was a quick down-and-dirty portable hearing assessment for patients. So anyone who was new to cisplatin, never gotten cisplatin treatment before, was enrolled into the study, and they received a hearing test every time that they came for chemo, and we gave it to them during their hydration." TS 28:59  

"We proposed a concept to the American Society of Clinical Oncology (ASCO), recognizing that extravasation management requires significant interdisciplinary collaboration and rapid action. There can occasionally be uncertainty or lack of clear guidance when an extravasation event occurs, and our objective was to look at this evidence with the expert panel to create a resource to support oncology teams overall. We hope that the guideline can help mitigate harm and improve patient outcomes," Caroline Clark, MSN, APRN, AGCNS-BC, OCN®, EBP-C, director of guidelines and quality at ONS, told Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS®, VA-BC, oncology clinical specialist at ONS, during a conversation about the ONS/ASCO Guideline on the Management of Antineoplastic Extravasation. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 2, 2027. 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 the management of antineoplastic extravasation. Episode Notes  Complete this evaluation for free NCPD. ONS/ASCO Guideline on the Management of Antineoplastic Extravasation ONS Podcast™ episodes: Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 335: Ultrasound-Guided IV Placement in the Oncology Setting Episode 145: Administer Taxane Chemotherapies With Confidence Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments ONS Voice articles: Access Devices and Central Lines: New Evidence and Innovations Are Changing Practice, but Individual Patient Needs Always Come First New Extravasation Guidelines Provide Recommendations for Protecting Patients and Standardizing Care Standardizing Venous Access Assessment and Validating Safe Chemo Administration Drastically Lowers Rates of Adverse Venous Events This Organization's Program Trains Non-Oncology Nurses to Deliver Antineoplastic Agents Safely ONS books: Access Device Guidelines: Recommendations for Nursing Practice and Education (fourth edition) Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition) ONS courses: Complications of Vascular Access Devices (VAD) and IV Therapy ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS Oncology Treatment Modalities Clinical Journal of Oncology Nursing articles: Chemotherapy Extravasation: Incidence of and Factors Associated With Events in a Community Cancer Center Standardized Venous Access Assessment and Safe Chemotherapy Administration to Reduce Adverse Venous Events Oncology Nursing Forum article: Management of Extravasation of Antineoplastic Agents in Patients Undergoing Treatment for Cancer: A Systematic Review ONS huddle cards: Antineoplastic Administration Chemotherapy Immunotherapy Implanted Venous Port ONS position statements: Administration (Infusion and Injection) of Antineoplastic Therapies in the Home Education of the Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies ONS Guidelines™ for Extravasation Management ONS Oncologic Emergencies Learning Library ONS/ASCO Algorithm on the Management of Antineoplastic Extravasation of Vesicant or Irritant With Vesicant Properties in Adults American Society of Clinical Oncology (ASCO) Podcast: Management of Antineoplastic Extravasation: ONS-ASCO Guideline 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 focus of this guideline was specifically on intravenous antineoplastic extravasation or when a vesicant or an irritant with vesicant properties leaks out of the vascular space. This can cause an injury to the patient that's influenced by several factors including the specific drug that was involved in the extravasation, whether it was DNA binding, how much extravasated, the affected area, and individual patient characteristics." TS 1:48 "The panel identified and ranked outcomes that mattered most with extravasation. Not surprising, one of the first was tissue necrosis. Like, 'How are we going to prevent tissue necrosis and preserve tissue?' The next were pain, quality of life, delays in cancer treatment: How is an extravasation going to delay cancer treatment that's vital to the patient? Is an extravasation also going to result in hospitalization or additional surgical interventions that would be burdensome to the patient? ... We had a systematic review team that then went in and summarized the data, and the panel applied the grading of recommendations, assessment, development, and evaluation (GRADE) criteria, grading quality of evidence and weighing factors like patient preferences, cost, and feasibility of an intervention. From there, they developed their recommendations." TS 7:35 "The panel, from the onset, wanted to make sure we had something visual for our readers to reference. They combined evidence from the systematic review, other scholarly sources, and their real-world clinical experience to make this one-page supplementary algorithm. They wanted it to be comprehensive and easy to follow, and they included not only those acute management steps but also guidance on 'How do I document this and what are the objective and subjective assessment factors to look at? What am I going to tell the patient?' In practice, for use of that, I would compare it to your current processes and identify any gaps to inform policies in your individual organizations." TS 16:34 "The guidelines don't take place of clinician expertise; they're not intended to cover every situation, but a situation that keeps coming up that we should talk about as a limitation, is we're seeing these case reports of tissue injury with antibody–drug conjugate extravasation. There's still not enough evidence to inform care around the use of antidotes with those agents, so this still needs to be addressed on a case-by-case basis. We still need publication of those case studies, what was done, and outcomes to help inform direction." TS 19:24 "Beyond the acute management is to ensure thorough documentation regarding extravasation. Whether you're on electronic documentation or on paper, are the prompts there for the nurse to capture all of the factors that should be captured regarding that extravasation? The size, the measurement, the patient's complaints. Is there redness? Things like that. And then within the teams, everyone should know where to find that initial extravasation assessment so that later on, if they're in a different clinic, they have something to go by to see how the extravasation is healing or progressing. ... I think there's an importance here, too, to our novice oncology nurses and their preceptors. This could be anxiety-provoking for the whole team and the patient, so we want to increase confidence in management. So, I think using these resources for onboarding novice oncology nurses is important." TS 22:34

"They [monoclonal antibodies] are able to cause tumor cell death by binding to and blocking to necessary growth factor signaling pathways for tumor cell survival. That's going to be dependent on the target of the antibody, but I'll give an example of epidermal growth factor, or EGFR. This is overexpressed in several different kinds of cancers where activation of this growth factor increases the amount of proliferation and migration of cancer cells. So, if we bind to it and block to it, then that would help halt these pathways and stop cancer cell growth," Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about monoclonal antibodies. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) (including 45 minutes of pharmacotherapeutic content) by listening to the full recording and completing an evaluation at courses.ons.org by December 26, 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 in the history of, the mechanism of action of, and the use of monoclonal antibodies in the treatment of cancer.  Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 383: Pharmacology 101: Bispecific Antibodies Episode 375: Pharmacology 101: VEGF Inhibitors Episode 338: High-Volume Subcutaneous Injections: The Oncology Nurse's Role Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction Episode 275: Bispecific Monoclonal Antibodies in Hematologic Cancers and Solid Tumors ONS Voice articles: An Oncology Nursing Overview of Biosimilars Make Subcutaneous Administration More Comfortable for Your Patients Oncology Nurses' Role in Translating Biomarker Testing Results Reduce Chair Time by as Much as 16 Minutes by Priming IVs With Drug Shorter Administration Times Still Require High-Acuity Care The Names of Targeted Therapies Give Clues to How They Work ONS Voice drug reference sheets: Datopotamab deruxtecan-dlnk Enfortumab vedotin Margetuximab-cmkb Mirvetuximab soravtansine-gynx Nivolumab and hyaluronidase-nvhy Nivolumab and relatlimab-rmbw Pembrolizumab and berahyaluronidase alfa-pmph Retifanlimab-dlwr ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) ONS course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ Clinical Journal of Oncology Nursing articles: Bolusing IV Administration Sets With Monoclonal Antibodies Reduces Cost and Chair Time: A Randomized Controlled Trial Management of Immunotherapy Infusion Reactions Nurse-Led Grading of Antineoplastic Infusion-Related Reactions: A Call to Action Safety and Adverse Event Management of VEGFR-TKIs in Patients With Metastatic Renal Cell Carcinoma Oncology Nursing Forum articles: Administration of Subcutaneous Monoclonal Antibodies in Patients With Cancer Depressive Symptoms and Quality of Life Associated With the Use of Monoclonal Antibodies in Breast Cancer Treatment ONS huddle cards: Bispecifics Checkpoint Inhibitors Monoclonal Antibodies Other ONS resources: Biomarker Database Bispecific Antibodies video Patient Education Sheets Antibodies article: A Comprehensive Review About the Use of Monoclonal Antibodies in Cancer Therapy Cureus article:  A Comprehensive Review of Monoclonal Antibodies in Modern Medicine: Tracing the Evolution of a Revolutionary Therapeutic Approach Association of Cancer Care Centers (ACCC) homepage Cancer Immunology, Immunotherapy article: Therapeutic Antibodies in Oncology: An Immunopharmacological Overview Drugs@FDA package inserts Future Oncology article: Biosimilars: What the Oncologist Should Know Hematology/Oncology Pharmacy Association homepage National Comprehensive Cancer Network homepage Network for Collaborative Oncology Development and Advancement (NCODA) subcutaneous therapy article Oncolink: Side Effects of Immunotherapy World Health Organization: New International Nonproprietary Names (INN) Monoclonal Antibody Nomenclature Scheme 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 "Prior to monoclonal antibodies, all we really had were these toxic chemotherapies or toxic radiation, so it was recognized how great it would be if we could have a treatment that was much more specific to the tumor cells and have agents that have less toxicities. These advancements in monoclonal antibody production began in the 1980s. ... Eventually, we had the first monoclonal antibody that was approved by the U.S. Food and Drug Administration (FDA) for an oncologic indication, rituximab." TS 4:14  "Nowadays, we do have treatments that are also considered tumor-agnostic. This is when a patient has a certain biomarker, then that treatment can be given and FDA approval was given, regardless what type of tumor the patient has. We typically see these kinds of tumor-agnostic therapies more so in patients who have recurrent or advanced diseases in solid tumors. One monoclonal antibody example that comes to mind is dostarlimab. That's a checkpoint inhibitor that's approved for patients who are deficient in mismatch repair mechanism." TS 23:48 "Our immune system constantly has this surveillance system and it's able to recognize foreign pathogens, abnormal cells, and even precancerous cells. And they're able to eliminate them before they become cancerous. But on the flip side, one of the regulatory mechanisms that we have so our immune system doesn't attack itself is the presence of checkpoints. When these checkpoints bind to their ligands, this can then act as an off switch so that, again, our immune system is not going to attack itself. But then the tumor cells can take advantage of this and actually use this mechanism to evade the immune system. So, when we're giving a checkpoint inhibitor, now we're removing that off switch. As a consequence, common adverse effects can include things like immune mediated adverse events. These most commonly affect the skin, gastrointestinal tract, and liver. Essentially, this can cause any '-itis' you can think of." TS 26:36 "Looking at strategies to prevent infusion reactions, one example is the use of premedication. If premedication is recommended, this typically includes any combination of antipyretics, which is typically acetaminophen. Antihistamine, which is typically an H1 antagonist like diphenhydramine. Although, there could be cases where we want to substitute this agent because maybe the patient has been tolerating therapy okay, and they're having a lot of side effects. So, we might use a second-generation antihistamine in some cases. The premedication may be given with or without some kind of steroid, whether that's methylprednisolone, hydrocortisone, or dexamethasone." TS 29:53 "We tend to think of monoclonal antibody usage to be primary oncology, but that's not really the case. The first monoclonal antibodies that were developed were not for oncologic indications, they were for transplant indication for cardiac indication. So, they're really diversely utilized across all specialties and medicines. We have monoclonal antibodies for hyperlipidemia, for neurology, for rheumatology, so the uses are so very expansive across all specialties." TS 41:01

"The thought of recurrence is also a psychosocial issue for our patients. They're being monitored very closely for five years, so there's always that thought in the back of their head, 'What if the cancer comes back? What are the next steps? What am I going to do next?' It's really important that we have conversations with patients and their families about where they're at, what we're looking for, and reassure them that we'll be with them during this journey and help them through whatever next steps happen," 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 survivorship considerations for nurses. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by December 19, 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 survivorship nursing considerations for people with prostate cancer. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 390: Prostate Cancer Treatment Considerations for Nurses Episode 387: Prostate Cancer Screening, Early Detection, and Disparities Episode 201: Which Survivorship Care Model Is Right for Your Patient? Episode 194: Sex Is a Component of Patient-Centered Care ONS Voice articles: APRNs Collaborate With PCPs on Shared Survivorship Care Models Exercise Before ADT Treatment Reduces Rate of Side Effects Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer Here Are the Current Nutrition and Physical Activity Recommendations for Cancer Survivors Nursing Considerations for Prostate Cancer Survivorship Care Regular Physical Activity and Healthy Diet Lower Risk of All-Cause and Cardiac Mortality in Prostate Cancer Survivors Sexual Considerations for Patients With Cancer Sleep Disturbance Is Part of a Behavioral Symptom Cluster in Prostate Cancer Survivors ONS course: Essentials in Survivorship Care for the Advanced Practice Provider Clinical Journal of Oncology Nursing articles: A Patient-Specific, Goal-Oriented Exercise Algorithm for Men Receiving Androgen Deprivation Therapy Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery Prostate Cancer: Survivorship Care Case Study, Care Plan, and Commentaries The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population Oncology Nursing Forum articles: A Qualitative Exploration of Prostate Cancer Survivors Experiencing Psychological Distress: Loss of Self, Function, Connection, and Control Identification of Symptom Profiles in Prostate Cancer Survivors Sleep Hygiene Education, ReadiWatch™ Actigraphy, and Telehealth Cognitive Behavioral Training for Insomnia for People With Prostate Cancer Understanding Men's Experiences With Prostate Cancer Stigma: A Qualitative Study Other ONS resources: Late Effects of Cancer Treatment Huddle Card Survivorship Care Plan Huddle Card Survivorship Learning Library American Cancer Society (ACS): Living as a Prostate Cancer Survivor ACS prostate cancer survivorship studies 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 "Some of the most common late side effects [are] urinary, bowel, and sexual dysfunction issues. For urinary effects, it can include urgency and frequency, some incontinence, or a weak or slow urine stream that frequently bothers the patient after treatment. Bowel effects can happen such as constipation, diarrhea, or inflammation of the rectum, which can lead to bleeding or mucus discharge. And then erectile dysfunction is another side effect that patients with prostate cancer often deal with and have to work with their physicians on, depending on what they want with that function. Fatigue, lymphedema, and skin changes can also occur after treatment." TS 1:40 "If we can catch [prostate cancer] and take care of it at an early stage, overall survival is about 90%. If the disease is localized, it's 99%. If we can take out the prostate, radiate the prostate, we can do something with that—localized, 99% survival rate. If there's regional metastasis, it's about 90%. And if there's distant metastasis, it's about 30% survival." TS 3:55 "Prostate cancer recurs in about 20%–30% of patients within the first five years of initial treatment. ... There's not a lot of research out there that shows what can reduce risk, but what has been shown to be effective is regular exercise, quitting smoking, and eating a healthy diet. ... It's really important for our patients to understand the importance of having follow-up visits so that we can catch a recurrence quickly instead of waiting years down the road. Prostate cancer is usually a slow-growing disease, so if we can pick it up quickly in those revisits, we can start another treatment for the patient." TS 6:00 "Sexuality is not something many people are comfortable discussing, but we really need to talk with patients and let them know that this is normal. It is normal that you may have some sexual dysfunction. It's normal that you may not feel the way you did before. Talk to us about it, let us know where you're at, let us know what your goals are, because there are a lot of things we can do. There are medications we can use for impedance. There are devices and implants available to help the patient to support them and give them whatever their goal is for their sexuality." TS 9:41 "Providing survivorship care plans are important for these patients—something that can be sent off to everyone else that's caring for that patient. You have your primary care physician, urologist, oncologist, the oncology nurse, maybe a navigator, and [others] who are looking into this patient. So, giving that patient a survivor care plan and putting it with their files to include a summary of the treatment received, because most of the time a patient is not going to remember exactly what they received. A suggested schedule for follow-up exams—so again, if a primary care provider is not used to dealing with a patient with prostate cancer, they have something to go off of. A schedule of other tests they may need in the future including screening for other types of cancer. Are they a smoker? Do they need lung screening? Do they need any other screenings related to types of cancers? And then a list of possible late or long-term side effects." TS 15:16 "I think a lot of people know about the long-term sexual effects, but what we don't really talk about is the effect that it has on the patient's self-image. How they define themselves, how they look, their body image, their self-image. It's really important that we continue to discuss it with patients and make them comfortable when discussing their sexuality and their goals for sexuality. They may be having these self-image issues after treatment that they're just not telling us about and that can affect their quality of life." TS 18:38

"I'll go back to the backpack analogy. When your kids come home with a backpack, all of a sudden their homework is not on the desk where it's supposed to be. It's in the kitchen; it kind of spreads all over the place, but it's still in the house. When we give antibody–drug conjugates (ADCs), the chemotherapy does go in, but then it can kind of permeate out of the cell membrane and something right next to it—another cancer cell that might not look exactly like the cancer cell that the chemotherapy was delivered into—is affected and the chemotherapy goes over to that cancer cell and kills it," ONS member Marisha Pasteris, OCN®, office practice nurse in the breast medicine service at Memorial Sloan Kettering Cancer Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ADCs in metastatic breast cancer. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  This podcast is sponsored by Gilead 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  This episode is not eligible for NCPD. ONS Podcast™ episodes: Episode 391: Pharmacology 101: Antibody–Drug Conjugates Episode 378: Considerations for Adolescent and Young Adult Patients With Metastatic Breast Cancer Episode 368: Best Practices for Challenging Patient Conversations in Metastatic Breast Cancer Episode 350: Breast Cancer Treatment Considerations for Nurses Episode 303: Cancer Symptom Management Basics: Ocular Toxicities ONS Voice articles: An Oncology Nurse's Guide to Cancer-Related Ocular Toxicities Black Patients With Metastatic Breast Cancer Are Less Informed About Their Clinical Trial Options Communication Case Study: Talking to Patients About Progressive Metastatic Breast Cancer What Is HER2-Low Breast Cancer? ONS Voice drug reference sheets: Belantamab mafodotin-blmf Datopotamab deruxtecan-dlnk Enfortumab vedotin-ejfv Fam-trastuzumab deruxtecan-nxki ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Breast Care for Oncology Nurses Guide to Cancer Immunotherapy (second edition) ONS courses: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing article: Antibody–Drug Conjugates and Ocular Toxicity: Nursing, Patient, and Organizational Implications for Care The Association Between Hormone Receptor Status and End-of-Life Care Among Patients With Metastatic Breast Cancer Oncology Nursing Forum article: Impact of Race and Area Deprivation on Triple-Negative Metastatic Breast Cancer Outcomes ONS huddle cards: Altered Body Image Huddle Card Chemotherapy Huddle Card Targeted Therapy Huddle Card Foundations of Antibody–Drug Conjugate Use in Metastatic Breast Cancer: A Case Study ONS Biomarker Database (refine by breast cancer) ONS Breast Cancer Learning Library American Society of Clinical Oncology (ASCO) homepage Drugs@FDA package inserts National Comprehensive Cancer Network homepage Susan G. Komen metastatic breast cancer page 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 "What an ADC is doing is taking the antibody and linking it to a cytotoxic chemotherapy with the idea of delivering it directly into the cell. How I explain this to new nurses or patients is a backpack analogy. If we think of it as a HER2 molecule wearing a chemo backpack, it's going to find the HER2 receptor attached to it and then drop the chemotherapy into the cell via the backpack. Similar to how we come home from work, we open the key to our door, we're carrying all of our items, and then we drop our own personal items in our house." TS 2:30 "The reason that so many patients with metastatic breast cancer are able to receive ADC therapy is because they are targeting two very common antibodies that we see in breast cancer. One is HER2 and the other is trophoblast cell surface antigen 2 (TROP2). These are seen across the board. We see these on triple-negative breast cancers, hormone receptor–positive cancers, and HER2-positive breast cancers. And now we have a new way to talk about HER2, which is a HER2-low. ... Recently, we have found that patients who express low levels of HER2 are able to receive ADC therapy, specifically fam-trastuzumab deruxtecan." TS 4:21 "Another [ADC] that has just been approved is datopotamab deruxtecan. This is another ADC that targets the TROP2 receptor on a cancer cell. This one carries a lot of side effects. I mentioned earlier that you need an ophthalmology clearance because there is a lot of ocular toxicity around this one. We see a lot of blepharitis, conjunctivitis, there can be blurred vision. Another thing we monitor on this one is mucositis. In the package insert, there's a recommendation for using ice chips while receiving the treatment. ... Then in the HER2-positive and HER2-low space is the big one, which is fam-trastuzumab deruxtecan. This was approved in 2019 for the HER2-positive patients, then more recently in the HER2-low [patients]. The big [side effect] with this one is interstitial lung disease." TS 10:11 "Interstitial lung disease is an inflammation or a little bit of fibrosis within the lung that causes an impaired exchange between the oxygen and carbon dioxide. This was seen in the clinical trials, specifically around fam-trastuzumab deruxtecan. During the trials, they had a very small percentage, I think it was 1%, that died due to interstitial lung disease. So, this is a very important side effect for us as nurses to be aware of. It typically presents in patients like a dyspnea. A lot of times, it's like, 'Well, I used to be able to walk my kid to the bus stop, but now when I walk there, I feel really short of breath.' Or 'I've had this dry cough for the past couple weeks and I've tried medications, but haven't had that relieved.' So, we really need to be aware of that because early intervention in interstitial lung disease is key." TS 12:57 "ADCs are toxic drugs. They have the benefit of being targeted, but we know that they carry a lot of side effects. ... Their specificity makes them so wonderful and we've seen amazing responses to these drugs. But also, we want patients to be safe. We want to give these drugs safely. So, we have to assess our patients and make sure that this is an appropriate patient to give this therapy to. I think that's an open conversation that clinicians need to have with patients regarding these drugs." TS 18:08

"Working as an oncology infusion nurse, being oncology certified, attending chapter meetings, going to ONS Congress® has really taught me plenty. But being an oncology patient taught me way more. I know firsthand the fears 'you have cancer' brings. Then going through further testing, CT scans, MRIs, genetics, the whole preparation for surgery was something I never considered when I treated a breast cancer patient," ONS member Catherine Parsons, RN, OCN®, told Valerie Burger, MA, MS, RN, OCN®, CPN, member of the ONS 50th anniversary planning committee, during a conversation about her experience being an oncology nurse and cancer survivor. Burger spoke with Parsons and ONS members Margaret Hopkins, MSN, RN, OCN®, HNB-BC, and Afton Dickerson, MSN, AGACNP-BCP, CBCN®, AOCNP®, CGRA, about how cancer survivorship has shaped their careers as oncology nurses and personal lives. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Episode Notes  This episode is not eligible for NCPD.  ONS Podcast™ episodes: 50th anniversary series Episode 385: ONS 50th Anniversary: Evolution of Cancer Survivorship Episode 263: Oncology Nursing Storytelling: Renewal Episode 253: The Ethics of Caring for People You Know Personally Episode 187: The Critical Need for Well-Being and Resiliency and How to Practice Episode 91: The Seasons of Survivorship ONS Voice articles: Being a Patient Taught Me How to Be a Better Oncology Nurse by Margaret Hopkins Sharing Our Stories Supports, Celebrates, and Advances the Nursing Profession Our Unified Voices Can Improve Cancer Survivorship Care Why I Truly Understand How Our Patients Hold Onto Hope ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (third edition) ONS course: Essentials in Survivorship Care for the Advanced Practice Provider ONS Nurse Well-Being Learning Library ONS Huddle Cards: Coping Moral Resilience Survivorship Care Connie Henke Yarbro Oncology Nursing History Center 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 Parsons: "I thought I knew cancer. I thought I knew the treatment. I thought I knew the side effects. There's so much I didn't know. There's so much behind the scenes before a patient comes and sits in my chair. The stuff that they go through I now can understand. It surprised me how much I didn't know." TS 11:39 Hopkins: "I had been thinking I'm going to be that hero, that I can go to work. I work at night, get 8 am radiation appointments, and go home and go to sleep and wake up and go to work again because everyone said, 'Oh, it's not that bad. Radiation will be okay. You can work.' … But the real challenge for me was I didn't know how to be a patient and a nurse at the same time. And my first radiation treatment, I go in there, and I change into the gown, and then I started cleaning up because I was getting treatment done at the hospital where I worked, and were taught if you see a mess, you clean it. So I was acting like a nurse. And I almost wanted to go help the other patients, but I couldn't because I had to focus on healing." TS 15:36 Dickerson: "What made the difference for me were the nurses who didn't just treat my illness. They treated me as a whole person—my emotions, my feelings. They made me smile. They would hold my hand or just take a moment to really ask, 'Hey, how are you?' And those small, little gestures made me feel worthy, made me feel like a human. I always tell nurses it's not just about the chemo; it's about the connection. Sometimes your presence is the most healing thing that you can offer to your patient." TS 30:52

"Antibody–drug conjugates (ADCs) have three basic parts: the antibody part, the cytotoxic chemo, and the linker that connects the two. First, the antibody part binds to the target on the surface of the cell. Antibodies can be designed to bind to proteins with a very high level of specificity. That's what gives it the targeted portion. Then the whole thing gets taken up by the cell and broken down, which releases the chemotherapy part. Some sources will call this the 'payload' or the 'warhead.'  That's the part that's attached to the 'heat-seeking' part, and that's what causes the cell death," Kenneth Tham, PharmD, BCOP, clinical pharmacist in general oncology at the University of Washington Medicine and Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about antibody–drug conjugates. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 28, 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 the mechanism of action of antibody–drug conjugates. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 303: Cancer Symptom Management Basics: Ocular Toxicities Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction ONS Voice articles: An Oncology Nurse's Guide to Cancer-Related Ocular Toxicities Antibody–Drug Conjugates Join the Best of Two Worlds Into One New Treatment Nursing Management of Adverse Events From Enfortumab Vedotin Therapy for Urothelial Cancer Oncology Nurses' Role in Translating Biomarker Testing Results The Pharmacist's Role in Combination Cancer Treatments ONS Voice drug reference sheets: Belantamab mafodotin-blmf Datopotamab deruxtecan-dlnk Enfortumab vedotin Fam-trastuzumab deruxtecan-nxki ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) ONS course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ Clinical Journal of Oncology Nursing articles: Antibody–Drug Conjugates and Ocular Toxicity: Nursing, Patient, and Organizational Implications for Care Nurse-Led Grading of Antineoplastic Infusion-Related Reactions: A Call to Action Other ONS resources: Antineoplastic Administration Huddle Card Biomarker Database Chemotherapy Huddle Card Monoclonal Antibodies Huddle Card Association of Cancer Care Centers (ACCC) antibody–drug conjugates page Drugs@FDA Hematology/Oncology Pharmacy Association (HOPA) National Cancer Institute cancer drugs page Network for Collaborative Oncology Development and Advancement (NCODA) clinical resource library ACCC/HOPA/NCODA/ONS Patient Education Sheets website 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 mechanism of action of the chemo itself depends on what agent or what 'warhead' is attached. Generally, [ADCs] have some kind of cytotoxic mechanism related to many of the chemotherapies that we use in practice, without attachment to the antibody. Some of them can be microtubule inhibitors, vinca alkaloids like vincristine. Some of them can be topoisomerase I (TOP1) inhibitors like irinotecan. Some can be alkylating agents that cause DNA breaks. So, again, looking back at the arsenal we have of cytotoxic chemo, these can all be incorporated into the ADCs." TS 5:54 "I want to talk about a case where the biomarker is being tested, but the biomarker isn't the target that you're looking for. One good case of this is a newer agent that was approved called datopotamab deruxtecan. The datopotamab portion is specific to a target called 'trophoblast cell surface antigen 2' (TROP2), which is expressed on the surface of many epithelial cancers. This agent was first approved in hormone receptor-positive, HER2-negative breast cancer, and received accelerated approval in patients with non-small cell lung cancer (NSCLC) with an EGFR mutation. ... The antibody looks for a target, TROP2. But in both of these cases—in the breast cancer and the NSCLC—you're testing for expression of different mutations or lack thereof. You're not looking for expression of TROP2. There's more research that needs to be done about the relationship between TROP2 expression and the presence or absence of these other biomarkers, but until we know more, we're actually testing for biomarkers that aren't the target of the ADC." TS 10:22 "There are common adverse advents to antibodies and chemo in general. Because we have both of these components, we want to watch out for the adverse effects of both of them. Antibodies, as with most proteins, can trigger an immune response or an infusion reaction. So, many ADCs can also cause hypersensitivity or infusion reactions. The rates of that are really variable and depend on the actual antibodies themselves. Then you have the cytotoxic component, the chemotherapy component, which has its own characteristic side effects. So, if we think of general chemo side effects—fatigue, nausea, bone marrow suppression, alopecia—these can [occur] with a lot of ADCs as well." TS 15:34 "The rate of ocular toxicity in [mirvetuximab soravtansine] is quite high. The manufacturer reports that this can occur in up to 60% of patients. With rates so high, the manufacturer recommends a preventive strategy. For this particular agent, [they] recommend patients have required eyecare. ... This ocular toxicity is something we do see in other ADCs that don't have the same target and don't necessarily have the same payload component. For example, tisotumab vedotin and again, datopotamab deruxtecan, can both cause ocular toxicities and both would have required ocular supportive care." TS 20:08 "Overall, I feel like the future is incredibly bright for these agents. There have only been around a dozen therapies approved by the U.S. Food and Drug Administration (FDA) despite this idea—the first agent came out in 2000. So, 25 years later, there are only around a dozen FDA-approved treatments. But there are so many more that are coming through the pipeline. And as we're discovering more biomarkers and developing more specialized antibodies, it's only natural that more ADCs will follow." TS 26:50

"Any time the patient hears the word 'cancer,' they shut down a little bit, right? They may not hear everything that the oncologist or urologist, or whoever is talking to them about their treatment options, is saying. The oncology nurse is a great person to sit down with the patient and go over the information with them at a level they can understand a little bit more. To go over all the treatment options presented by the physician, and again, make sure that we understand their goals of care," 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 treatment considerations for nurses.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 21, 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 the treatment of prostate cancer. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 387: Prostate Cancer Screening, Early Detection, and Disparities Episode 373: Biomarker Testing in Prostate Cancer Episode 324: Pharmacology 101: LHRH Antagonists and Agonists Episode 321: Pharmacology 101: CYP17 Inhibitors Episode 208: How to Have Fertility Preservation Conversations With Your Patients Episode 194: Sex Is a Component of Patient-Centered Care ONS Voice articles: Communication Models Help Nurses Confidently Address Sexual Concerns in Patients With Cancer Exercise Before ADT Treatment Reduces Rate of Side Effects Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer Nurses Are Key to Patients Navigating Genitourinary Cancers Sexual Considerations for Patients With Cancer The Case of the Genomics-Guided Care for Prostate Cancer ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition) Manual for Radiation Oncology Nursing Practice and Education (Fifth Edition) Clinical Journal of Oncology Nursing articles: Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers Physical Activity: A Feasibility Study on Exercise in Men Newly Diagnosed With Prostate Cancer The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population Oncology Nursing Forum articles: An Exploratory Study of Cognitive Function and Central Adiposity in Men Receiving Androgen Deprivation Therapy for Prostate Cancer ONS Guidelines™ for Cancer Treatment–Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer Other ONS resources: Biomarker Database (refine by prostate cancer) Biomarker Testing in Prostate Cancer: The Role of the Oncology Nurse Brachytherapy Huddle Card External Beam Radiation Huddle Card Hormone Therapy Huddle Card Luteinizing Hormone-Releasing Hormone Antagonist Huddle Card Sexuality Huddle Card American Cancer Society prostate cancer page National Comprehensive Cancer Network homepage 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 "I think it's important to note that urologists are usually the ones that are doing the diagnosis of prostate cancer and really start that staging of prostate cancer. And the medical oncologists usually are not consulted until the patient is at a greater stage of prostate cancer. I find that it's important to state because a lot of our patients start with urologists, and by the time they've come to us, they're a lot further staged. But once a prostate cancer has been suspected, the patient needs to be staged for the extent of disease prior to that physician making any treatment recommendations. The staging includes doing a core biopsy of the prostate gland. During this core biopsy, they take multiple different cores at different areas throughout the prostate to really look to see what the cancer looks like." TS 1:46 "[For] the very low- and low-risk group, the most common [treatment] is active surveillance. ... Patients can be offered other options such as radiation therapy or surgery if they're not happy with active surveillance. ... The intermediate-risk group has favorable and unfavorable [status]. So, if they're a favorable, their Gleason score is usually a bit lower, things are not as advanced. These patients are offered active surveillance and then either radical prostatectomy with possible removal of lymph nodes or radiation—external beam or brachytherapy. If a patient has unfavorable intermediate risk, they are offered radical prostatectomy with removal of lymph nodes, external radiation therapy plus hormone therapy, or external radiation with brachytherapy. All three of these are offered to patients, although most frequently we see that our patients are taken in for radical prostatectomy. For the high- or very high-risk [group], patients are offered radiation therapy with hormone therapy, typically for one to three years. And then radical prostatectomy with removal of lymph nodes could also be offered for those patients." TS 7:55 "Radiation can play a role in any risk group depending on the patient's preference. ... The types of radiation that we use are external beam, brachytherapy, which is an internal therapy, and radiopharmaceuticals, [which are] more for advanced cancer, but we are seeing them used in prostate [cancer] as well. External beam radiation focuses on the tumor and any metastasis we may have with the tumor. It can be used in any risk [group] and for recurrence if radiation has not been done previously. If a patient has already been radiated to the pelvic area or to the prostate, radiation is usually not given again because we don't want to damage the patient any further. Brachytherapy is when we put radioactive pellets directly into the prostate. For early-stage prostate cancer, this can be given alone. And for patients who have a higher risk of the cancer growing outside the prostate, it can be given in combination with external beam radiation. It's important to note with brachytherapy, it cannot be used on patients who've had a transurethral resection of the prostate or any urinary problems. And if the patient has a large prostate, they may have to be on some hormone therapy prior to brachytherapy, just to shrink that prostate down a little bit to get the best effect. ... Radiopharmaceuticals treat the prostate-specific membrane antigen." TS 11:05 "The side effects of surgery are usually what deter the patient from wanting surgery. The first one is urinary incontinence. A lot of times, a patient has a lot of urinary incontinence after they have surgery. The other one is erectile dysfunction. A lot of patients may not want to have erectile dysfunction. Or, if having an erection is important to the patient, they may not want to have surgery to damage that. In this day and age, physicians have gotten a lot better at doing nerve-sparing surgeries. And so they really do try to do that so that the patient does not have any issues with erectile dysfunction after surgery. But [depending on] the extent of the cancer where it's growing around those nerves or there are other things going on, they may not be able to save those nerves." TS 15:26 "Luteinizing hormone-releasing hormone, or LHRH antagonists or analogs, lower the amount of testosterone made by the testicles. We're trying to stop those hormones from growing to prevent the cancer. ... When we lower the testosterone very quickly, there can be a lot more side effects. But if we lower it a little bit less, we can maybe help prevent some of them. The side effects are important. When I was writing this up, I was thinking, 'Okay, this is basically what women go through when they go through menopause.' We're decreasing the estrogen. We're now decreasing the testosterone. So, the patients can have reduced or absent sexual desire, they can have gynecomastia, hot flashes, osteopenia, anemia, decreased mental sharpness, loss of muscle mass, weight gain, and fatigue." TS 17:50 "What we all need to remember is that no patient is the same. They may not have the same goals for treatment as the physicians or the nurses want for the patient. We talked about surgery as the most common treatment modality that's presented to patients, but it's not necessarily the option that they want. It's really important for healthcare professionals to understand their biases before talking to the patients and the family. It's also important to remember that not all patients are in heterosexual relationships, so we need to explain recovery after treatment to meet the needs of our patients and their sexual relationships, which is sometimes hard for us. But remembering that—especially gay men—they may not have the same recovery period as a heterosexual male when it comes to sexual relationships. So, making sure that we have those frank conversations with our patients and really check our biases prior to going in and talking with them." TS 27:16

"It's critical to identify those mutations found that are driving the cancer's growth and guide the personalized treatment based on those results. And important to remember, too, early testing is crucial for patients with non-small cell lung cancer (NSCLC). In studies, it has been found to be associated with improved survival outcomes and reduced mortality," ONS member Vicki Doctor, MS, BSN, BSW, RN, OCN®, precision medicine director at the City of Hope Atlanta, GA, Chicago, IL, and Phoenix, AZ, locations, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the oncology nurse's role in NSCLC biomarker testing. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  This podcast is sponsored by Lilly Oncology 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  This episode is not eligible for NCPD. ONS Podcast™ episodes: Episode 363: Lung Cancer Treatment Considerations for Nurses Episode 359: Lung Cancer Screening, Early Detection, and Disparities Episode 238: Cancer Genomics for Every Oncology Nurse Episode 157: Biomarker Testing Improves Outcomes for Patients With Non-Small Cell Lung Cancer ONS Voice articles: Non-Small Cell Lung Cancer Prevention, Screening, Diagnosis, Treatment, Side Effects, and Survivorship Only a Third of Patients With Advanced Cancer Get Biomarker Testing, Limiting Use of Potentially Effective Precision Therapies Precision Medicine in Lung Cancer: How Comprehensive Testing Optimizes Patient Outcomes Targeted Therapies Are Transforming the Treatment of Non-Small Cell Lung Cancer ONS book: Guide to Cancer Immunotherapy (second edition) ONS course: Genomic Foundations for Precision Oncology Clinical Journal of Oncology Nursing article: Using Nurse Navigators to Improve Timeliness of Biomarker Testing for Non-Small Cell Lung Cancer Oncology Nursing Forum article: Precision Medicine Testing and Disparities in Health Care for Individuals With Non-Small Cell Lung Cancer: A Narrative Review Other ONS resources: Best Practices for Biomarker Testing in Non-Small Cell Lung Cancer: A Case Study Genomics and Precision Oncology Learning Library Genomics Case Study: Precision Medicine in the Setting of Metastatic Non-Small Cell Lung Cancer Biomarker Database (refine by non-small cell lung cancer) Genomic Biomarkers Huddle Card Targeted Therapy Huddle Card National Comprehensive Cancer Network homepage 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 "These biomarkers are used to provide information about cancer's characteristics or behavior. In oncology precision medicine specifically, molecular tests can help with diagnosing a cancer that is maybe an unknown primary. It can help with monitoring response to therapy, detect recurrence of disease before other tests can find that, predict prognosis or how aggressive the cancer may be, and guide treatment decisions for targeted therapies." TS 3:14 "Some of the key biomarkers recommended by the National Comprehensive Cancer Network (NCCN) to be tested in patients who have NSCLC are EGFR, ALK, KRAS, BRAF, MET exon 14 skipping mutation, HER2 which is a protein expression from an ErbB protein, PD-L1 which is a protein expression that's used to guide immunotherapy choices, and then finally there are three fusions: ROS1, RET, and NTRK. [These] are pretty rare but really important to be tested for in patients who have NSCLC." TS 3:46 "Another important challenge for nurses related to this topic is that these results may not reveal a targeted mutation for the patient and that could be very disappointing. So, being able to provide that emotional support to a patient if they have that result … you can actually reinforce with them that if [they] go onto another treatment that the physician decides to put [them] on, the tumor can change. New pathogenic variants can develop based on the treatment that they're getting, and another test can be done. And maybe at that time—a new biomarker that could be targeted—we'd be seeing on the new test." TS 7:32  "Another circumstance we didn't talk about yet is that maybe the result came back saying that the quality was not sufficient. And sometimes that happens, but that doesn't mean that we're at the end of the road, necessarily. So, you could explain to the patient that that may mean that possibly, a new biopsy would be ordered by the physician. Or if a new biopsy or another tissue sample is not available, then maybe the physician would pivot to sending a blood specimen for the molecular testing. So that would definitely be a way [nurses] could support their patients." TS 11:52 "In the case of patients with NSCLC, early testing is so important. So, advocating for that prompt biomarker testing to be done, making sure that it's comprehensive, that it's actually looking for all of those—I think it was 12 biomarkers—that I mentioned earlier. That this testing is done as soon as possible after diagnosis or progression. Something that I talk about all the time—personalized care, precision medicine—really matters. So, tailoring treatments for patients based on the biology of the tumor that's driving the cancer's growth is really crucial if you're going to be working as an oncology nurse. Another crucial thing, because it's changing so quickly, is to stay informed." TS 16:23

"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  This episode is not eligible for NCPD.  ONS Podcast™ episodes: ONS 50th anniversary series Episode 229: How Advocacy Can Shape Your Nursing Career ONS Voice articles: Oncology Nurses Take to Capitol Hill to Advocate for Cancer Care Priorities Our Unified Voices Can Improve Cancer Survivorship Care With Voices Amplified by ONS, Oncology Nurses Speak Out for Patients and the Profession on Capitol Hill NOBC Partnerships Advance Nurses' Placements on Local and National Boards Nursing Leadership Has Space for You and Your Goals ONS courses: Advocacy 101: Making a Difference Board Leadership: Nurses in Governance Oncology Nursing Forum articles: Nurses on Boards: My Experience on the Moonshot Strengthening Oncology Nursing by Using Research to Inform Politics and Policy ONS Center for Advocacy and Health Policy Current ONS position statements Connie Henke Yarbro Oncology Nursing History Center Campaign for Tobacco-Free Kids Cancer Moonshot National Cancer Policy Forum National Council of State Boards of Nursing APRN Roundtable National Patient Advocate Foundation Nurses on Boards Coalition One Voice Against Cancer Patient Quality of Life Coalition Robert Wood Johnson Foundation Health Policy Fellows 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

"[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  Complete this evaluation for free NCPD. ONS Podcast™ Episode 149: Health Disparities and Barriers in Metastatic Castration-Sensitive Prostate Cancer ONS Voice articles: Gender-Affirming Hormones May Lower PSA and Delay Prostate Cancer Diagnosis in Transgender Women Healthy Lifestyles Reduce Prostate Cancer Mortality in Patients With Genetic Risk Hispanic Patients Are at Higher Risk for Aggressive Prostate Cancer but Less Likely to Get Treatment Leveling State-Level Tax Policies May Increase Equality in Cancer Screening and Mortality Rates Most Cancer Screening Guidelines Don't Disclose Potential Harms ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses ONS course: Genomic Foundations for Precision Oncology Clinical Journal of Oncology Nursing article: Barriers and Solutions to Cancer Screening in Gender Minority Populations Oncology Nursing Forum articles: Disparities in Cancer Screening in Sexual and Gender Minority Populations: A Secondary Analysis of Behavioral Risk Factor Surveillance System Data Symptom Experiences Among Individuals With Prostate Cancer and Their Partners: Influence of Sociodemographic and Cancer Characteristics Other ONS resources: Genomics and Precision Oncology Learning Library ONS Biomarker Database (refine by prostate cancer) American Cancer Society prostate cancer early detection, diagnosis, and staging page National Institutes of Health prostate cancer screening page U.S. Preventive Services Task Force prostate cancer screening recommendation statement 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

"This was a panel of subject matter experts of various nurses and pharmacists. We often found common ground but also discovered new ideas, different touchpoints, and key junctures along that oral anticancer medication journey. For example, the pharmacists were able to share their insights into their unique workflows within their practice setting. What resulted is a resource that truly reflects that collaborative effort between the disciplines," ONS member Mary Anderson, BSN, RN, OCN®, senior manager of nursing membership and professional development at the Network for Collaborative Oncology Development and Advancement (NCODA) in Cazenovia, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS. Weimer spoke with Anderson and Kris LeFebvre, DNP, RN, NPD-BC, AOCN®, oncology clinical specialist at ONS, about the Oral Anticancer Medication Care Compass: Resources for Interprofessional Navigation, a project created as a collaboration between ONS and NCODA. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Episode Notes  This episode is not eligible for NCPD contact hours. ONS Podcast™ episodes: Episode 215: Navigate Updates in Oral Adherence to Cancer Therapies Episode 16: Navigating the Challenges of Oral Chemotherapy ONS Voice articles: As Institutions Establish Oral Agent Workflows, Savvy Educators Help Nurses Apply Them to Practice Maintain Oral Adherence With ONS Guidelines™ The Oncology Nurse's Role in Oral Anticancer Therapies ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition) ONS courses: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS/ONCC®Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing article: Implementation of an Oral Antineoplastic Therapy Program: Results From a Pilot Project Oncology Nursing Forum articles: Domains of Structured Oral Anticancer Medication Programs: A Scoping Review Interventions to Support Adherence to Oral Anticancer Medications: Systematic Review and Meta-Analysis ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications Other ONS resources: ASCO/ONS Antineoplastic Therapy Administration Safety Standards Oral Anticancer Medication Care Compass: Resources for Interprofessional Navigation Oral Anticancer Medication Learning Library Drugs@FDA Hematology/Oncology Pharmacy Association Oral Chemotherapy Collaborative National Comprehensive Cancer Network homepage NCODA homepage Patient Education Sheets website 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 LeFebvre: "There are five different elements to the care compass itself. The first is called the OAM [oral anticancer medication] workflow analysis tool. ... This [tool] allows an OAM program to really study where their processes are. Where are the gaps in the process and where might their patients be at risk? It's something that you can use within your setting to analyze your current processes and see where you can strengthen them. The second tool is something focused on patient and caregiver education. This includes a lot of information about what should be taught, how it could be taught, the best timing and so forth, according to the literature. ... The third tool is an assessment and grading tool. It's a fun tool that approaches symptom management using the Common Terminology Criteria for Adverse Events grading tool. ... The fourth tool is a specialty pharmacy and patient assistance contact directory template. This is a spreadsheet that can be used by anyone navigating patient care with OAMs to keep track of their professional contacts. ... The final [tool] is the OAM adherence blueprint. This has a lot of important information on adherence, methods to assess adherence, and calculate adherence rate." TS 7:15 LeFebvre: "Interprofessional collaboration is so essential just in day-to-day care, and OAM care is no different in that regard. Oncology nurses work in so many different settings and their role may be very different even if they have the same title. You can have OAM navigation that is completely handled in the pharmacy. I've talked with nurses who have said, 'We don't even touch it.' But they do. Because when a patient has a combination regimen, they might have an infusion regimen that goes along with an oral therapy. Or that patient might just know that infusion room nurse so much better and they feel more comfortable [contacting them] when they have a side effect from their oral therapy. So, infusion nurses need to be aware of what the patients are on and what the potential side effects are." TS 14:14 Anderson: "The resource for OAM education that we created is literally a blueprint of many resources out there to help nurses, pharmacists, and oncology professionals educate their patients on taking OAMs. ... [The OAM Care Compass] also helps with communication channels. It helps knowing that all the documentation is occurring and when everybody is documenting within their role and according to those key touchpoints, there's less opportunity to lose track of your patients because we know what's happening." TS 16:33 Anderson: "I think the biggest misconception we see is that people think taking OAMs is easier than infusion therapies. And while it's true that OAMs do offer significant benefits such as the convenience and the ability for patients to take their medication at home, we are also placing a huge burden on our patients. They need to navigate that very complex health system to obtain their medication and understand their treatment plan and adhere to that precise regimen. Additionally, we are seeing more and more complex treatment regimens with combination therapies, which further increases the need for that early and ongoing education, monitoring, and support." TS 20:38

"It started out by doing a kind of a white paper that we called Imperatives for Quality Cancer Care. Ellen Stovall, our CEO [of the National Coalition for Cancer Survivorship] at the time, gave this report to Dr. Richard Klausner, who was the head of National Cancer Institute at the time. He called Ellen immediately and said, 'Why are we not doing something about this?' Within one year, we had the Office of Cancer Survivorship at NCI," ONS member Susan Leigh, BSN, RN, told ONS member Ruth Van Gerpen, MS, RN-BC, APRN-CNS, AOCNS®, PMGT-BC, member of the ONS 50th anniversary committee, during a conversation about her involvement in cancer survivorship advocacy. Van Gerpen also spoke with ONS members Deborah Mayer, PhD, RN, AOCN®, FAAN, and Timiya S. Nolan, PhD, APRN-CNP, ANP-BC, about the history and future of cancer survivorship. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Episode Notes  This episode is not eligible for NCPD. ONS Podcast™ episodes: Episode 201: Which Survivorship Care Model Is Right for Your Patient? Episode 91: The Seasons of Survivorship Episode 49: The Cancer Survivorship Conundrum ONS Voice article: Our Unified Voices Can Improve Cancer Survivorship Care ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (third edition) ONS course: Essentials in Survivorship Care for the Advanced Practice Provider Clinical Journal of Oncology Nursing articles: Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery Survivorship Care: More Than Checking a Box The Missing Piece of Survivorship: Cancer Prevention Oncology Nursing Forum articles: Patient Perceptions of Survivorship Care Plans: A Mixed-Methods Evaluation Survivorship Care Plans: Health Actions Taken and Satisfaction After Use ONS Survivorship Learning Library Rehabilitation of People With Cancer: Position Statement from the Association of Rehabilitation Nurses (ARN) and endorsed by the Oncology Nursing Society Connie Henke Yarbro Oncology Nursing History Center American Cancer Society Survivorship resources Cancer Survivors Network Cancer Nation (formerly National Coalition for Cancer Survivorship) Cancer Survival Toolbox Imperatives for Quality Cancer Care: Access, Advocacy, Action, and Accountability (white paper) National Cancer Survivors Day Foundation New England Journal of Medicine article: Seasons of Survival: Reflections of a Physician With Cancer by Fitzhugh Mullan 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 Leigh: "Another way that [National Coalition of Cancer Survivorship] got very involved with looking at how we keep this information coming and how we really share care with our outside physicians is the development of survivorship care plans. And then we also hoped that we would see more survivorship clinics by now. But between trying to get people to develop care plans and clinics, it's been like pulling teeth. It has been very difficult. And a lot of this struggle to get this going has been, first of all, there isn't enough money to do this. There isn't enough time for immediate staff to take these on, and we just don't have enough staff as it is now. And survivorship is not a moneymaker, so it's just something that has to be done kind of on the side." TS 11:54 Mayer: "When I became ONS president in the '80s—I was the fourth ONS president—we were given a cancer grant to do something with our presidency. And that was when I really wanted to bring attention to rehabilitation as a means to address cancer survivorship issues because we had a very 'treat 'em and street 'em' attitude. We gave you your treatment, and we sent you home, and you had to figure out the rest. And there wasn't a lot of knowledge or support to help you put your life back together again afterwards. And so in that process, it was an interdisciplinary group of professionals that tried to come up with what was an appropriate position statement because ONS was just starting to do position statements. And so we developed a first position statement on cancer rehabilitation to address survivorship issues in like 1987 to '89." TS 17:15 Mayer: "When I went back to school for my PhD, I did my dissertation on health behaviors of cancer survivors and realizing the huge gap in the care that they were getting for anything other than their cancer. We were still focused on their tumor and on treating their tumor. But we were missing the picture that if the cancer didn't kill them, their heart disease would, and they would develop diabetes and other things. … But as people started living longer and longer, we were missing all these other chronic illnesses that would contribute to their quality of life and overall lifespan. So my dissertation put me on a different path, and I think the second part of my career was really focusing on instead of just relieving suffering and the quality of life issues, really looking at cancer care delivery and how we could do a better job of doing the team of teams that people needed to have their issues addressed." TS 19:34 Nolan: "I ended up having my first permanent role on a hematology-oncology unit at the University of Alabama at Birmingham. And there, I literally saw patients who were fighting for their lives. And despite the severity of their illness, they wanted more than just survival. They wanted to have meaning. They wanted to have dignity. They wanted to have impact with the time that they had left, whatever it was. And so those experiences planted a seed in me. And that seed was that cancer care must extend beyond treatment and we need to embrace, really, quality of life." TS 23:31 Leigh: "I was not the researcher. I was not the major writer. I was not the identifier of a lot of the risk factors. But I spread the seed. I took all that information from different sources and shared that with all of the audiences that I spoke to. So I was called a seed spreader, kind of the Johnny Appleseed of oncology nursing at that particular time. And then once we saw academia step in and say, 'We need to get good data about what's going on here,' … then my stories and stories from survivors started decreasing and the presentations were given more from the academic standpoint." TS 34:41 Nolan: "I really believe in community, academic, government, and industry approaches to survivorship as well. We can no longer operate in silos. We really need to learn how to walk across the aisle, build bridges as we can so that we can do this work together because we know that communities bring lived wisdom and context. And academicians bring the research and the ability to create the evidence. The government brings policy and public health infrastructure, and certainly industry brings innovation and scalability. But also in this new paradigm that we find ourselves in, the industry may also bring the dollars to be able to help us to do even more work." TS 43:45

"Chemotherapy-induced alopecia does cause a lot of stress. It's associated with lower quality of life. Scalp cooling may really help improve quality of life. Some studies have shown that women in the scalp cooling group felt less upset about losing their hair and less dissatisfied with their appearance compared to the women in the control group that didn't receive any scalp cooling. So a lot of these studies are showing it does have a very positive impact on psychosocial feelings and side effects in relation to overall cancer treatment," ONS member Jaclyn Andronico, MSN, CNS, OCN®, AOCNS®, clinical nurse specialist at Memorial Sloan Kettering Cancer Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about chemotherapy-induced alopecia and scalp cooling. The advertising messages in this episode are paid for by Paxman. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Episode Notes  This episode is not eligible for NCPD. ONS Podcast™ Episode 250: Cancer Symptom Management Basics: Dermatologic Complications ONS Voice articles: Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy Follow the Evidence When Using Scalp Cooling for Cancer Alopecia Reimbursements Are Making Scalp Cooling More Accessible for Patients With Cancer The Case of the CIA-Combatting Combination ONS Voice oncology drug reference sheets: Docetaxel Doxorubicin Hydrochloride Sacituzumab Govitecan-Hziy ONS Guidelines™ for Cancer Treatment-Related Skin Toxicity Clinical Journal of Oncology Nursing articles: Chemotherapy-Induced Alopecia: Examining Patient Perceptions and Adherence to Home Haircare Recommendations Scalp Cooling: Implementing a Cold Cap Program at a Community Breast Health Center Scalp Cooling: Implementation of a Program at a Multisite Organization Oncology Nursing Forum articles: Effectiveness, Safety, and Tolerance of Scalp Cooling for Chemotherapy-Induced Alopecia The Effect of Chemotherapy-Induced Alopecia on Distress and Quality of Life in Male Patients With Cancer ONS Altered Body Image Huddle Card Journal of Market Access and Health Policy article: Expanding the Availability of Scalp Cooling to All Patients at Risk of Chemotherapy-Induced Alopecia HairToStay Paxman patient assistance program Rapunzel Project 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 "Some of the classes that are high risk for chemotherapy-induced alopecia can include antitumor antibiotics, such as doxorubicin, epirubicin; antimicrotubule drugs, such as taxanes like docetaxel, paclitaxel; alkylating agents such as cyclophosphamide. The lower risk alopecia-causing chemo agents are the antimetabolite classes, which a lot of people know as gemcitabine or fluorouracil. We also are seeing patients experience some degree of alopecia with a drug called sacituzumab govitecan, which is an actual antibody–drug conjugate." TS 2:09 "Scalp cooling is approved for solid tumor patients. Patients receiving chemotherapy agents, as we discussed before, with that high incidence of chemotherapy-induced alopecia really should be considered for scalp cooling as long as they don't have certain contraindications. Some contraindications do exist for these populations. Those are patients that have cold agglutinin diseases, cryoglobulinemia, cryofibrinogenemia, and any cold sensitivity issues. Patients also with abnormal liver functions are not suggested to receive scalp cooling because their liver function is associated with the metabolism of the drug agent. It's also not recommended for patients with hematologic malignancies who are higher risk for cutaneous metastatic disease or failed chemotherapy and even reduced survival rates." TS 9:23 "Overall, scalp cooling has a good tolerance, but it's important to be aware that scalp cooling can be uncomfortable for some, and it isn't always tolerated by some patients. Patients have reported side effects such as headaches, dizziness, chills, cold sensations, scalp pain, head discomfort, and even claustrophobia. Among these, the most common is the cold feeling and headaches. So when caring for patients that undergo scalp cooling, the nurses really should recognize the patient's feelings and help relieve that discomfort with position changes, prophylactic painkillers such as [acetaminophen] or [ibuprofen] if they're allowed to take that, additional warm blankets. Even antianxiety medications can really help, especially if that claustrophobia feeling is there. So collaborating with that team, the doctors, the nurse practitioners, just to be aware that if the patient's not comfortable during this treatment of scalp cooling, they should have those things on board prior to starting." TS 12:23 "A lot of primary education points for nurses to review with patients is explaining the financial reimbursement process and assistance options—collaborating with that financial department within your institution. Also discussing the efficacy of the scalp cooling and the tolerability of it as well. I don't know if patients are always aware of the feeling of the cold—really warning them, letting them know what they're going to experience while in the chair attached to that cooling machine." TS 18:55 "Nurses, we're at the forefront of scalp cooling, and we manage a lot of this area that comes with the service. They are managing, the coordination of the care, the education. They're assisting with that financial discussion and collaborating with the financial department. The symptom management—they're helping make the patients feel more comfortable with the symptoms of scalp cooling. They are the real deal here, so they are the best in helping with the situation. Nurses should be really familiar with the efficacy, again, and the tolerability, the contraindications, the side effects, and the costs and even the access for scalp cooling." TS 20:57

"I think that this is an area that is exploding. Working with drug development, I see new agents all the time, with unique targets I've never heard about, with targets I have heard about used in a different way. So, I really think we're going to see more and more bispecifics. A lot of these drugs are used second line, third line, fourth line. I would not be surprised if they moved up in treatment, especially as we learn safer ways to give these drugs," ONS member Moe Schwartz, PharmD, BCOP, FHOP, professor of pharmacy practice at the James L. Winkle College of Pharmacy at the University of Cincinnati, OH, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about bispecific antibodies.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by October 3, 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: Learner will report an increase in knowledge related to the use of bispecific antibodies in the treatment of cancer. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 275: Bispecific Monoclonal Antibodies in Hematologic Cancers and Solid Tumors Episode 261: CAR T-Cell Therapy for Hematologic Malignancies Requires Education and Navigation Episode 176: Oncologic Emergencies: Cytokine Release Syndrome ONS Voice articles: An Oncology Nurse's Guide to Bispecific Antibodies Bispecific Antibodies Cross-Discipline Cancer Care ONS Voice oncology drug reference sheets: Amivantamab-Vmjw Blinatumomab Epcoritamab-Bysp Glofitamab-Gxbm Mosunetuzumab-Axgb Tebentafusp-Tebn Teclistamab-Cqyv ONS book: Guide to Cancer Immunotherapy (second edition) ONS course: ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles Other ONS resources: Bispecific Antibodies Video Bispecifics Huddle Card Cytokine Release Syndrome Huddle Card Immune Effector Cell–Associated Neurotoxicity Syndrome Huddle Card DailyMed homepage Hematology/Oncology Pharmacy Association late-breaking news article: The Emerging Use of Bispecific Antibodies with Chemotherapy in Diffuse Large B-Cell Lymphoma 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 "It was 2014 that most of us think of as the beginning of bispecifics in cancer, and that was with approval of blinatumomab. That was granted accelerated approval for the treatment of patients with Philadelphia chromosome–negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia. It is a bispecific that targets CD19-expressing tumor cells and CD3 on T cells. It's the original bispecific T-cell engager and is often called a 'BiTE.'" TS 2:11 "The term 'bispecific' means that this is an artificial protein that's developed to hit two different antigens simultaneously. They can be two different epitopes on the same antigen. They can be an antigen on a cancer cell and CD3 on a T cell that kind of recruits the T cell to the cancer. So, there are different types [of bispecific antibodies]. The subtype that we often talk about are bispecific T-cell engagers, which are those bispecifics that do target the T cell. And currently, the target on the T cell that's utilized is the CD3 molecule. That's not the only one that will be used in the future because there's a lot of work being done on other types of T-cell engagers." TS 4:21 "The targets for lymphoma are CD20. Those are bispecific T-cell engagers that hit CD20 on the lymphoma cell, as well as CD3 on a T cell. ... In myeloma, we have two different targets that have been utilized. One is BCMA or B-cell maturation antigen. That sits on the surface of myeloma cells and on some healthy B cells. ... There's also a target used in myeloma that's called GPRC5D, which stands for G protein–coupled receptor, class C, group 5, member D. ... In small cell lung cancer, there's delta-like ligand 3 (DLL3); it's part of the NOTCH pathway. ... And then this year, we've had a couple agents come out that target HER2." TS 6:52 "[Toxicities] are very dependent on what your target is. ... The bispecific T-cell engager that's used in myeloma that targets the GPRC5D is also expressed on tissues that produce hard keratin like hair follicles and actually, within the tongue. So the toxicities that we see with that agent are something you wouldn't expect to see if you were using a myeloma agent. You see nail and skin issues. You see taste problems. So it's very specific about the target, which says to me, that every time a new one of these agents comes out, I have to learn about the target that helps me learn about the toxicity. I find that fascinating and really appreciate that." TS 16:19 "Cytokine release syndrome has been one of the areas that drug development has really focused on to see how they can help mitigate the severity [of it]. ... [One of] the strategies that has been incorporated and studied in clinical trials is the step-up dosing scheme. [It's] where you give initial small doses and over time, increase the dose to the dose you're going to continue with. Usually, monitoring in the hospital is required by the FDA approval for anywhere from 28–48 hours for the first couple of doses. And that's a real common strategy that you'll see. Premedication with H2 blockers, H1 blockers, sometimes steroids. These are also things that are incorporated within the approvals of these drugs and are important to look at." TS 20:53

"I think sometimes people don't expect pediatric patients to handle radiation as well as they do. They may have a family member who also had radiation for breast cancer or for prostate cancer and they were an older adult and had really severe side effects. And then they say, 'Oh, no, I've got to put my little baby through this. I don't really want to do this.' We say kids are very different in how they handle this. They're very resilient, so we can provide good education about that," Elizabeth Cummings, MSN, CPNP-AC, CPHON®, radiation oncology nurse practitioner at Children's Hospital of Philadelphia in Pennsylvania, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radiation treatment care for pediatric patients. Music Credit: "Fireflies and Stardust" by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0   Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by September 26, 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: Learner will report an increase in knowledge related to radiation oncology treatment care for pediatric patients. Episode Notes   Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 365: Radiation-Associated Secondary Cancers Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices Episode 298: Radiation Oncology: Nursing's Essential Roles Episode 204: How Radiation Is Used in Palliative Care Episode 50: Difficult Decisions in Childhood Cancer ONS Voice articles: Fertility Preservation Protects Possibilities for Patients With Cancer Have Meaningful Conversations With Pediatric, Adolescent, and Young Adult Patients and Their Families Pediatric Cancer Survivors Require Additional Care and Monitoring Prepare Survivors for the Risk of Secondary Cancers Secondary Cancers in Pediatric Survivors ONS book: Manual for Radiation Oncology Nursing Practice and Education (Fifth Edition) ONS courses: Essentials in Survivorship Care for the Advanced Practice Provider ONS/ONCC® Radiation Therapy Certificate™ Clinical Journal of Oncology Nursing articles: Radiation Therapy Survivorship: Healthcare Providers' Perspectives on Education and Care Radiation Therapy: Understanding the Patient Experience Reducing Pediatric Patient Anxiety: Implementing a Nonpharmacologic Intervention to Aid Patients Undergoing Radiation Therapy Other ONS Resources Inclusive Care Learning Library Late Effects of Cancer Treatment Huddle Card Proton Therapy Huddle Card Radiation Huddle Card Radiation Learning Library Oncolink Jr. Pediatric Radiation Oncology Society  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  "I think one of the things to think about with kids is sometimes they're not as forthcoming with what's going on, and sometimes it's a little bit harder to understand. Sometimes that's just because developmentally, they're much younger. A 1-year-old can't exactly tell you what's wrong. And so you're really trying to figure it out based on their cues versus a teenager who can tell you, but maybe they're too embarrassed about something in a way that an adult might not be." TS 7:01 "Child life specialists are incredible. ... They provide age-appropriate education and explanations for patients, so talking to a 3-year-old about cancer is very different from an 8-year-old or even a teenager. They really are able to meet each patient exactly where they are and at the level that they are, and then provide the appropriate amount of information, which is so helpful for a patient since they learn to build trust and cope with their treatment and [they feel like they] have somebody who can relay that information in a clear and concise way." TS 11:16 "There's certainly growing concern about the potential effects of anesthesia on brain health, especially in a vulnerable population like very young children, which are the ones who need anesthesia. We really try to mitigate this by optimizing our anesthetic agents, so we'll use propofol, which has a really quick onset and offset. And even when the radiation treatment is done, they'll stop the propofol in the radiation room—even though they are still walking back to recovery, just to minimize the amount of time that it's on—and trying to use the lowest dose possible. We also [explore] a lot of nonanesthetic strategies, [like] child life support, trying to introduce video distraction when we can, and having music and audiobooks." TS 17:47 "[In] pediatrics, the patient, not the parent, is your patient. And that can look really different for a 3-year-old versus a 17-year-old. Somebody who can't officially sign consent, but they certainly have a lot of buy-in about the things that reach their body, versus a 3-year-old, where the parents are really taking ownership of that. I think sometimes it's tricky in the world of pediatrics as we think about the ethics of 'Who are we training here? Is it the patients? Is it the parents?' And we continue to advocate for our patients." TS 23:32 "I think that pediatric patients still want to be normal kids. They still want to do their normal activities. ... Our pediatric patients, a lot of times, have healthier tissues. They haven't seen as much wear and tear. They haven't developed the bad habits of some adults. They don't have the same environmental exposures, they're not smoking, they probably have fewer comorbidities. ... They're a different population. ... They're just amazing. They still want to be a kid, they still want to go to school, they still want to be with their friends. It's really encouraging to see that." TS 36:03 

"As ONS continues to look ahead, its commitment to shaping the future of oncology nursing remains unwavering. ONS is proactively developing the tools, capabilities, and strategies needed to support oncology nurses in a rapidly evolving healthcare landscape. ONS will continue to set the standard, ensuring that oncology nurses are equipped with clinical expertise, collaborative skills, technology proficiency, and mentorship necessary to thrive," ONS member Diane Barber, PhD, APRN, ANP-BC, AOCNP®, FAANP, FAAN, member of the ONS 50th anniversary committee, said regarding the continuously changing roles of oncology nurses. Barber spoke with ONS members Danelle Johnston, MSN, RN, HON-ONN-CG, OCN®, RuthAnn Gordon, MSN, RN, FNP-BC, OCN®, Tamika Turner, DNP, NP-C, AOCNP®, and Bertie Fields, MS, RN, about their experience in nursing roles in navigation, clinical trials, advanced practice, and the pharmaceutical industry and how these roles have evolved and may change in the future. The advertising messages in this episode are paid for by Natera. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Episode Notes  This episode is not eligible for NCPD. ONS Podcast™ episodes: ONS 50th anniversary series Episode 331: DNP and PhD Collaboration Strategies to Help Advance Oncology Care Episode 312: Virtual Nursing in Health Care Episode 304: Nursing Roles in FDA: The Drug Labeling and Package Insert Process Episode 302: Patient Navigation Eliminates Disparities in Cancer Care Episode 284: How AI Is Influencing Cancer Care and Oncology Nursing Episode 119: What Will the Future of Cancer Care Look Like in 2029? ONS Voice articles: Leadership Is the Foundational Competency for Oncology Nursing in 2029 New Technology Tools Help Oncology APRNs Improve Patient Outcomes Oncology Nurses Drive Discovery in Cancer Clinical Research The Oncology Nurse's Role in Interprofessional Collaboration in Clinical Research What the New CMS Reimbursement for Principal Illness Navigation Means for Oncology Nurses ONS books: Manual for Clinical Trials Nursing (third edition) Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (third edition) ONS competencies: Oncology Clinical Nurse Specialist Competencies Oncology Clinical Research Nurse Competencies Oncology Nurse Generalist Competencies Oncology Nurse Navigator Competencies Oncology Nurse Practitioner Competencies ONS course: Professional Practice for the Advanced Practice Registered Nurse Clinical Journal of Oncology Nursing articles: How Do I Evolve as a Research Nurse Practitioner? Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery Oncology Nurse Practitioner Competencies: Defining Best Practices in the Oncology Setting ONS Learning Libraries: Clinical Trials Nurse Navigation Connie Henke Yarbro Oncology Nursing History Center American Cancer Society National Navigation Roundtable 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 Johnston: "In the early years, navigation programs varied widely. We had minimal technology, no standardized training, and often tracked our work on spreadsheets and narrative notes. The broader healthcare team didn't always understand navigation, so educating colleagues in defining our role was essential. Today, navigation is becoming a well-established specialty. It's recognized by the Commission on Cancer, supported by [Centers for Medicare and Medicaid Services] reimbursement codes, and integrated across diverse care settings. It's backed by evidence, standardized training, and emerging technologies that improve both patient care and program sustainability. I'm proud to have witnessed and contributed to the incredible evolution, and I'm excited for what's next in advancing navigation to better support patients and families." TS 6:20 Gordon: "When I was first introduced to the [clinical trial nurse] role, there weren't published competencies in order to learn the role or any real standardization of the role. And so when you worked in clinical trials, you kind of picked up things from the providers, from the other investigators on how you should operationalize the role. We've seen that evolve. We've seen ONS develop competencies, ONS come out with the clinical trial nursing manual. And our organization has been able to use those tools to standardize the practice of the clinical trial nurse across our institution. So we take those competencies, and they are the foundation of our program. And we've been able to build our program over the last decade, mostly by the use of the tools that ONS has and the ability to share knowledge." TS 14:22 Fields: "For nurses, many of my colleagues are going on to get master's in things other than nursing. They're getting master's in public health. They're getting master's in business. I have a colleague who is in [information technology], and so we should not limit ourselves. We should expand ourselves. And the more varied degrees that we have, we are more viable candidates for positions. I was never a clinical nurse specialist, even though that was my goal, but I have done above and beyond what I ever anticipated that I would do. And there are so many more new degrees for us to make us viable in this changing environment." TS 28:30 Turner: "It is vital that the current generation of oncology nurse practitioners take the lead to mentor the next generation. The next generation needs to be educated regarding the importance of oncology nurse practitioners, filling those critical gaps in health care by caring for patients in rural areas and those areas where healthcare resources are scarce. Technology should be utilized to bring oncology care—for example, office visits, imaging, and treatments—closer to those areas where patients live further away or have difficulty accessing transportation and health care. This will provide continuity of care." TS 32:42

  "One powerful, overlooked aspect of colorectal cancer survivorship is the emotional and identity transformation that our survivors undergo—and really how little space is given in the clinical arena for that. No one really talks about this 'invisible recovery.' Facing mortality can lead to prolonged changes in values, relationships, and life goals. And these experiences aren't captured in lab results or imaging scans, but they really shape how survivors live, love, and heal and continue with their lives," ONS member Kris Mathey, DNP, APRN-CNP, AOCNP®, gastrointestinal medical oncology nurse practitioner at The James Cancer Hospital of The Ohio State University Wexner Medical Center in Columbus, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about colorectal cancer survivorship. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by September 12, 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: Learner will report an increase is knowledge related to colorectal cancer survivorship nursing considerations. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 374: Colorectal Cancer Treatment Considerations for Nurses Episode 370: Colorectal Cancer Screening, Early Detection, and Disparities Episode 201: Which Survivorship Care Model Is Right for Your Patient? Episode 153: Metastatic Colorectal Cancer Has More Treatment Options Than Ever Before ONS Voice articles: Genetic Disorder Reference Sheet: Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) Here Are the Current Nutrition and Physical Activity Recommendations for Cancer Survivors ONS course: Essentials in Survivorship Care for the Advanced Practice Provider Clinical Journal of Oncology Nursing article: Closing the Gaps: Addressing the Unmet Needs of Cancer Survivors Oncology Nursing Forum articles: Symptom Occurrence, Frequency, and Severity During Acute Colorectal Cancer Survivorship The Relationship Between Colorectal Cancer Survivors' Positive Psychology, Symptom Characteristics, and Prior Trauma During Acute Cancer Survivorship ONS Survivorship Care Plan Huddle Card ONS Learning Libraries: Colorectal cancer Survivorship Academy of Oncology Nurse and Patient Navigators American Cancer Society National Colorectal Cancer Roundtable Colorectal Cancer Alliance Colorectal Cancer Resource and Action Network Fight Colorectal Cancer Resource Library Livestrong at the YMCA Pan Ohio Hope Ride 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 "As of the most recent data, more than 1.5 million people in the United States are living as colorectal cancer survivors. So this includes not only those who are currently undergoing active cancer treatment but also those who have completed treatment and ultimately are hopefully in remission. Just a reminder that colon cancer is the third most commonly diagnosed cancer in the United States and it's the fourth leading cause of cancer-related deaths." TS 1:53 "Our colorectal cancer survivors may have significant barriers when receiving this comprehensive survivorship care, and these challenges can affect not only their physical recovery but their emotional well-being and, ultimately, their long-term health outcomes. We as oncology nurses do play a pivotal role in identifying and addressing these barriers. So these can include fragmented care. Who's caring for these patients? That care coordination between the oncologist and the oncology team and then the primary care providers and team. Limited access—so our patients that may have geographic limited access or also financial- or insurance-related obstacles to follow-up services." TS 9:10 "Our nurses can also facilitate the communication between specialists and primary care providers, so making sure that we're sending records, keeping those lines of communications open. Also, nurses can provide that psychosocial support, so our screening for distress and also advocating and supporting for referral to counseling or support groups for a patient. Nurses can also act as navigators to guide these patients through complex care systems." TS 11:21 "Some of the recommended changes—nutrition—enhancing and emphasizing fruits, vegetables, that colorful plate, with whole grains. Limit those red and processed meats, and reduce sugary drinks and alcohol. I know we will all have those patients who have read things or cancer myths about, 'Oh, cancer feeds on sugar, so I shouldn't drink anything or eat anything with sugar,' and maybe addressing that, just really emphasizing the well-rounded meals." TS 19:57 "When we think about [ourselves], 'Well, I don't have an implicit bias,' but we may not think about what that is. Some common preconceived assumptions are that survivorship equals a cure. And this assumption may overlook that chronic symptoms or those late effects and emotional needs of long-term survivors. So knowing that when a patient is coming to us on surveillance, they may be cured; they may not have active cancer, but they're still dealing with some of those chronic symptoms—and acknowledging that." TS 30:37 "There's an assumption that an ostomy equals poor quality of life, and this may stigmatize patients and discourage open conversations about adaptation and support. A couple weeks ago, I volunteered at the Pan Ohio Hope Ride, which is with the American Cancer Society, and several states have a ride that's similar. And there was a patient riding, and I could tell over his jersey that he had an ostomy bag underneath that. And I just looked at him and I thought, 'That's amazing. You are still functioning, still living, still riding a bike throughout the entire state of Ohio with an ostomy.' So he's still having that good quality of life. That doesn't stop him from living." TS 31:39