The ONS Podcast

"The question isn't simply, 'does this patient need their chemo or other cancer treatment or do they need rehabilitation?' It's often about how we can safely provide both of these things that they need. Don't assume that rehab means that cancer treatment needs to stop. The oncology and the rehabilitation teams can work with each other, especially if that starts early, and determine what we can safely coordinate," Grace Campbell, PhD, MSW, CRRN, FARN, adjunct assistant professor at the University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center in Pennsylvania, and immediate past president for the Association of Rehabilitation Nurses, told Katie Hubbard, MSN, RN, OCN®, NPD-BC, oncology clinical specialist at ONS, during a conversation about inpatient cancer rehabilitation. 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 October 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 related to inpatient rehabilitation and its role in the care of people with cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 318: Early Mobility for Hospitalized Patients Episode 58: The Power of Cancer Rehabilitation ONS Voice article: Cancer Rehabilitation Serves a Critical Role in Patient Care Clinical Journal of Oncology Nursing articles: Examining Contributors to Intent to Continue Exercising in Patients With Cancer in Rehabilitation Physical and Psychological Effects of a 12-Session Cancer Rehabilitation Exercise Program The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise American Cancer Society: Cancer Rehabilitation Association of Rehabilitation Nurses resources:  Cancer Rehabilitation and the Role of the Rehabilitation Nurse: A White Paper by the Association of Rehabilitation Nurses Learning Center Position Statement: Rehabilitation of People With Cancer (endorsed by ONS) Contemporary Issues in Cancer Rehabilitation article: A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes ECOG: Performance Status Scale Inpatient Rehab Versus Skilled Nursing Comparison National Academies of Sciences, Engineering, and Medicine book: Diagnosing and Treating Adult Cancers and Associated Impairments Rehabilitation Nursing Journal article: The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting 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 [email protected]. Highlights From This Episode "When we talk about inpatient rehab, we're really talking about a level of rehabilitation designed for patients who have significant functional impairments, often in multiple areas of function, along with having medical, nursing, and rehabilitation needs that require an inpatient interdisciplinary environment for that sort of intensive, around-the-clock care. It's important to emphasize here that rehabilitation in general, and inpatient rehab in particular, is so much more than just getting stronger." TS 1:46 "Oncology nurses are in a great position here because as we know, nurses often see functional decline before anyone else does. These can be simple things, like she used to walk to the bathroom and now she needs a bedside commode; or he used to be able to transfer independently, and now it takes two people to get him out of bed. The patient is medically ready for discharge, but their spouse or partner can't physically get them into the house because of lower extremity muscle weakness and a full flight of steps to enter the home. Those are some really key rehab signals. Some other things to watch for include new difficulty with bathing or dressing, frequent falls or near falls, wheelchair dependance when they were not previously a wheelchair user, difficulty managing stairs, and new cognitive or safety concerns. These can be very subtle, but nurses can pick up on these as well as talk with the family or the patient's significant others." TS 12:41 "It's really important that we define success from the patient's perspective. What does the patient want to do? That is really the measure of success. Some patients just want to be able to walk to the bathroom by themselves. Some patients want to be able to get in and out of a car and even drive, if that's appropriate for them. Some patients may need to go back to work. How can we, in inpatient rehab, set them up to be able to go back to work?" TS 22:06 "Rather than saying to somebody, 'We're sending you to rehab because you're too sick to go home,' we can say something like, 'You've had a huge change in what you're able to do and we want to help you regain as much independence as possible while we continue your cancer care.' And while we haven't really talked about patients with advanced cancer who may be receiving palliative care, it's important to note that even these patients may benefit from a brief inpatient rehab admission ... particularly to provide in-depth evaluation for home equipment, and to provide family training on caring for this patient, permitting them to then go home if that's what they choose. You don't have to necessarily be able to get better to benefit from inpatient cancer rehab." TS 34:05 "Rehab should be considered as a part of cancer care, not something that simply happens when cancer treatment is over. It really should be an active part of the cancer care continuum. And the final thing that I would like to leave the audience with is a simple five question framework: What could the person do before cancer? What can they do now? What has changed and why? What do they need to be able to do? And what do they want to be able to do? If we ask those questions about every patient, we are much more likely to identify patients who could benefit from rehab and from any type of rehab—inpatient, outpatient, et cetera. I think this message for oncology nurses is particularly important. You don't have to be a rehabilitation expert, but you can be the person who recognizes that something has changed. You can ask the important questions. You can document what you see, and you could get the rehab team involved early." TS 46:49

"Biomarker testing isn't just about generating more information. It's about answering very practical questions for our patients. Can we identify disease earlier? Can we understand whether treatment is working? Are we able to identify why a cancer has become resistant? Ultimately, I think that's where precision oncology becomes very meaningful. It's not about the molecular report sitting in the chart. It's about taking that information and using it to make the best possible decision for our individual patients," ONS member Erica Bello Rodriguez, MSN, AGNP, NP-C, AOCNP®, oncology nurse practitioner and supervisor of advanced practice providers at Northwell Health Cancer Institute in Westchester, NY, told Katie Hubbard, MSN, RN, OCN®, NPD-BC, oncology clinical specialist at ONS, during a conversation about precision oncology. This podcast episode was produced by ONS and is sponsored by AstraZeneca. 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 contact hours. ONS Podcast™ episodes: Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices Episode 238: Cancer Genomics for Every Oncology Nurse Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies ONS Voice articles: An Oncology Nurse's Guide to Tumor-Agnostic Therapies Gene Alterations in Circulating Tumor DNA Can Help Guide Treatment Decisions in Patients With Advanced Breast Cancer Genetic Counselors Help Patients and Oncology Nurses Predict Current and Future Cancer Diagnoses Germline and Somatic Variants: What Is the Difference? Learn How to Read a Germline Genomic Testing Report Learn How to Read a Somatic Biomarker Testing Report Oncology Nurses' Role in Translating Biomarker Testing Results Pharmacogenomics Testing Helps to Ensure That Effective Therapy Is Safe Therapy The Oncology Nurse's Role in Identifying Patients for Cancer Genetics Counseling What Is a Liquid Biopsy? ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses Clinical Journal of Oncology Nursing articles: Pharmacogenomic Germline Testing: Applications in Oncology Nursing Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence Shifting to a Biomarker Paradigm Across Cancer Care Using a Genomics Taxonomy: Facilitating Patient Care Safety and Quality in the Era of Precision Oncology ONS Huddle Cards: Genomic Biomarkers Genomic Testing Methods Pharmacogenomics Referring for Germline Biomarker Testing ONS Biomarker Guides ONS Genomics and Precision Oncology Learning Library ONS Genomics Taxonomy American Cancer Society: Precision or Personalized Medicine American Society of Clinical Oncology Publications: JCO Precision Oncology National Cancer Institute: Cancer Genomics Research 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 [email protected]. Highlights From This Episode "Some of the most important developments since 2020 have really been broader than any single variant or drug. We've seen precision oncology evolve from simply identifying a genomic alteration to developing a much more comprehensive understanding of what is driving an individual's cancer and how we can act on that information. One major development has been the expansion and accessibility of comprehensive biomarker testing and next-generation sequencing. We're able to identify more of the molecular characteristics of a tumor, and those findings can increasingly help inform treatment decisions and clinical trial opportunities for our patients. We've also seen the continued evolution of tumor agnostic therapy, which represents a really important shift in how we think about cancer treatment." TS 3:52 "Nurses have become increasingly important as a translator and advocate. Genomic reports are incredibly complex, and patients don't necessarily understand terms such as 'pathogenic variant,' 'actionable biomarker,' or 'tumor agnostic therapy.' Nurses are often the people who have meaningful relationships with the patients, and they have to take that complex science, simplify it, and highlight it for them. ... The science is becoming more precise but the need for a nurse to make that science understandable and patient-centered is becoming even greater." TS 7:12 "I'm really excited about circulating tumor DNA, or ctDNA. For example, I think about a patient with stage III colon cancer who has completed treatment with curative intent. Her scans may look completely clear and clinically, she looks great, but we're beginning to use ctDNA to look for molecular residual disease. Essentially, we're trying to determine whether there may be microscopic disease present that we just can't see on imaging yet. For that patient, a positive ctDNA result could tell us that there may still be disease at a molecular level, even though the computed tomography (CT) scan looks normal to us. It also has the potential to help us monitor disease over time, understand treatment response, and identify emerging resistance. I think that's really exciting because historically, we thought about biomarkers more as a snapshot. With ctDNA, we're beginning to think about biomarkers as something we can follow longitudinally. I think it's important to acknowledge that we're still learning exactly when ctDNA results should change treatment, but the potential is enormous." TS 9:09 "We have incredible biomarker-driven treatments, but not every patient has equal access to comprehensive testing, genetic counseling, clinical trials, or the therapies a biomarker may identify. Access can vary based on geography, insurance coverage, the healthcare system, and many other external factors. So one of the challenges is making sure that precision oncology doesn't become something that's only available to patients who have the resources to navigate the system. We really need to work on helping those that don't have as much access." TS 18:14 "If I had to summarize where I think we're headed, I would say we're moving from precision oncology being a snapshot of a patient's cancer to something much more longitudinal. ... We're going to be better at understanding what's driving the cancer, how it's changing, how it's responding, and hopefully intervening earlier and more precisely. Ultimately, I think the goal is to not just give more information, but to provide better decisions and better outcomes for our patients." TS 24:36

"The most important thing related to hypersensitivity reactions is that there is often a potential for rapid progression, and that's what makes these reactions an oncologic emergency. The patients may have symptoms that are mild, and that quickly can progress to respiratory compromise, hypertension, cardiovascular issues, or anaphylaxis. Early recognition is so important, so we don't want to wait for our patient to become hypotensive or significantly hypoxic before we identify that they're having a serious reaction," ONS member Christina Matousek, DNP, RN, OCN®, patient education specialist at Smilow Cancer Hospital in New Haven, CT, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about hypersensitivity reactions. 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 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 managing hypersensitivity reactions in people receiving antineoplastic therapies. Episode Notes  Complete this evaluation for free NCPD. ONS Podcast™ episodes: Oncologic Emergencies 101 series Episode 395: Pharmacology 101: Monoclonal Antibodies Episode 299: Pharmacology 101: Plant Alkaloids Episode 286: Pharmacology 101: Alkylating Agents Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction ONS Voice articles: Master Hypersensitivity Reactions With These Strategies for Prevention and Management Nurses Have Immediate Access to Necessary Medications and Supplies With Hypersensitivity Reaction Kits Oncology Drug Reference Sheet: Carboplatin Oncology Drug Reference Sheet: Docetaxel Oncology Drug Reference Sheet: Paclitaxel ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging Course: ONS Oncologic Emergencies™ Clinical Journal of Oncology Nursing articles: Early Recognition and Response of Chemotherapy-Induced Hypersensitivity Reactions: A Nursing Discussion Prophylactic Protocol for Carboplatin Hypersensitivity in High-Risk Patients With Gynecologic Cancer How Do Oncology Nurses Feel During a Hypersensitivity Reaction? ONS Oncologic Emergencies Learning Library ONS Huddle Card: Anaphylaxis 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 [email protected]. Highlights From This Episode "Traditionally, hypersensitivity reactions are divided into four different types. Type 1 are reactions that are immediate, which are often IgE mediated and are the reactions we tend to worry most about during an infusion because they can lead to anaphylaxis. Our types 2, 3, and 4 involve different immune mechanisms and may have a more delayed presentation. But clinically, when an oncology nurse has a patient receiving an infusion and the patient suddenly says something doesn't feel right, our first priority isn't necessarily identifying the exact immunologic mechanism. It's recognizing the reaction, stopping or pausing the agent according to one's institutional protocol, assessing our patient, and then determining how severe the reaction is." TS 2:08 "The first step always, always, always is to stop or pause the infusion according to the medication and institutional protocol, and then you're immediately assessing the patient. The patient may say to you, 'I have an itchy throat.' And while they're stating that, I'm going over and shutting off the pump immediately. Treatment after that really depends on the severity of symptoms. So when the nurse is doing their assessment, they're going to be assessing, of course, airway, breathing, circulation, so our ABCs. They're going to be obtaining vital signs. They're going to get an O2 saturation. Stay with the patient, of course. Call for assistance. And then notify the appropriate provider and activate any institutional hypersensitivity protocol." TS 6:44 "For patients who still need a medication that caused a reaction, there are desensitization protocols that may sometimes allow the medication to be administered safely. These protocols use carefully controlled, progressively increasing doses, but it does require specialized monitoring and collaboration with oncology, pharmacy, and allergy specialists to ensure that the patient receives the medication safely. The most important thing is that a rechallenge should never be an automatic decision, and it really should be based on the patient's individual risk–benefit assessment and an established protocol within the institution itself." TS 11:50 "I think that this is an area where simulation and competency-based education are incredibly valuable. I know at my institution, we train all of our nurses on giving chemotherapy after they take the ONS chemotherapy immunotherapy course. We actually have our own chemotherapy skills day, and we do a simulation on hypersensitivity reactions. I think it's one thing to read a hypersensitivity protocol. I can give anyone an algorithm and tell them to read it and memorize it. But I think it's another thing to have a patient suddenly become short of breath or hypotensive when you're administering chemotherapy. The nurses really need opportunities in a safe space to practice recognizing symptoms, grading the severity of the reaction, activating the appropriate response, and locating and administering emergency medications." TS 17:27 "I think we don't talk about the psychological trauma that can happen of having a reaction to these types of drugs. For instance, someone has cancer; they're coming in for a medication that you know that they need. And suddenly they feel that they can't breathe, and they're watching the entire healthcare team rush into their room. Even when the reaction is managed successfully, the patient remembers that. So when they come in for their next infusion, they're not just receiving chemotherapy. They may be thinking, 'Is this going to happen again?' And so that's why I think oncology nursing really matters. We can explain what happened, what we're changing, what we're going to do to prevent this from happening in the future, and what we're going to do if symptoms occur again." TS 22:33

"The accumulation of these malignant and reactive cells, that's what causes the lymph nodes to get big. That's why they grow. And that's why the classic presentation is persistent, painless, enlarged lymph nodes. So when we think of the pathophysiology of Hodgkin lymphoma, there are really two processes contributing to the presentation: One is the physical effects of enlarging lymph nodes or the involved organs. The second is the systemic inflammatory response generated by it and its surrounding immune environment," ONS member Victoria Krogg, DNP, APRN-CNP, AOCNP®, nurse practitioner at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, OH, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about an overview of Hodgkin lymphoma for oncology 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 October 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 pathophysiology and diagnosis of Hodgkin lymphoma. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 208: How to Have Fertility Preservation Conversations With Your Patients Episode 184: Oncologic Emergencies 101: Tumor Lysis Syndrome ONS Voice articles: Diabetes May Increase Hematologic Cancer Risk and Mortality Have Meaningful Conversations With Pediatric, Adolescent, and Young Adult Patients and Their Families Non-Hodgkin Lymphoma Symptoms, Diagnosis, Treatment, and Survivorship Recommendations Clinical Journal of Oncology Nursing articles: Non-Hodgkin Lymphoma: Examining Mycosis Fungoides and Sézary Syndrome in the Context of Oncology Nursing The Unexpected Cancer Journey: Navigating Cancer as Adolescents and Young Adults Tumor Lysis Syndrome in Solid and Hematologic Malignancies: A Guide for Early Detection and Intervention ONS Huddle Cards: Fertility Preservation Oncogenic Viruses Tumor Lysis Syndrome ONS Symptom Management Resource: Fatigue Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library Blood Cancer United: Hodgkin Lymphoma Lymphoma Research Foundation: Hodgkin Lymphoma National Comprehensive Cancer Network 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 [email protected]. Highlights From This Episode "Hodgkin lymphoma can be diagnosed at virtually any age but is more common in younger patients as well as older adults. It kind of skips middle-aged people, but it occurs in our geriatric population as well. There are different prognostic implications depending on the group of patients that are diagnosed with Hodgkin lymphoma. As far as risk factors ... Hodgkin lymphoma is not considered a hereditary disease. There's not a specific gene we know of today that can be passed down to children and put them at risk. But if there is a first-degree relative affected by a lymphoma, we do find that noteworthy. We do consider it a risk factor. But that risk factor isn't necessarily a hereditary component so much as it is having that same genetic susceptibility to Hodgkin's or perhaps sharing common environmental exposures." TS 5:46 "Sometimes the subtypes of Hodgkin lymphoma can vary in terms of presentation. It's certainly not textbook how someone can present. But generally, we worry about enlarged lymph nodes, especially if they are notably enlarged to the point where someone can even see them when they're standing a few feet away from that individual. ... We also worry about what we call B symptoms, related to B lymphocytes, such as unexplained and persistent fevers, drenching night sweats, unexplained weight loss, and new progressive fatigue. ... Interestingly, there is a phenomenon where sometimes people who have an underlying Hodgkin lymphoma will experience lymph node pain or tenderness when they drink alcohol. It's kind of a unique presenting symptom. But I also want to point out that you don't have to have all of these symptoms. A lot of patients are relatively asymptomatic, meaning without symptoms." TS 8:37 "It's always important to consider if there is any very obvious infectious or inflammatory correlate that could explain the enlarged lymph node. Something I've seen in my practice is someone gets a flu vaccine in their right arm and then a couple of days later they notice a lump in their right armpit. And yeah, it might be a flared lymph node, but they also had a vaccine in their arm recently, which would stimulate your lymph node, because the purpose of the vaccine is to have an effect on the immune system. So I always want to make sure—is there something really obvious that could explain these lymph nodes being abnormal? A recent tattoo, recent injury, or infection proximal to where that enlarged lymph node is? So, you have to think of all of that when you're thinking of the differential diagnoses that come to mind." TS 19:19 "Nurses can be monumentally helpful with the education role with any patients who may have lymphoma. It would be helpful if nurses guide patients on the diagnostic process, providing support, guidance and encouragement, and of course, advocating for patients. Also, when you think of Hodgkin lymphoma and you think of the younger patients that are diagnosed with it, there's some additional supportive care that we need to consider, and we may need to refer them for fertility preservation. That can be very daunting for our young patients, so it's helpful to have nursing support in those situations." TS 22:55 "People think of Hodgkin lymphoma as a very treatable disease—and it can be very curable for certain patient populations—but it's not a 100% success rate. We do still have fatalities, so it's a very serious thing. I try to always educate my patients about seeking out care if they notice new lumps or bumps on their bodies. We can observe enlarged lymph nodes most easily on the neck, under the armpit, and in the groin area. If someone were to notice a lump in that area, short-term observation—keeping an eye on it for two weeks is fine—but if it persists past that, they should definitely seek care to get it evaluated." TS 33:18

"Nurses are the front line. Oncology nurses see their patients almost all day. If you're noticing that anxiety is causing significant distress or anxiety is disrupting a patient's ability to concentrate during medical conversations or decision-making—anytime you're seeing significant distress or disruption to functioning, that's a pretty good indicator that referral to a psychiatric nurse and psychiatric care could be very helpful for that patient," Amber Altidor, DNP, APRN-FPA, PMHNP-BC, assistant professor at Rush University College of Nursing and psychiatric nurse practitioner at Optimal Mental Health PLLC and Rush MD Anderson Cancer Center in Chicago, IL, told Katie Hubbard, MSN, RN, OCN®, NPD-BC, oncology clinical specialist at ONS, during a conversation about oncology and psychiatric nurse collaboration to support psychosocial health. 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 September 25, 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 of how oncology nurses can collaborate with psychiatric nurses to support the psychosocial health of people with cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology Episode 421: Medical Trauma in Oncology Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care Episode 240: Spirituality in Cancer Care Episode 219: Use Acupuncture and Acupressure to Manage Cancer Symptoms and Side Effects ONS Voice articles: Anxiety and Depression Are Biggest Concerns for Patients With Cancer, Survivors, Caregivers AYA Cancer Survivors Experience Five Times Higher Depression Rates Than Individuals Diagnosed at Older Ages Guidelines Define the Role of Integrative Oncology Care for Managing Anxiety and Depression in Adults With Cancer Natural Language Processing Can Tell You Which Patients May Benefit From Psychosocial Referrals Physical Activity, Psychological Care Reduce Cancer-Related Fatigue What Assessment Tools Are Used for Patients With Cancer and Psychiatric Diagnoses? ONS course: Psychosocial Dimensions of Cancer Care™ Clinical Journal of Oncology Nursing articles: Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach Psychosocial Distress Screening: An Educational Program's Impact on Participants' Goals for Screening Implementation in Routine Cancer Care Oncology Nursing Forum articles:  Effects of Expressive Writing on Psychosocial Symptoms and Quality of Life in Patients With Breast Cancer: A Systematic Review and Meta-Analysis Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers The Distress Thermometer: Cutoff Points and Clinical Use ONS Symptom Management Resources:  Anxiety Depression Fatigue ONS Coping Huddle Card American Cancer Society: Therapy, Counseling, and Support Resources for People With Cancer American Psychological Association: Patient Health Questionnaire-9 (PHQ-9) American Psychosocial Oncology Society:  Distress Screening Resources for Psychosocial Oncology Professionals Columbia-Suicide Severity Rating Scale (C-SSRS) Generalized Anxiety Disorder 7-Item (GAD-7) Scale National Comprehensive Cancer Network  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 [email protected]. Highlights From This Episode "Cancer is traumatic. It's sudden. And many patients have not previously had a serious health condition, so in the beginning, they're just kind of focused on survival. Get the biopsy done. Have the conversations with teams. Have the imaging that's recommended. Many, many appointments. The medical appointment burden is very high. Sometimes patients are not processing what's happening in the moment. Sometimes we also see some lingering symptoms of trauma as care goes on as well. Sometimes patients are having intrusive thoughts and flashbacks to their cancer experience too." TS 4:55 "The National Comprehensive Cancer Network, or NCCN as we commonly refer to it, created a distress thermometer that can be provided to patients each during each encounter at a cancer center. It has an actual written thermometer on it where patients can rate their distress from 0–10: 0 being none, 10 being the most extreme that they could imagine. A score of 4 or higher for most cancer centers would indicate that the patient needs further evaluation and referral to psychosocial or supportive care services. There's also a section on the distress thermometer handout where patients can identify specific areas for concern. And that's really helpful for the healthcare team because we can take a look at exactly what that patient is noting as contributing to their distress." TS 9:33 "When we start to notice that there are significant sleep issues that are not responding to just psychotherapy on its own, or if there is significant depression, anxiety symptoms that are moderate to severe, or other underlying psychiatric concerns that are more chronic in nature ... at that point, it's important for the multidisciplinary team to start thinking about a referral to psychiatry and medication management. Medications can be very effective for treating those symptoms, so it's important for nurses to assess using the skills that we discussed to identify those categories for severity and think about medication management at that point." TS 16:01 "I think that it's important to remember that there's a stigma about cancer, but there's also a stigma about accessing mental health care as well. As nurses, we definitely want to be aware of that and address that with patients. Do you have any specific concerns about what it means to be someone who is seeking therapy services or someone who's seeking medication for symptom management? What does that mean to you, to your community, to others in your religion? Talk with me about this stigma that you're experiencing. Patients need a chance to process that. Oncology nurses certainly can identify if a patient has some ambivalence towards seeking psychosocial care and explore that with them or refer them to a therapist or a psychologist." TS 23:09 "Grief is not linear, so it's important to educate patients after you tell them about the stages that we talked about earlier. Remind them that grief is not linear. It's very common to at one time feel like you're angry, and then also feel sad, then also go back to a sense of, 'This is not real. This is not happening.' So remind your patients that it's not linear. This is something that we can continue to talk about, continue to process, so that they can feel a sense of acceptance. We don't want grief to become complicated and just kind of persist long term. We talked about how there's that survival mode that patients are in, so they don't always have a chance to process in the moment." TS 30:14