The Oncology Nursing Podcast

Oncology Nursing Society

  • 34 minutes 46 seconds
    Episode 356: A Nurse’s Guide to the 2024 NIOSH List of Hazardous Drugs

    “And so you have different kinds of hazards with the drugs that you’re using. That means that in the past, when a lot of oncology drugs, antineoplastic drugs used to treat cancer would have been added, you may see that a lot of oncology drugs either weren’t added or they’re added in a different place on the list than they were in the past. That’s due to some of the restructuring of the list we’ll probably talk about later,” Jerald L. Ovesen, PhD, pharmacologist at the National Institute for Occupational Safety and Health (NIOSH) and Centers for Disease Control and Prevention, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the latest update to the NIOSH list of hazardous drugs. 

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

    Licensed under Creative Commons by Attribution 3.0  

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “So we look for a carcinogenic hazard. So does this molecule, does this chemical, this drug, have the ability to increase the risk of cancer? A lot of the time that will also tie with genotoxic hazards, but not always. There are some drugs on the list that are carcinogenic through other mechanisms. Sometimes carcinogenicity can be related to hormone signals, can lead to increased risk of cancer. There’s some nuance there, but is it a carcinogenic hazard? That can get it onto the list. Is it a developmental and reproductive hazard?” TS 10:48 

    “NIOSH can’t say what’s right for every situation, but some organizations have suggested further precautions such as temporary alternative duty for workers who are pregnant or are looking to become pregnant. NIOSH can’t say what’s best for any given facility, but other organizations have given some good suggestions you may want to look into.” TS 13:18 

    “The list doesn’t really rank hazard. I know a lot of people have kind of treated it that way a lot of times. We don’t say that something is less hazardous if it’s only a developmental or reproductive hazard, because if you’re trying to have a child, then that’s an important hazard to you. And we don’t necessarily say something that’s carcinogenic is more hazardous.” TS 14:34 

    “Some standard setting organizations have set standards for handling. Really in the oncology setting, particularly oncology pharmacy setting, it’s really changed how some of the handling happens there because some of the standards come out of the pharmacy world. And what’s happened there is some drugs that are oncology drugs, they might have been on table one before just because they were used in the treatment of cancer. They were antineoplastics, so they were on table one. Now, because they’re not identified as a potential carcinogen and they don’t have manufactured special handling information, they are now on table two.” TS 23:39 

    “Occasionally, if a drug comes out and has manufacturer special handling information, we’ll go ahead and add it to the list. And since we won’t add it into the publication, we typically have a table on that page that puts that there. If a drug is reevaluated and we find that the hazard is not as bad as expected or it’s not a hazard, actually, and we can remove it from the list; sometimes we get new information and that happens.” TS 30:30 

    28 March 2025, 7:00 am
  • 29 minutes 46 seconds
    Episode 355: Pharmacology 101: Hedgehog Pathway Inhibitors

    “I genuinely think nurses and pharmacists need to know why these medicines are called hedgehog inhibitors so that we can, in fact, effectively educate our patients. Just because to date, this class has the weirdest name I’ve encountered, and I almost expect at this point that my patients are going to ask me about it. I think that we need to be informed that, just on, where do these names come from, why is it called this, and does it matter to my patient?” Andrew Ruplin, PharmD, clinical oncology pharmacist at 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 hedgehog pathway inhibitors. 

    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 March 14, 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 hedgehog pathway inhibitors used for cancer treatment. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “Many patients unfortunately will have side effects with this class. I mean—and I know that’s not controversial—but you actually find callouts in some of the kind of the national consensus guidelines. These treatments might not be tolerable for a decent number of patients. Some of these side effects can certainly reduce quality of life. Again, nothing that controversial here when we say it out loud, but just the frequency with which it occurs can make it quite difficult for some patients.” TS 9:13 

    “Certainly, based on what we said before, I think one of the easiest things to do for patients starting this class is to just make sure that they have really classical supportive medicines like antidiarrheals and antiemetics before they start treatment. Diarrhea, nausea occurred in about 20%–40% of patients across trials. So certainly patients should be aware of that risk. Again, not a controversial side effect, but it’s just simple things we can do to make sure that our patients are quick to start treatment is to make sure that they have these medicines and they’re educated on how to use them.” TS 11:21 

    “I think patients need to be aware that side effects, as I had mentioned before, can be especially frequent with this class. So for a patient, they need to be aware that communicating your needs to your oncology team is really crucial to their own ability to use these treatments with minimal interruptions.” TS 14:45 

    “I think that regardless of whoever is following up with our patients, though, as our arsenal of oral anticancer therapies does continue to expand, both nurses and pharmacists need to have specialized knowledge of these agents to be successful in their patient care roles.” TS 18:28 

    “When there are clear recommendations for reproductive health, as I summarized before with these agents, I obviously think we need to be aware of them and not just defer to these generic recommendations. Because if you just defer to, ‘Well, use barrier contraception and then for a week after your last dose,’ you know, ‘Okay, it’s not true with these agents.’” TS 24:37 

     
    21 March 2025, 7:00 am
  • 43 minutes 37 seconds
    Episode 354: Breast Cancer Survivorship Considerations for Nurses

    “You can give someone a survivorship care plan, but just giving them doesn’t mean that it’s going to happen. Maybe there’s no information about family history. Or maybe there’s information and there’s quite a bit of family history, but there’s nothing that says, ‘Oh, they were ever had genetic testing,’ or ‘Oh, they were ever referred.’ So the intent is so good because it’s to really take that time out when they’re through with active treatment and, you know, try to help give the patient some guidance as to what to expect down the line,” Suzanne Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, professor emeritus at Saint Louis University in Missouri, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about breast 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 March 14, 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 breast cancer survivorship. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “I think the biggest thing is to really communicate is that people are living with breast cancer for a long, long periods of time, and a lot of that with really good quality overall.” TS 4:07  

    “As a general rule, they’re going to be seen by the breast surgeon probably every four to six months for a while. After about five years, a lot of times people are ready to say, ‘Okay, annually is okay.’ And eventually they may let that drop off. But it also depends on did they have a mastectomy? Did they have breast conserving surgery? And then if they had reconstruction with an implant, how often do they see the plastic surgeon? Because they need to check integrity of the implant. So those schedules are really individualized.” TS 13:24 

    “When you think about long-term effects, I think you need to kind of think about that survivors can have both acute and long-term chronic effects. And a lot of that depends on the specifics of the treatment they had. I think as oncology nurses, we’re used to, ‘We give you this chemotherapy or this agent, and these are the side effects.’” TS 15:36 

    “The diet issues are huge. And I think we are slow to refer to the dietician, you know, you can get them a couple of consults and because you’re saying to them, ‘This is really important. We need you to lose weight or we need you to eat more of this.’ Ideally, fruits and vegetables are going to be about half of your plate. And what’s the difference between a whole grain and not, less processed foods, making sure that they’re getting enough protein. And then once again, really kind of making sure that they’re not taking a lot of supplements and extra stuff because we don’t really understand all that fully and it could be harmful.” TS 34:53 

    “Breast cancer is a long, long journey, and I think you should never underestimate the real difference that nurses can make. I think they can ask those tough questions. And I think ask the questions that are important to patients that patients may be reluctant to ask. I think giving patients permission to talk about those less-talked-about symptoms and acknowledge that those symptoms are real and that there are some strategies to mitigate those symptoms.” TS 42:28 

     
    14 March 2025, 7:00 am
  • 42 minutes 10 seconds
    Episode 353: ONS 50th Anniversary: Evolution of Oncology Nursing Certification

    “The response was, in my opinion, sort of overwhelmingly positive. I think all of us old-timers who were at ONS Congress® in 1986 remember those 1,600 nurses waiting in line to enter the ballroom to take that inaugural exam. It takes a while to check in 1,600 people. They kind of all filled up the lobby outside of the ballroom, and then they spilled over down into the escalator, and the escalators had to be turned off,” Cyndi Miller-Murphy, MSN, FAAN, CAE, first executive director of the Oncology Nursing Certification Corporation (ONCC), told Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, ONS member and member of the ONS 50th anniversary committee, during a conversation about the evolution of oncology nursing certification. Beaver spoke with Tony Ellis, MSEd, CAE, ICE-CCP, executive director of ONCC, and Miller-Murphy about the history, current landscape, and future of certification in oncology nursing.

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod

    Licensed under Creative Commons by Attribution 3.0 

    Episode Notes 

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

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

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

    Highlights From This Episode

    Miller-Murphy: “Oncology nursing is a highly specialized area with a broad, well-defined body of knowledge, and it’s essential for employees and healthcare consumers to be able to identify nurses who have demonstrated that they possess the knowledge that’s necessary to practice competently in the specialty. Nurses who become certified take that essential step to publicly demonstrate their knowledge. And I believe this makes them a known commodity, so to speak.” TS 1:49

    Ellis: “Oncology nursing is an area of high-stakes patient care, and a core purpose of certification is to safeguard the public. This is certainly an area of health care that benefits from having that role of professional certification being played, from the knowledge requirements to the practice hours that a nurse must have, to the performance on the exam and continued competence required to maintain the certification. Our certifications hold nurses to a higher standard, which helps protect the public in the care that they provide.” TS 2:45

    Miller-Murphy: “A group of, I think, 200 nurses got together at an American Cancer Society conference back in 1980 to discuss the desire for certification in ontology. Nurses wanted a way to verify their specialized knowledge and skills. They wanted to raise the level of professionalism, and ONS was the most appropriate organization to develop the certifications. And by 1983, a survey of members revealed strong interest in specialty certification in oncology.” TS 5:29

    Ellis: “The pace of change in oncology care is really the challenge for certification programs proper right now. There’s so many wonderful advances—oncology treatments and drugs that are coming to the market that are being used in non-oncology settings and other advancements in the practice, that keeping up with that change puts pressure on certification programs because they must validate knowledge and practice that has become standard. It has to have been in the practice long enough that whatever the content, whatever the practice is that you’re testing on, that there is one single correct answer. So you can’t necessarily test on the very latest of what has come to the market or to the practice. The other flipside of that is that pace of change, the new emerging things in the practice create opportunities for other kinds of credentials.” TS 24:31

    Ellis: “What we have found is that there are thousands and thousands of oncology nurses that are practicing at a level and doing specialized work beyond the scope of the OCN® body of knowledge—so at the master’s level, PhD, especially with the advent of the DNP, and there is work there. And this really came out of our work to update the advanced oncology nurse competencies. … So the new certification is the Advanced Certified Oncology Nurse, or the ACON. In certification, and it is suited for those nurses that are practicing at that higher level.” TS 32:52

    7 March 2025, 8:00 am
  • 40 minutes 8 seconds
    Episode 352: Pharmacology 101: Epigenetics

    “Now, what we found is that epigenetics is actually heritable and it’s actually reversible. And we can now manipulate these principles with pharmacotherapy drugs,” Eric Zack, RN, OCN®, BMTCN®, clinical assistant professor at Loyola College Chicago Marcella Niehoff School of Nursing in Chicago, IL, and RN3 at Rush University Medical Center in Chicago, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the epigenetics drug class. 

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

    Licensed under Creative Commons by Attribution 3.0  

    Earn 0.75 contact hours (including 40 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 28, 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 epigenetics drug class. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “Epigenetics is influenced by several factors. Right now, there’s about seven of them that we’ve identified, and we can only manipulate right now about two of those seven. So the first one is DNA methylation. When you methylate DNA, that’s adding or subtracting a methyl group, which is CH3, chemically. The addition of methyl to DNA tightens the DNA around the chromatin, which then can block some genes from being expressed.” TS 7:21 

    “Histones basically package DNA into the chromatin, which is a mixture of DNA and proteins, and they spool around this structure like the DNA is coiled around that. And again, it has to do with how tight or loose that is coiled. That determines if the genes are expressed or not. And again, we found that histones also play a role in DNA repair as well as regulating the cell cycle.” TS 8:21 

    “When we’re dealing with the azacitidine and decitabine, these drugs cause pancytopenia. Pancytopenia is neutropenia, thrombocytopenia, and anemia. So it affects the complete blood count. We see GI toxicity, nausea, vomiting, diarrhea, constipation, sometimes mouth sores, and urticaria—hives.” TS 15:34 

    “It’s really, really important to take these drugs exactly as they are prescribed. They have to follow the doctor’s orders carefully, which requires taking them properly, doing the proper follow up. There’s a lot of blood tests and appointments that we have to do to make sure that everything is okay. And again, because we know when there is nonadherence, the disease progresses and becomes resistant, so that’s a really, really important teaching point. We have to monitor the patient for expected side effects and unexpected side effects.” TS 23:58 

    “Now, we expect the landscape to change dramatically over the next few years. And again, it’s just an explosion of science information. As we learn more about the science, it’s going to translate into practice. We’re always identifying new biomarkers. These biomarkers are essentially DNA mutations or variations. There’s so many variants of unknown significance.” TS 30:02 

    “Every patient deserves biomarker testing. Very important, whether it’s through IHC, polymerase chain reactions, or the most common next-gen sequencing. Again, there’s several companies out there that have standard kits available.” TS 31:33 

    “This is a precision medicine. This is what we’ve always dreamed about—tailoring the treatment to the specific patient. We’ve gone away from treating standard diseases, like lung cancer and breast cancer, the way they’re supposed to be treated to now looking at these biomarkers and using epigenetic drugs and other medications tailored to those variants that that patient is having, not necessarily based on their disease type.” TS 33:59 

     
    28 February 2025, 8:00 am
  • 22 minutes 29 seconds
    Episode 351: What It’s Like to Develop Symptom Intervention Resources

    “It is very much a collaborative group process. There are group meetings where we come to consensus on our different ratings. There’s so much support from ONS staff, even amongst our different groups, even when you’re assigned to one peer reviewer. Let’s say you go on vacation, sometimes we’re paired with other people, too. So there is some flexibility in the opportunity as well,” Holly Tenaglia, DNP, APRN, AGCNS-BC, OCN®, lecturer at Old Dominion University in Norfolk, VA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about what oncology nurses need to know about volunteering as a reviewer for ONS’s symptom intervention resources. 

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

    Licensed under Creative Commons by Attribution 3.0  

    Episode Notes  

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

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

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

    Highlights From This Episode  

    “As far as how it would help oncology nurses, we try to make it honestly simpler by doing the legwork of reviewing the evidence, synthesizing what the rating of the evidence and what it means. And then as you’ll see on the symptom intervention resource, you’ll see kind of a snapshot of what our recommendations are for applying it to practice.” TS 7:46 

    “I am a clinical nurse specialist and now that I work in academia, this is a very important skill for me to build and have in my profession. Also, those group meetings that we have, I really appreciated being able to learn from others and then being able to teach that to others. So in this second round, for example, the thing that I’ve really enjoyed personally is actually being able to mentor somebody that maybe hasn’t done it as often and just being able to watch them grow and improve in their skills while you provide feedback.” TS 9:05 

    “We get a new article about every two weeks, and this involves about a week for myself and then about a week or less than that for my partner to go through this process as well. So being able to manage your time to afford your partner the time to solidly look through the article as well. And then being able to collaborate and receive feedback from your peers.” TS 13:06 

    “There have been times where the evidence has not given us the results that I think we were assuming we would see. And so while the standardized tools mitigate some of the bias, we do recognize that it won’t remove the bias entirely, but it does help make your view more objective. What are some common misconceptions about developing symptom intervention resources? I’d say personally, I don’t know if I had misconceptions before I was part of the team as much as I just didn’t know what the process entailed.” TS 18:18 

    “ONS is really committed to the growth of its members. I’ve really enjoyed being part of this volunteer opportunities and the other ones that I’ve been a part of. So truly, if you have a passion for something and you have the skills, ONS would love to have you and you will meet some of the greatest people in doing these opportunities. I’ve made some of the best connections and friendships through the volunteer opportunities I’ve done.” TS 21:35 

    21 February 2025, 8:00 am
  • 52 minutes 45 seconds
    Episode 350: Breast Cancer Treatment Considerations for Nurses

    “This is what totally drives the treatment decisions, and that’s why having that pathology report when the nurse is educating the patient is so important, because you can say, well, you have this kind of breast cancer, and this kind of breast cancer is generally treated this way,” Suzanne Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, professor emeritus at Saint Louis University in Missouri, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about what oncology nurses need to know about breast cancer treatment. 

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

    Licensed under Creative Commons by Attribution 3.0  

    Earn 1.0 contact hours (including 15 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 14, 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 breast cancer treatment considerations. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “Local treatment is typically going to consider some kind of surgery with or without radiation, depending on the surgery and the extent of the breast cancer. All women are going to have, and today when you use the word women, individuals assigned female at birth, they are the vast majority of individuals being treated for breast cancer, but for individuals assigned male at birth, there’s not near as much research, but generally their treatment is very similar. So that’s something to kind of keep in the back of your mind.” TS 2:39 

    “This is very confusing for patients because they’re like, ‘Well, my friend at church had this and why am I getting this and why are they getting something different?’ And that is because of the pathology report. So taking that time to explain that with a pathology, I think is really important.” TS 8:31 

    “When they see the breast surgeon, all individuals are going to have some kind of axillary evaluation.  Now, hopefully it’s going to be a sentinel lymph node. So they’re going to, at the time of surgery, put a tracer and, you know, they’re going to take out maybe one, two, three lymph nodes and hopefully, you know, there is not a lot of disease there. And if that’s the case, they’re kind of done with that. So the sentinel lymph node evaluation, it’s really more to stage and provide that information, but it kind of sets the stage a lot of times for the other treatments selections. And I think people need to realize that this is important. This is a very important procedure.” TS 15:31 

    “Years ago, when women had a breast mass, they went to the OR and it was biopsied in a frozen section and if it was positive, they had a mastectomy. So women would wake up and they’d be feeling their chest because they’re like, ‘What happened here?’ And that is not great care. It doesn’t give that woman any autonomy, but it was the best that could be done at that point. Now, with the diagnostic where we can do a needle biopsy, they can kind of stop and take a timeout and we can kind of clinically stage that.” TS 17:04 

    “For women that really desire breast-conserving therapy, they can anticipate that postoperatively at some point, they’re going to have treatment to the entire breast, we typically call whole breast radiation, and then they may have a boost. Now, in many, many probably cases, that’s going to be over five to six weeks, Monday through Friday. So the treatment itself doesn’t take but a couple of minutes, but you have to get to the facility. And even though we streamline check-in processes and whatnot, you have to get undressed, you have to get positioned on the table. So it is a commitment, and it can be disruptive.” TS 24:49 

    “The hormone-blocking agents are going to be the cornerstone of all those treatments for anyone who has hormone receptor–positive breast cancer. So they are going to take these agents and as you said, they’re probably going to take them for 5–10 years. It’s quite the journey.” TS 32:33  

    “I think you need to be mindful that if someone has had germline testing and they’ve tested positive, they are not only worried about themselves, and they are worried about the rest of their family. That is a big deal. And even though I’ll hear mothers say, ‘I feel so guilty, now my daughter has this,’ now, I’ve never heard a daughter come and say, ‘Gosh, I wish my mom hadn’t had me because of this.’ There’s a lot of feeling and emotion that goes on with that, and realize that those individuals are probably going to have fairly complicated management that goes over and above their breast cancer.” TS 41:50 

    14 February 2025, 8:00 am
  • 27 minutes 46 seconds
    Episode 349: ONS 50th Anniversary: Evolution of Safe Handling and ONS’s Legacy in Developing Safe Handling Guidelines

    “What I find most rewarding is connecting with nurses, who now understand the risks of exposure and are committed to minimizing their personal exposure. When I first started speaking about safe handling, there were a lot of nurses who were skeptical about the need for self-protection. I rarely see that now. Nurses are concerned for their own safety and more open to protective behaviors,” ONS member Martha Polovich, PhD, RN, AOCN®-Emeritus, adjunct professor in the School of Medicine at the University of Maryland, told Liz Rodriguez, DNP, RN, OCN®, CENP, ONS member and 50th anniversary committee member, during a conversation about the evolution of safe handling of hazardous drugs and ONS’s role in shaping safe handling policies.

    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 February 7, 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 evolution of safe handling guidelines.

    Episode Notes 

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

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

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

    Highlights From This Episode

    “PPE has always been recommended to reduce exposure because gloves and gowns provide physical barrier to protect against dermal absorption. But what we didn’t know back then was what gloves and gowns were made of mattered. So PVC gloves were often used just because they were readily available in all our clinical settings. Gowns were rarely worn for drug administration, even though they had been recommended since early on, and many considered gowns back then as optional because the wording in the [Occupational Safety and Health Administration] guidelines said ‘recommended’ and not ‘required.’” TS 3:19

    “Those early chemo gloves were a bit like wearing gloves you might use to clean your oven. They were so thick and got in the way of taking care of patients or mixing drugs or administering drugs. So the biggest change, I think, is that gloves that are currently available are very thin, and they provide the necessary protection for those who are handling hazardous drugs. We now have a gloves standard that requires permeation studies to demonstrate the protective ability of the gloves before they can be labeled for use with hazardous drugs.” TS 11:56

    “ONS and HOPA developed a position statement on safe handling of hazardous drugs. … This came because our two organizations were unable to support some of the other proposed guidelines from another organization. So we got together, and through our cooperation, resulted in language about the importance of safe handling, about supporting safe handling for practitioners, pharmacists, and nurses. Also, I feel really good about this—our cooperation resulted in language about protecting the rights of staff who are trying to conceive or who are pregnant or who are breastfeeding to engage in alternative duty that doesn’t require them to handle hazardous drugs.” TS 17:12

    “If there’s no worker safety, then who’s going to take care of the patients?” TS 21:52

    “What I find most rewarding is connecting with nurses, who now understand the risks of exposure and are committed to minimizing their personal exposure. When I first started speaking about safe handling, and that’s going back a long way, there were a lot of nurses who were skeptical about the need for self-protection. They had been handling hazardous drugs for years and had no signs of ill effects, and so they assumed that we weren't overreacting with all of the recommendations. They saw the use of precautions and PPE as a speed bump in their busy day and also thought that was unnecessary. I rarely see that now. Nurses are concerned for their own safety and more open to protective behaviors.” TS 23:50

    7 February 2025, 9:00 am
  • 39 minutes 9 seconds
    Episode 348: Breast Cancer Diagnostic Considerations for Nurses

    “We know that some women are going to get called back. And it’s just because usually they can’t see something clearly enough. And so in most cases, those women are going to get cleared with one or two images, and they’re going to say, ‘Oh, we compressed that better, we checked it with an ultrasound, we’re fine.’ That woman can go ahead and go. But we don’t want to miss those early breast cancers,” Suzanne Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, professor emeritus at Saint Louis University in Missouri, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about what oncology nurses need to know about breast cancer diagnosis. 

    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 31, 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 breast cancer diagnostic considerations. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “When a woman gets a callback, that is incredibly anxiety provoking, because they’re very scared and they don’t know what it means. And I think that’s a place where oncology nurses can remind—if it’s patients or friends who are asking—that just because you have a call back, doesn’t mean you have a malignancy.” TS 8:16 

    “We also know that when we call somebody back, that’s very scary and anxiety provoking. And we don’t want to subject women to unnecessary anxiety and stress through the procedure. And if it’s too stressful, they won’t come back again. That is actually a big harm that we don’t want to occur. That’s considered an acceptable amount. So we know that some women are going to get called back, and it’s just because usually they can’t see something clearly enough.” TS 11:26 

    “I think one of the most important things is to really help that woman understand the biopsy report. So now everybody, with most of the electronic medical records, that woman seeing that biopsy result—maybe before her provider is seeing it, depending on whether they get a chance to call that individual. But, you know, they could get a notification in their medical record, or a new report is available, and they can click on there and they could be looking at something that is very scary, not necessarily a good time, you know, like they’re getting ready to do something. And so that is a problem overall with sometimes getting bad news in oncology.” TS 15:09 

    “Sometimes it’s really good [for patients to bring] someone who can just be that set of ears or who can answer those questions, who’s emotionally involved but maybe not so emotionally involved, if that makes sense. And I think that that is something we can really encourage people to identify that person who’s going to really be able to support them.” TS 16:42 

    “When we approach a pathology report, the patient, you know, if they open that on their own, they’re just going to see breast carcinoma, or they aren’t going to look at all of the details of it. They can be quite overwhelming to look at. But I think that it’s important to kind of take the patient through it, step by step, and realize that it’s often a case of repeated measures—that you might do it and then you might do it again the next day or a day later.” TS 20:55 

    “Breast cancer care has changed so much over the past few decades. And I think people forget, you know, I’ve been in the business a long time, but years ago, everybody kind of got the same treatment if they got diagnosed. And we now understand so much about breast cancer treatment, but I think that has come on the shoulders of so, so, so many women who have enrolled in clinical trials to help us understand pathology better, to help us understand the impact of certain treatments. And so I think, first of all, we need to thank those women who have generously contributed to this base of knowledge. And it’s a place where those clinical trials have really made a difference.” TS 35:46

    31 January 2025, 8:00 am
  • 27 minutes 42 seconds
    Episode 347: Care Considerations for Radiopharmaceuticals and Theranostics in Patients With Cancer

    "If you take your normal radiation oncology experience, as we know in radiation oncology, radiations are done by the machines, you know, externally. Nurses deal with the side effects and everything like that, whereas radiopharmaceuticals are given kind of on the internal basis, they’re systemic,” ONS member John Hollman, BSN, RN, OCN®, radiation nurse educator for Texas Oncology, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about caring for patients receiving radiopharmaceuticals and theranostics. 

    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 24, 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 radiopharmaceuticals and theranostics in cancer care. 

    Episode Notes  

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

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

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

      Highlights From This Episode 

    "I think most places are now doing the seven days, just to be extra cautious and you know, can't you be around any pregnant women or children, you can’t just be going to Target and stuff like that right after your injection because you are radioactive, and try not to share a bathroom with your family, that can be difficult and that leads into, as we’ve talked about in many talks that we’ve had, the social situation.” TS 8:08

    “It’s really up to that nurse to recognize, like a good infusion nurse, to recognize the signs and symptoms of an infusion reaction and then to catch it at the earliest possible moment.” TS 11:42

    We’re not really dependent on lab values between treatments, whereas the infusion you have to look at your lab values. These are the game changer.” TS 13:20

    “You just hear the term radiation, and you just think of Chernobyl, or you think of like these worst-case, media-blown things and you think, how are you not being dosed with radiation every day? Because they don’t realize that you have this whole radiation safety team that’s required to be overseeing that you’re doing things safely and effectively, that these nurses that are administering these therapies or these therapists that are helping with the therapy are the safest as possible.” TS 18:37

    “If it wasn’t safe, we wouldn’t be doing it. You know what I mean? So, there is that implicit bias that I think I can foresee a lot of people trying hard to get over. And if you do have questions, anyone who’s listening, and you’re scared that your center is going to roll this out, please talk to your physicians, please talk to your radiation oncologists, please talk to your radiation safety officers. They can definitely assure and put your fears at rest, hopefully. I 100% trust the radiation safety officers.” TS 19:45

    “That’s why the nurses really need to be educated by those radiation safety teams so they can pass those questions, or they can answer those questions, alleviate those fears on consultation—or actually during the week when we’re calling in for questions.” TS 21:07

    “I think getting both teams involved, if you’re going to really do this partnership, I find it really rare that it’s ever solely in rad onc. It’s always usually a combination of both. They’re always referred to us from that onc or somewhere. So, you really need that partnership.” TS 23:20

    “This is so great to see what the future holds with these. And like I said, now they’re trying to do clinical studies for different diagnoses. So I think it’s just going to explode in the next few years about what we can use these for. It’s really an exciting time to be not only in oncology, but in radiation oncology.” TS 26:54

    24 January 2025, 8:00 am
  • 52 minutes 47 seconds
    Episode 346: Pharmacology 101: BTK Inhibitors

    "In B cell malignancies, BTKi inhibits that BTK enzyme which is very upstream. It tells NF-κB to stop signaling into the nucleus and then inhibits proliferation and survival of B cells,"  Puja Patel, PharmD, BCOP, clinical oncology pharmacist at Northwestern Medicine Cancer Center at Delnor Hospital in Geneva, IL, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about BTK inhibitors. 

    Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

    Licensed under Creative Commons by Attribution 3.0  

    Earn 1.0 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 17, 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 BTK inhibitor drug class. 

    Episode Notes  

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

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

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

    Highlights From This Episode 

    “1952 we have the discovery by Colonel Ogden Bruton of that severe immunodeficiency due to lack of B-cell maturation, and next linked to e-gamma globular anemia. In 1993, we had Professor Vetrie and colleagues discover that this was actually due to mutation in a kinase, and they called that BTK. And then in 1993 was a discovery of our first BTKi inhibitor in the lab setting, and that’s called LFM-A13. It wasn’t until 2013, so that’s 20 years after BTK kinase was discovered, where ibrutinib was our first-in-class BTK inhibitor, and the success of ibrutinib really promoted the exploration of second- and third-generation BTKis.” TS 6:24   

    “It’s thought that BTK and other members in the pathway are constitutively phosphorylated, which just means they’re spontaneously on. This leads to this uncontrolled activation of NF- κB signaling and thus uncontrolled proliferation and suppression of apoptosis. So, these B cells are rapidly dividing, but they’re not functioning like they’re supposed to be, meaning they won’t differentiate, or, you know, they won’t grow up to be either a plasma cell, like we talked about, or a memory B cell. They’ve been hacked.” TS 10:11 

    “This class is generally called—if you have to think of an umbrella term—it’s just called targeted small molecule therapies. Now a subclass is BTKi or Bruton tyrosine kinase inhibitors. So, we’re really shifting away from the use of cytotoxic chemotherapy, which is kind of designed to indiscriminately destroy rapidly dividing cells, to a more precise approach of targeting cells based on specific molecular changes in tumor DNA.” TS 13:47 

    “Cardiac toxicity can manifest as atrial fibrillation. And here I’ll specifically talk about ibrutinib values because we have the most data with it, and the numbers actually get better with second- and third-generation BTKis. So frequency: Grade 1–2 atrial fibrillation was reported in 12%–15% of patients on Ibrutinib. And grade 3 AFib is 3%–5%. The onset, median onset is 8–13 months.” TS 20:23 

    “For nurses, they should really advise their patients that the caliber of headaches are easily managed and they will decrease over time over a period of four weeks. This is an upfront conversation reassuring the patient that this is not a long-term side effect.” TS 33:47 

    “One aspect that was being discussed at length was kind of identifying biases and then methods to neutralize those biases. So, I think first you have to identify what your bias could be toward BTK, maybe it’s age or comorbidities or side-effect profile. And then, how can we mitigate our own biases is kind of the solution part to that.” TS 46:26 

    17 January 2025, 8:00 am
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