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Episode 330: Stay Up to Date on Safe Handling of Hazardous Drugs

The ONS Podcast

Release Date: 09/20/2024

Episode 395: Pharmacology 101: Monoclonal Antibodies show art Episode 395: Pharmacology 101: Monoclonal Antibodies

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“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,...

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“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...

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“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...

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“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...

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The ONS Podcast

“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...

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“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...

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“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...

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“[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,”...

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“The reality is that we are responsible for creating a culture of safety together for everybody in the clinical area. We have to think not only about ourselves and our personal risk, but how exposure to these hazardous drugs persists in the work environment for everybody. And we have to be part of the solution for everybody, even if it’s not something that we’re personally really worried about being exposed to,” AnnMarie Walton, PhD, MPH, RN, OCN®, CHES, FAAN, associate professor at Duke University School of Nursing in Durham, NC, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about updates to the fourth edition of Safe Handling of Hazardous Drugs, one of ONS’s book publications.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

AnnMarie Walton serves in a compensated consultant role with Splashblocker LLC and as a compensated speaker for BD. 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 safe handling of hazardous drugs. 

Episode Notes

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

To find resources for creating an Oncology Nursing 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 know that this book is used in practice sites across the country and increasingly around the world, and we have the privilege of answering lots of questions of ONS’s members routinely. And we’ve also been part of writing guidance documents for ONS. And so, we utilized, as well, some of those questions that have come to us, and we know what people want to know more about. So we’ve made sure that we’ve developed a book that would be the most helpful in clinical practice settings.” TS 2:42

“We ensured that the book was in alignment with all of the most recent organizational position statements, standards, and recommendations. And there have been some big ones between the publication of the third and fourth book. So USP 800 is one that everyone knows about, and that became enforceable in November of 2023. … The ONS/HOPA [Hematology/Oncology Pharmacy Association] position statement, which was most recently updated in 2022, was also folded into this book. NIOSH [National Institute for Occupational Safety and Health] came out with two new guidance documents in 2023, and I had the opportunity to serve as a reviewer on one and a contributor to the other. Those two NIOSH guidelines have been folded into this book And then the ONS Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice, which MiKaela Olsen was a lead editor on and I was an author for, have also been folded into this text.” TS 7:01

“We’ve understood the NIOSH hierarchy of controls for years, and if we look at that hierarchy, it tells us that PPE is important but also the least effective when it comes to controlling exposure. And what’s slightly more effective is administrative controls, which are things like changes in our practices, more education, and training. And then even more powerful than administrative controls are engineering controls, and these are your closed-system transfer devices, for example, that are really important in minimizing exposure.” TS 10:31

“[Toilet pluming] is a place that I, for better or worse, spend a lot of time. And I have a colleague, Tom Connor from NIH [National Institutes of Health], who likes to joke when people ask him about his work. He says, ‘Oh, it’s in the toilet.’ And so I’m going to steal that from him and say a lot of my research is in the toilet, too.” TS 13:16

“I feel like people don’t know how contaminated toilets are and how contaminated floors are. And I’ve already told you my tip about leaving your work shoes outside. But I think if people were more aware that the toilets and the floors are often the most contaminated places on a unit, there would be more attention paid to people who are coming into contact with those surfaces and bear a lot of the exposure risk.” TS 22:51