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Episode 396: Nursing Considerations From the ONS/ASCO Extravasation Guideline

Release Date: 01/02/2026

Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse’s Role

The ONS Podcast

“We thought, from a nursing standpoint, ‘What is our goal for doing this?’ What we wanted was first, education of the patient. Can we successfully educate the patient to prepare them? Can we alleviate as much anxiety as possible so that they feel comfortable coming in and having this done? The second goal is to preserve kidney function throughout the treatment. To date, we’ve been successful with that. And the third goal is to complete treatment without infection,” ONS member Chris Amoroso, BSN, RN, OCN®, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime...

Episode 412: Pharmacology 101: Cytokines

The ONS Podcast

“They are small, powerful little nuggets. They are actually small signaling proteins that our immune cells use to communicate. They really help regulate immune activation or inflammation and even the growth and survival of immune cells. When cytokines are used therapeutically in oncology, they help to stimulate immune cells such as T cells or natural killer cells to better recognize and attack cancer cells,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center of Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN,...

Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses

The ONS Podcast

“Not every patient with myelodysplastic syndrome (MDS) is going to progress and die. Only 10%–20% of them will evolve into acute myeloid leukemia. And not all of them need blood transfusions. Some present with low platelet count. It’s not just people who are anemic that have MDS—it’s different depending on what type of MDS they have. These are averages. We’re giving you statistics based on averages, and you’re an individual, so we want to treat you as an individual,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt...

Episode 410: The Evidence for the Environment’s Impact on Cancer Outcomes

The ONS Podcast

“Cancer and environmental disasters in particular, but the worsening of our environment, are really things that are great equalizers. And we recognize that we’re all kind of in this world together. We can really face these issues on a more human level. I think always recognizing that if we look at something, we think, ‘Well, that doesn’t relate to me or that problem is it really isn’t my problem’—it sure is,” ONS member Margaret “Peggy” Rosenzweig, PhD, CRNP-C, AOCNP®, FAAN, ONS scholar-in-residence and distinguished service professor of nursing and Nancy Glunt Hoffman...

Episode 409: An Overview of Interventional Oncology for Nurses

The ONS Podcast

“Interventional oncology has really evolved into an important component of modern cancer care and is often described now as the fourth pillar alongside medical, surgical, and radiation oncology. The specialty now encompasses a broad spectrum of image-guided procedures that support from cancer diagnosis, treatment, to effectively managing symptoms that are caused by the disease. In other words, what we’re seeing is that across the continuum of care, IO is playing a vital role,” ONS member Evelyn P. Wempe, DNP, MBA, APRN, ACNP-BC, AOCNP®, CRN, NEA-BC, executive director for advanced...

Episode 408: Radiation Site-Specific Side Effects: Breast Cancer

The ONS Podcast

“A side effect patients might experience is lymphedema. This is an increased buildup of lymphatic fluid in the tissues, either in the breast or in the arm and hand of the affected side. It’s quite problematic for women. They might feel self-conscious. It might feel uncomfortable that the arm feels like it’s throbbing or heavy. Clothing may not fit quite right. So we’re always on the lookout for lymphedema,” Maria Fenton-Kerimian, APRN, AOCNP®, nurse practitioner at Weill Cornell Medicine in New York, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice...

Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy

The ONS Podcast

“You want to try to act quickly and be able to know what the pathways are for appropriate escalating when a patient is having symptoms that are reflective of cytokine release syndrome (CRS) or neurotoxicity. These toxicities are very manageable and treatable when recognized early. To summarize, choosing the right patient, knowing the toxicity profile for each product, and acting early is really what helps to prevent severe outcomes with chimeric antigen receptor (CAR) T-cell therapy,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center at...

Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices

The ONS Podcast

“Our goal of precision oncology has been to shift to tailored therapies that can help to improve treatment efficacy and ultimately improve patient outcomes. Resistance biomarker testing can help the care team to detect these genomic changes that the tumor may have acquired during therapy that makes the cells resistant to therapy. This information can be extremely helpful when we’re talking about making choices about second-line or subsequent-line therapy,” ONS member Danielle Fournier, DNP, APRN, AGPCNP-BC, AOCNP®, advanced practice RN at the University of Texas MD Anderson Cancer...

Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses

The ONS Podcast

“The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®,...

Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications

The ONS Podcast

“We print education sheets that we have, and we say, ‘Just ignore this part that says cancer. You’re getting this med but for a different indication.’ And then you have to really point out what our goals of care are. You’re using the information that, as oncology nurses, we like and love, but we’re having to cross it out and say, ‘Just read this portion and just do this here.’ And that can be challenging for the nurse and probably confusing for the patient,” ONS member Brandy Thornberry, RN, OCN®, outpatient infusion and VAD supervisor at Logan Health in Kalispell, MT,...

More Episodes

“We proposed a concept to the American Society of Clinical Oncology (ASCO), recognizing that extravasation management requires significant interdisciplinary collaboration and rapid action. There can occasionally be uncertainty or lack of clear guidance when an extravasation event occurs, and our objective was to look at this evidence with the expert panel to create a resource to support oncology teams overall. We hope that the guideline can help mitigate harm and improve patient outcomes,” Caroline Clark, MSN, APRN, AGCNS-BC, OCN^®, EBP-C, director of guidelines and quality at ONS, told Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS^®, VA-BC, oncology clinical specialist at ONS, during a conversation about the ONS/ASCO Guideline on the Management of Antineoplastic Extravasation.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 2, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the management of antineoplastic extravasation.

Episode Notes

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

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

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

Highlights From This Episode

“The focus of this guideline was specifically on intravenous antineoplastic extravasation or when a vesicant or an irritant with vesicant properties leaks out of the vascular space. This can cause an injury to the patient that’s influenced by several factors including the specific drug that was involved in the extravasation, whether it was DNA binding, how much extravasated, the affected area, and individual patient characteristics.” TS 1:48

“The panel identified and ranked outcomes that mattered most with extravasation. Not surprising, one of the first was tissue necrosis. Like, ‘How are we going to prevent tissue necrosis and preserve tissue?’ The next were pain, quality of life, delays in cancer treatment: How is an extravasation going to delay cancer treatment that’s vital to the patient? Is an extravasation also going to result in hospitalization or additional surgical interventions that would be burdensome to the patient? ... We had a systematic review team that then went in and summarized the data, and the panel applied the grading of recommendations, assessment, development, and evaluation (GRADE) criteria, grading quality of evidence and weighing factors like patient preferences, cost, and feasibility of an intervention. From there, they developed their recommendations.” TS 7:35

“The panel, from the onset, wanted to make sure we had something visual for our readers to reference. They combined evidence from the systematic review, other scholarly sources, and their real-world clinical experience to make this one-page supplementary algorithm. They wanted it to be comprehensive and easy to follow, and they included not only those acute management steps but also guidance on ‘How do I document this and what are the objective and subjective assessment factors to look at? What am I going to tell the patient?’ In practice, for use of that, I would compare it to your current processes and identify any gaps to inform policies in your individual organizations.” TS 16:34

“The guidelines don’t take place of clinician expertise; they’re not intended to cover every situation, but a situation that keeps coming up that we should talk about as a limitation, is we’re seeing these case reports of tissue injury with antibody–drug conjugate extravasation. There’s still not enough evidence to inform care around the use of antidotes with those agents, so this still needs to be addressed on a case-by-case basis. We still need publication of those case studies, what was done, and outcomes to help inform direction.” TS 19:24

“Beyond the acute management is to ensure thorough documentation regarding extravasation. Whether you’re on electronic documentation or on paper, are the prompts there for the nurse to capture all of the factors that should be captured regarding that extravasation? The size, the measurement, the patient’s complaints. Is there redness? Things like that. And then within the teams, everyone should know where to find that initial extravasation assessment so that later on, if they’re in a different clinic, they have something to go by to see how the extravasation is healing or progressing. ... I think there’s an importance here, too, to our novice oncology nurses and their preceptors. This could be anxiety-provoking for the whole team and the patient, so we want to increase confidence in management. So, I think using these resources for onboarding novice oncology nurses is important.” TS 22:34

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