Episode 403: Pharmacology 101: Checkpoint Inhibitors
The ONS Podcast
“Because the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That’s one of our biggest questions that we ask, usually every consult that we’re seeing with solid tumor. ‘Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?’ And then also patients who have undergone organ transplants. Now, interestingly, this does include stem...
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Episode 402: Radiation Site-Specific Side Effects: Head and Neck Cancer
The ONS Podcast
“It’s important to clarify that most patients will experience and at least some side effects—and often several. So prevention really means reducing severity, complications, and long-term impact rather than avoiding side effects altogether. This process starts before radiation begins and continues throughout the treatment and includes dental evaluation, baseline swallowing assessments, and thorough patient education,” ONS member Astrid Amoresano, RN, OCN®, lead oncology nurse specialist at New York Proton Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager...
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Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses
The ONS Podcast
“You also want to deal with patient preferences. We do want to get their disease under control. We want to make them live a long, good quality of life. But do they want to come to the clinic once a week? Is it a far distance? Is geography a problem? Do they prefer not taking oral chemotherapies at home? We have to think about what the patient’s preferences are to some degree and kind of incorporate that in our decision-making plan for treatments for relapsed and refractory myeloma,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University...
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Episode 400: Pharmacology 101: Radioimmunoconjugates
The ONS Podcast
“Radioimmunoconjugates work through a dual mechanism that combines immunologic targeting with localized radiation delivery. The monoclonal antibody components bind to specific tumor-associated antigens such as CD20, expressed on malignant B cells. Once found, the attached radioisotope delivers beta radiation directly to the tumor, causing DNA damage and cell death,” Sabrina Enoch, MSN, RN, OCN®, CNMT, NMTCB (CT), theranostics clinical specialist at Highlands Oncology in Rogers, AR, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a...
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Episode 399: National Hazardous Drug Exposure Registry
The ONS Podcast
“The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we’re trying to set up, is a way to make what is currently an invisible risk, visible,” ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public...
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Episode 398: An Overview of Multiple Myeloma for Oncology Nurses
The ONS Podcast
“[Multiple myeloma] is very treatable, very manageable, but right now it is still considered an incurable disease. So, patients are on this journey with myeloma for the long term. It’s very important for us to realize that during their journey, we will see them repeatedly. They are going to be part of our work family. They will be with us for a while. I think it’s our job to be their advocate. To be really focused on not just the disease, but periodically assessing that financial burden and psychosocial aspect,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer...
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Episode 397: Cancer Symptom Management Basics: Ototoxicity
The ONS Podcast
“Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it’s really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the ‘so what’: We are the first line of defense,” ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer...
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Episode 396: Nursing Considerations From the ONS/ASCO Extravasation Guideline
The ONS Podcast
“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...
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Episode 395: Pharmacology 101: Monoclonal Antibodies
The ONS Podcast
“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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Episode 394: Prostate Cancer Survivorship Considerations for Nurses
The ONS Podcast
“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...
info_outline“Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it’s really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the ‘so what’: We are the first line of defense,” ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer Institute in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ototoxicity in cancer care.
Music Credit: “Fireflies and Stardust” by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 9, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the management of ototoxicity after chemotherapy treatment.
Episode Notes
- Complete this evaluation for free NCPD.
- ONS Podcast™ Cancer Symptom Management Basics series
- ONS Voice articles:
- Oncology Drug Reference Sheet: Cisplatin
- Oncology Drug Reference Sheet: Carboplatin
- Oncology Drug Reference Sheet: Oxaliplatin
- FDA Approves Sodium Thiosulfate for Cisplatin-Associated Ototoxicity in Pediatric Patients
- ONS book: Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)
- American Cancer Society resources:
- American Speech-Language-Hearing Association (ASHA)
- Hearing Loss: An Under-Recognized Side Effect of Cancer Treatment
- Embedded Ear Care: Audiology on the Cancer Treatment Team
- American Society of Clinical Oncology (ASCO) Annual Meeting abstract: Innovative Infusion Center Assessments of Chemotherapy-Induced Neurotoxicities: A Pilot Study Supporting Early and Routine Screenings as Part of Survivorship Programs
- Children’s Oncology Group supportive care endorsed guideline: Prevention of Cisplatin-Induced Ototoxicity in Children and Adolescents With Cancer: A Clinical Practice Guideline
- Ear and Hearing article: Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment
- International Ototoxicity Management Group (IOMG)
- Shoebox hearing assessments
- World Health Organization initiative: Make Listening Safe
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
“At different pitches, the eardrums move faster or slower, signaling the inner ear, or the cochlea—the thing that looks like a snail in the pictures. The cochlea has fluid and hair cells inside of it that receive movements from the eardrum. The hair cells change the movement into electrical signals that actually go to the auditory nerves or the cranial nerve VIII.” TS 2:15
“Ototoxicity is an umbrella term for some sort of exposure to a toxin that causes damage to the inner ear. These toxins can be in the environment, such as loud or different noises, or they can be from medications, including antibiotics or commonly cancer treatments, such as radiation chemotherapy. Some common chemotherapies can be platinum-based chemotherapies like cisplatin or carboplatin. And then what patients are experiencing if they have ototoxicity can be hearing loss.” TS 3:15
“The hypothesized mechanism of action is that the chemicals like the platinum compound in cisplatin … that platinum compound travels through our bloodstream. Since chemotherapy is systemic, it’ll go to the inner ear, and it gets stuck there by binding to the cellular DNA in that cochlea, or that snail-looking image. That initiates the release of the reactive oxygen species, which are really trying to help clean it out, but releases such high levels that it ends up causing damage to those inner ear hairs. These inner ear hairs cannot regenerate themselves, so then they’re permanently damaged. And remember we said that those hairs send electrical signals to the brain that recognize sound. So that function is permanently gone once those hair cells are damaged.” TS 7:10
“I definitely think this is a huge interdisciplinary collaborative effort. As nurses and advanced providers, we’re assessing and providing education. Our medical oncologists are doing those dose modifications and submitting those audiology referrals. The radiation oncologists are very important to know about this—maybe dose localization awareness. Maybe they do some changes with the doses. And then our audiologists and [ear, nose, and throat physicians], they can do that diagnostic confirmation and any rehabilitation measurements and really monitor them throughout their journey as well. And nurse navigators play a huge part in making sure those patients get those referrals, because a lot of the time the audiologists aren’t in the cancer clinic, so they may have to go to another location or may need help coordinating with all their appointments that they have.” TS 22:28
“We had a really innovative way of monitoring the hearing that a couple other studies have also tested. It’s a remote point-of-care hearing screen. It was on [a tablet] with calibrated headphones. And then it’s a paid-for subscription to an audiology testing platform. … Myself, along with a couple of other nurses, were trained how to use this testing device with the tablet and the headphones and the software program. And it was a quick down-and-dirty portable hearing assessment for patients. So anyone who was new to cisplatin, never gotten cisplatin treatment before, was enrolled into the study, and they received a hearing test every time that they came for chemo, and we gave it to them during their hydration.” TS 28:59