Episode 432: Long-Term Chronic Lymphocytic Leukemia Considerations for Oncology Nurses
The ONS Podcast
“It’s a chronic disease. It never goes away for some people, and so therefore it has these periods of remission where it’s really quiet and well controlled. Then there can be periods of flares where you’re actively engaged in treatment or it’s impacting other pieces. There’s this feeling patients have of, ‘When am I going to have that flare?’ You know, this anticipatory anxiety of, ‘When are things going to be done differently?’ or ‘When do I need to change?’” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer...
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Episode 431: Oncologic Emergencies 101: Urinary Obstruction
The ONS Podcast
“Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you’re having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed,” ONS member Brenda S....
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Episode 430: Leadership Unlocked: Is It Your Time to Serve?
The ONS Podcast
“If you are considering board service, I would say take the leap. Start with your local chapter. It will give you some valuable skills that will help prepare you when you are applying for your national level. And I always say, if you want to do it, just do it because what’s the worst that can happen? They can say no, but that doesn’t mean that you will never serve on a board. I always tell people delayed is not denied,” Cassandra Green, DNP, RN, OCN®, ONS member and past president of the Oncology Nursing Certification Corporation (ONCC) Board of Directors, told Evelyn Wempe, DNP,...
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Episode 429: Radiation Site-Specific Side Effects: CNS Cancers
The ONS Podcast
“They’re really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we’re using the masks on the table, and those masks are very tight and hold their heads very, very still. So they’ll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they’ll come to me and they’ll say, ‘This really hasn’t been as bad as I thought it was going to be,’” ONS member Catherine McCluskey, BSN, RN, OCN®, ROCN™, radiation oncology...
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Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
The ONS Podcast
“Measurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments,” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical...
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Episode 427: Pharmacology 101: Resistance Pathways
The ONS Podcast
“A good way of thinking about this is this is the survival of the fittest clone. There could be a portion of a cancer that naturally has some resistance or ability to survive a particular drug. And over time, as the other cells around it are dying off, that particular clone is able to replicate and continue to survive in the face of that drug therapy and eventually take over as being the fittest clone. At that point, we’re often seeing disease progression,” Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services at the Allegheny Health Network Cancer Institute in Pittsburgh,...
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Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology
The ONS Podcast
“When people with PTSD [post-traumatic stress disorder] get quite avoidant—and that can be expressed in so many different ways—the implications can be really profound. I think an important invitation to oncologists and oncology nurses and primary care providers who care for people battling cancer is let’s explore what's underneath these avoidant behaviors. Is it a very practical thing? Or is it that underneath this avoidant behavior is really profound fear?” James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Lenise Taylor, MN,...
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Episode 425: How AI Can Help Healthcare Organizations Improve the Cancer Experience
The ONS Podcast
“In oncology specifically, where care is complex, artificial intelligence (AI) can really synthesize large volumes of clinical information, flag risks such as treatment complications, and support adherence to evidence-based pathways. For nurses specifically, this enables them more time for direct patient care, clinical judgment, and care coordination, and really practice to the top of their license while reducing repetitive time and administrative tasks,” Jenn Frith, DNP, RN, OCN®, NE-BC, associate vice president of clinical operations at Duke Cancer Institute in Durham, NC, told Jaime...
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Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis
The ONS Podcast
“Think about what organs lie in the radiation field, and anything that lies in that radiation field is likely going to have some potential temporary—hopefully temporary—side effects. If you think about the pelvis, the things that live in there are the bladder, urethra, some bowel, rectum, reproductive organs, skin, some lymph nodes. And so, all of those things could potentially have associated side effects,” ONS member Kayla Kafka-Peterson, BSN, RN, ROCN™, nurse navigator and leader in the brachytherapy and peri-anesthesia programs at UCLA Health, in Los Angeles, CA, told Lenise...
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Episode 423: Pharmacology 101: Interaction Pathways
The ONS Podcast
“When we think of drug interactions, specifically, the National Cancer Institute actually defines this as a change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods or when taken with certain medical conditions. Drug interactions may cause the drug to either be more or less effective or cause effects on the body that are not expected,” Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology...
info_outline“A good way of thinking about this is this is the survival of the fittest clone. There could be a portion of a cancer that naturally has some resistance or ability to survive a particular drug. And over time, as the other cells around it are dying off, that particular clone is able to replicate and continue to survive in the face of that drug therapy and eventually take over as being the fittest clone. At that point, we’re often seeing disease progression,” Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services at the Allegheny Health Network Cancer Institute in Pittsburgh, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about resistance pathways.
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), including 30 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by August 7, 2027. Roman has served on advisory boards for Genetech, Pfizer, Regeneron, and Daiichi Sankyo and received honoraria payments from Pharmacy Times and Decera for faculty lectures. These financial relationships have been mitigated. 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 increased knowledge related to resistance pathways in oncology care.
Episode Notes
- Complete this evaluation for free NCPD.
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- OncoKB.org
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Highlights From This Episode
“As we look at drug resistance, this is the concept that cancer cells are no longer able to respond to a cancer treatment. The downstream of this is that we could end up with progression of the disease and need to look at alternative therapies that may be beneficial for the patient. This is unfortunately a very common phenomenon. Drug resistance is a major cause of treatment failure and poor patient outcomes with treatments. Unfortunately, this is an issue we see that increases over time on treatment.” TS 2:29
“Genetics play a really big role in drug resistance. We know that drug resistance can be due to different things. It could be epigenetics. It could be the tumor microenvironment factors. But genetics often play a very big role in resistance pathways. It’s generally considered to be a critical contributor to resistance, particularly in the way of acquired variants to drug targets or amplifications of certain oncogenes that can lead cancers to have progression. A well-known genetic alteration is the BRCA1/BRCA2 variant that helps to make the cancer more efficient at fixing DNA damage. So we’re trying to get DNA damage with chemotherapy, and this particular variant helps at fixing that damage to allow the cancer to progress. So that is one genetic variant we see that plays a big role in a number of different cancers.” TS 4:51
“These pathways are not mutually exclusive. Oftentimes we have multiple resistance pathways involved. I think it’s important to understand some of those individually, but kind of thinking about this as we might be facing multiple resistance pathways. ... We can see resistance mechanisms that vary based on the type of treatment we use, for example, traditional cytotoxic chemotherapy. We may be more likely to see some resistance mechanisms that are working at DNA: repairing broken DNA or working on those efflux pumps that are being used to push chemotherapy out of cells. If we’re talking more about the targeted therapies such as tyrosine kinase inhibitors or monoclonal antibodies, we may be more likely to see resistance mechanisms that are what we discussed with that drug target alteration: changing the way that the target agents are able to bind to the tumor cells to activate or inactivate pathways so we may see some changes there.” TS 12:39
“One way to overcome this and to help to decrease the resistance from developing is using combination therapy: drugs that are targeting different pathways at once or potentially using combinations with things like chemotherapy in addition to immunotherapy. In this way, as we’re getting these different targets, we can hopefully decrease the mechanism of resistance that may be developing.” TS 14:48
“Biomarker testing is an incredibly important part of our practice. In many situations now, we are getting upfront, comprehensive biomarker testing to identify whether the patient may have any of those intrinsic or primary resistance mechanisms that might make it so a patient is never going to respond to a particular type of treatment. And in that case, we can spare the patient from the potential toxicities of that treatment if we don’t think that there’s going to be benefit there. So I think that that has become a really important way that we can tailor patients for understanding what treatments are going to be more effective. And then after that, there’s usually additional biomarker testing that may be warranted at the time of progression in certain types of cancer. And that really helps us to understand that acquired resistance that might be developing.” TS 17:32
“Nurses are really helpful with filling in the gaps and bringing back patient concerns that might be shared with them. And these might be early signs of progression. Better understanding how our patients are feeling and what’s going on with them may help us to identify a patient that we need to do some additional testing for to understand whether there is drug resistance ongoing and potential progression of disease.” TS 21:52