The ONS Podcast

Where ONS Voices Talk Cancer Join oncology nurses on the Oncology Nursing Society's award-winning podcast as they sit down to discuss the topics important to nursing practice and treating patients with cancer. ISSN 2998-2308

Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis 07/17/2026

Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis “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 Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about radiation side effects in cancers of the pelvis. Music Credit: “” 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 July 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 radiation to the pelvis. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS book: (fifth edition) ONS courses: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS Guidelines™ and Symptom Management Resources: (ASTRO) (ESTRO) To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Brachytherapy is delivered two main ways. The most common is LDR and HDR. LDR stands for low-dose-rate radiation, which is the older type of brachytherapy, but it is still very much practiced today. And it is where we put radioactive seeds directly into the tumor or tumor resection bed, depending on what you’re treating. And those pieces of radioactive material, such as iodine-125 or palladium-103, those will give off radiation over time and treat the area that they are in, and they will place more or less seeds into the tumor, depending on that patient’s needs and their anatomy.” TS 3:26 “The most common [side effect] for external beam is bladder irritation—cystitis. It can be some burning, some frequency, some urgency, and it can often mimic a UTI [urinary tract infection]. We also have to make sure our patients do not have a UTI. Most of the time they don’t, but we don’t want to miss that. Once a UTI has been ruled out, the mucosa in the bladder and the urethra, it has a very high cell turnover rate. And things with a high cellular turnover rate like mucosal linings, they respond to radiation very quickly. They also heal very quickly, but they start to break down quite quickly during radiation.” TS 16:15 “For the bladder, some things that we can teach the patients … to keep their urinary system as comfortable as possible during treatment. We really encourage hydration because the more hydrated they are, the more diluted their urine will be and the less acidic it will be. As those tissues start to respond to the radiation, they will become, for lack of a better word, a little bit raw. And if you think of something acidic going on something that is raw, it’s going to burn, and these patients do get burning. And so by promoting hydration, their urine becomes less acidic; it doesn’t burn as much when they do urinate. And I find a lot of patients who are experiencing the urinary side effects, they don’t want to drink because they’re afraid to urinate. And it actually makes the burning worse because their urine gets ultra-concentrated.” TS 22:29 “Anybody who has a vagina, who receives treatment to the pelvis—it doesn’t matter if it’s for vaginal cancer or if it’s for bowel or rectal—if they have received radiation to the pelvis, they are at risk for vaginal stenosis and adhesions. And this, of course, can be more pronounced in patients who have a higher dose in the vagina or a larger surface volume of the vagina treated. But over time, that tissue, even long after radiation is done, will undergo late changes where they will have continued scar formation, and it starts to lose its elasticity and its functionality. And at times it can stick to itself, causing these adhesions.” TS 28:15 “I think a common misconception is that you cannot safely work around radiation. That is something that I have heard a lot. In certain regions of the world, the nurses actually report that they have been having trouble getting good applicants because nobody wants to work in radiation because they think that you’ll get radiated, that it’s not safe. We’ve really tried to make radiation safety a big part of our teaching to show that actually, you can safely work around radiation with today’s technology.” TS 41:43 /episode/index/show/onsvoice/id/41981265

Episode 423: Pharmacology 101: Interaction Pathways 07/10/2026

Episode 423: Pharmacology 101: Interaction Pathways “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 nursing practice at ONS, during a conversation about interaction pathways. Music Credit: “” 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 July 10, 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 increased knowledge related to drug interactions in oncology care. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS books: (second edition) (fourth edition) ONS Huddle Cards: American Journal of Nursing articles: Journal of Nuclear Medicine Technology articles: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “One of the most notable food interactions that interacts with many different medications is actually grapefruit or grapefruit juice. This is known to be a very strong CYP3A4 inhibitor. … A lot of medications are metabolized through the CYP3A4 pathway. By inhibiting the effect of these enzymes, that can actually increase and significantly increase the concentrations of these therapies. It’s not an interaction that’s just limited to grapefruit. I would say grapefruit being in the food interaction is kind of one of the most well-known, but it can also be seen with other foods as well, like pomegranate juice or a very specific type of orange called Seville oranges. And this is really just due to the presence of a substance called furanocoumarins.” TS 6:12 “There have been a pretty large number of genes identified that are responsible for coding some of those common enzyme families that I had been discussing, some of those CYP450 enzymes, but other enzymes as well that are important for drug metabolism. Based on the type of gene, there could be some different categories where patients are normal metabolizers, intermediate metabolizers, or poor metabolizers. There are some other categories as well based on the type of gene we’re looking at. And that can ultimately impact the way you are able to metabolize drugs.” TS 15:56 “Another common [geneotypic variation] that we always think about in oncology is G6PD, where if someone has G6PD deficiency, these patients can be at greater risk of hemolytic anemias when receiving certain types of therapies. Dapsone and rasburicase are just a couple that have been associated with this risk.” TS 17:50 “One of the big concerns is always polypharmacy. Our patients truly can be on a lot of medications. In the field that I work in, transplant, patients automatically from their transplant are on many, many different medications that can potentially predispose them to side effects. … But I think when it comes to the many drug interactions that may flag in these situations, we really have to look at the patient as a whole. Like, how long have these patients been on these therapies? Are they having side effects? Have they been on the combination for a very long time now? So I think that not just looking at the drug reference and seeing that there are like 10 different interactions flagged, but really assessing your patient as a whole can be very important—just because real-world practice, of course, is not black and white. It’s often very gray, so it’s just important to use clinical judgment in those scenarios.” TS 26:10 /episode/index/show/onsvoice/id/41908195

Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses 07/03/2026

Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses “What I appreciate about our patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia is the consideration that they receive a cancer diagnosis, and the best thing for them to do is actually nothing. There is a large population of patients that we don’t recommend any type of treatment. We recommend that they establish care with an oncologist and that they have a relationship with those care teams,” ONS member Caitilin 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 specialist at ONS, during a conversation about an overview of CLL for oncology nurses. Music Credit: “” 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 July 3, 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 increased knowledge of the diagnosis and management of chronic lymphocytic leukemia. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: ONS book: (first edition) ONS clinical practice resource: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Some of the common risk factors are environmental exposures, occupational exposures, and chemical exposures. For example, in certain farming communities where there are pesticides, that can definitely contribute to the risk of developing CLL. There’s some consideration for high levels of radon exposure or exposure to Agent Orange. So our veterans, both from the Vietnam War but also more recently in Iraq. There’s definitely a consideration that those types of exposures increase the risk of developing CLL.” TS 3:01 “Generally, the average age of diagnosis for CLL is in the seventh decade of life. But over 90% of people are diagnosed at age 50 and above. So, this tends to be a diagnosis in the six or seventh decade of life. It’s extremely rare in children, although it has been observed, and it’s twice as likely to develop in men than it is compared to women. And then individuals who are White are more frequently affected by CLL than other racial or ethnic groups, followed by people of color. And that includes Black, Hispanic, and Native American individuals, but it’s rarer in Asian populations.” TS 9:33 “There’s a lot of adjustment and coping with a new diagnosis. When we think about the diagnostic approach, we get a lot of information that’s incredibly valuable and helps us really to pivot and guide patients as to where they need to go and how we can best support them. We’ve had well-established studies that look to say, ‘If we were to treat patients earlier or have different thresholds for consideration for treatment, do patients do better?’ ... I think it’s really great that we can actually guide patients in a much more precise way, that you don’t need any type of therapy at this point, and it may change and evolve in the future.” TS 20:29 “I have some patients that are doers and they want to do something, so this active surveillance or watch and wait really paralyzes their coping. And so they want to do something. Oftentimes, that’s really when I pull in some integrative strategies and say exercise is always going to be beneficial. The more active you are, the more physically fit you are. If you really want to do something, make sure that you stay hydrated, that you eat well, and you’re engaged in a physical activity that you enjoy and can be consistent with.” TS 32:37 “I think another piece that we don’t often discuss is around the immunoglobulins and the immune system, but CLL has a pretty significant impact on immune dysfunction. And so patients with CLL, even if they are not on any type of active treatment, their immune system doesn’t necessarily function fully. And so they’re more likely to develop some upper respiratory infections or more easily develop the flu or coronavirus. ... Often times, we think a lot about supporting patients to get vaccines and to have early evaluation if those symptoms develop because you’re more likely to develop upper respiratory infections. I think there’s a component around immune dysfunction that I think is really valuable for people to understand that it’s not contingent upon the treatment. It’s contingent upon the disease and mechanistically, how the B cells are dysfunctional and don’t provide that immunity that otherwise would be in a healthy B cell.” TS 42:54 /episode/index/show/onsvoice/id/41664790

Episode 421: Medical Trauma in Oncology 06/26/2026

Episode 421: Medical Trauma in Oncology “There are a huge array of medical dynamics that people endure, and when they leave a lasting impact, a word that we don’t use widely enough is the word ‘trauma.’ There’s an entire category of phenomena in the medical arena that are, in fact, traumatic. One way we know that these experiences are traumatic is that we know that huge portions of people who experience things like cancer do indeed develop problems like [post-traumatic stress disorder],” James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about understanding medical trauma in oncology. Music Credit: “” 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 June 26, 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 increased knowledge of medical trauma and its effects on patients with cancer, caregivers, and healthcare professionals. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS course:   Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum articles: by James C. Jackson To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Many people have a notion about what medical trauma is, but perhaps they lack a definition. I use a definition that is deliberately broad because I think it is better to be inclusive than exclusive. A medical trauma to me is a medical experience or a medical encounter that basically leaves a mark. It leaves an emotional mark, and that mark is significant enough to disrupt your daily life.” TS 2:06 “When somebody develops a life-threatening illness—let’s say cancer—it’s not their problem only. It’s very much a family problem. It affects any manner of people. There is literature that says that family members of people with life-threatening conditions often have rates of PTSD that are every bit as high as the patients do. There’s also literature that says that if we can identify this issue as a family problem—a family challenge, not just an individual challenge—then very often that patient is going to do better.” TS 8:23 “We just need to make space for people to feel however they feel. And we need to emphasize, I think, that in some ways, even though there’s no cancer on the scan, cancer casts a long shadow in the lives of people, which is why when patients after cancer see their primary care provider, when they come back for a checkup with oncology, we need to continue this conversation of ‘How is your mental health? Are you okay? How’s your anxiety? How are you managing?’ … We need to be really curious and kind, and we need to query people about how they’re doing, even if officially they don’t have cancer.” TS 16:20 “Trauma-informed care has become a bit of a buzzword in our culture. But when it is engaged correctly, I think it’s really important. And I think in a nutshell, what it means is that as providers, we need to recognize that some situations and circumstances are likely to be traumatic, and we need to pivot and engage people differently now that we know that. Specific features of trauma-informed care might be we’re really going to value your emotional safety. We’re going to emphasize that. We are going to emphasize boundaries. We are going to ask your permission instead of telling you how to do things. We are going to be really attentive to the language we use to engage you because we’re aware of there might be things about your situation that are really triggering.” TS 28:15 “I think one [misconception] certainly is that it is only afflicting and affecting people who are frail or weak—not very strong. That’s emphatically not true. But that’s a popular misconception—that if I’m strong enough, if I’m resilient enough, this experience will not be traumatic to me. It’s just not true. Medical trauma doesn’t just happen in emotionally weak people. Medical trauma can impact people of all sorts.” TS 33:42 “The other misconception, I think, is that there is no hope for people in the throes of medical trauma. I’m not advocating ‘hopium,’ It’s a term that was coined, I think, during the pandemic. I don’t think that living with medical trauma is all rainbows and unicorns and shiny things. But the truth is, if you get the treatment that you need, you can find a way to thrive with medical trauma even as you’re impacted by medical trauma. This, this ‘both-and-ness’ is really true. You can both be adversely affected and you can even find some beauty in your struggle. Both can be true.” TS 34:13 “I wish people understood that there is a name for this phenomenon. We’re naming it here today medical trauma. Not everyone who has cancer has medical trauma—not even close—but there are many people who do. And I think many of those people, they don’t quite have a name for it. And when I introduce this name for it—trauma—many of them say, ‘Oh, my gosh, that makes so much sense. I didn’t quite understand why I was struggling so much with this. I didn’t quite understand why it casts such a long shadow in my life. I didn’t really understand why I was having panic attacks every time I had to get another scan at the oncology office to see if my breast cancer had returned. Now I understand. Now I understand it’s because it was trauma.’” TS 35:09 /episode/index/show/onsvoice/id/41622945

Episode 420: Long-Term Myelodysplastic Syndrome Considerations for Oncology Nurses 06/19/2026

Episode 420: Long-Term Myelodysplastic Syndrome Considerations for Oncology Nurses “We typically think of the disease progressing for our higher-risk patients because many of them already start with increased blasts or a lot of dysplasia. And they have these chromosomal variants that make them prone to evolving into acute myeloid leukemia (AML). With them, we can anticipate that they are going to progress to AML. And that’s what we’re trying to prevent. It’s kind of like a biologic evolution and not a switch,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term myelodysplastic syndrome (MDS) considerations for oncology nurses. Music Credit: “” 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 June 19, 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 management of long-term side effects related to myelodysplastic syndrome and its treatment. Episode Notes . ONS Podcast™ episodes: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS book: (second edition) ONS course: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “When our higher-risk patients have disease-related progression, their [malignancy] can transform to AML. And we know this occurs in about one-third of our patients and is one of the most serious late effects. Even in lower-risk disease, we have this worsening marrow failure with or without increasing blast, where [patients] may have just started out with anemia, then they also develop neutropenia and thrombocytopenia. And as those counts worsen, we usually know that their disease is progressing.” TS 2:47 “The golden rule is looking at the blood count but also looking at the patient and how they’re doing over time. The backbone of MDS monitoring is the complete blood cell count with the differential. What you’re looking for is trends over time. How many units of blood are they receiving, what threshold are you going to transfuse them at, and how many units of blood are they getting at a time? ... And then paying attention to the absolute neutrophil count for infection risk. [Another] really important piece of when you look at the differential with patients is seeing if they have any abnormal cell counts. Do they have circulating blasts? Are those monocytes going up? If you start to see blasts circulating or increasing monocytes, then their disease could be changing, even if they have low-risk disease.” TS 15:58 “For lower-risk disease, we’re paying more attention to their quality of life, how the patient’s tolerating therapy, trying to help them stay safe over the long haul, and starting them on iron chelation if it matches that patient and they can have access to those drugs. ... For higher-risk disease, if the patient’s goal is to be cured and not to progress to AML, you want to get them to transplant if that’s [also] one of their goals. If they do evolve into AML, try and see what treatment matches best for them.” TS 22:28 “You want to start early for patients who have febrile neutropenia—that’s really important when a patient is an hour or two away from a center where they can get started on antibiotics. So, you have to think outside the box. What can we do to keep them safe? ... I know this group in Alaska that’s in our advisory meetings and they try to facilitate transportation to Seattle. That’s the closest academic center to them. Collaborating with telemedicine appointments, starting earlier, developing that strong relationship with patients, and contacting them between visits [can help patients living in rural areas].” TS 25:22 “I think the biggest [psychosocial challenge] I see is a lot of unmet anxiety and depression counseling. A lot of times, [patients are] losing their place in their family because they’re the ones that need all the help now. Also, the uncertainty that goes along with the diagnosis. There is communication skills counseling, and End-of-Life Nursing Education Consortium (ELNEC) has a lot of training for communication skills and how to really talk to patients. Not that we take the place of a psychologist, but just being able to talk to somebody can go a long way. And if we can get training for that, we can help more patients.” TS 31:15 /episode/index/show/onsvoice/id/41597910

Episode 419: Pharmacology 101: Immunomodulators 06/12/2026

Episode 419: Pharmacology 101: Immunomodulators “Until immunomodulators, patients [with myeloma] did not have a great overall survival rate. But when we introduced lenalidomide, we started seeing our patients have life expectancies between five and seven years—which was unheard of prior to these immunomodulators going forward. I think it’s promising and allows patients to have quality of life versus therapy of life,” ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about immunomodulators. Music Credit: “” 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 June 12, 2027. Daniel Verina is on the speakers' bureau for Johnson & Johnson, GlaxoSmithKline, and Pfizer. This financial relationship has 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 an increase in knowledge about the use of immunomodulators to treat cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing article: Oncology Nursing Forum articles: ONS book: (third edition) ONS Symptom Intervention resource: Risk Evaluation and Mitigation Strategies (REMS) To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “We definitely want the diagnosis of multiple myeloma before initiating these drugs. We’re going to look at serum protein electrophoresis. We want to make sure that we know the patient has serum free light chains and myeloma proteins to really confirm their disease. Plus, a bone marrow biopsy.” TS 7:21 “Each immunomodulator has slightly different side effects. Thalidomide’s biggest side effects are constipation, weakness, fatigue, somnolence, peripheral neuropathy, mood swings, hand tremors, and depression. With each generation, less of the side effects actually occurred. Most of lenalidomide’s side effects, not discounting the deep vein thrombosis, are pancytopenia—the neutropenia, the anemia, and the thrombocytopenia. [The side effects] are very similar in pomalidomide.” TS 15:40 “The REMS program is critical for oral immunomodulator therapies—thalidomide, pomalidomide, and lenalidomide. It was developed due to the risk of developing embryofetal toxicities. ... It is mandatory testing and counseling, so all females of reproductive potential must have two negative pregnancy tests prior to starting the therapy and then monthly pregnancy tests while on the therapy alone. Again, they must use two forms of effective contraceptives or abstain from heterosexual sex four weeks prior, during, and after. And the same thing for men. I focus on that because males may say, ‘I have a vasectomy.’ These therapies tend to bind to the semen. So, males must still use a latex or synthetic condom during any sexual contact with a female of reproductive potential, even if they did have a vasectomy.” TS 18:31 “The capsule itself cannot be chewed, crushed, or opened. I bring that up because as healthcare professionals, we have educated our patients. If it’s difficult to swallow capsules or tablets, we’ve always said to them, ‘Oh, don’t worry, just crush it into applesauce or open it up and sprinkle it on your mashed potatoes.’ But because of this embryofetal toxicity, I advise my patients not to open the capsule. If they can’t swallow it for any reason, they have a sore throat or they’re just unable to, then [we tell them] to hold the therapy and then call us.” TS 22:49 “We spoke about three generations already, but there’s actually a fourth generation [of immunomodulators]. They’re called cereblon E3 ligase modulators(CELMoDs). They’re still in clinical trials but really showing promise in the therapy of myeloma. They’re showing very good affinity to cereblons, just like the immunomodulators do. I think, in all cancer therapies, as newer generations come out or newer therapies move forward, some of the older generations might move aside, but they get integrated later on. So I don’t think [immunomodulators] will disappear totally, but they will probably be modified.” TS 36:39 /episode/index/show/onsvoice/id/41377990

Episode 418: Radiation Site-Specific Side Effects: Colorectal Cancer 06/05/2026

Episode 418: Radiation Site-Specific Side Effects: Colorectal Cancer “Radiation therapy is often extremely well tolerated in colorectal cancer. Technology has really changed things. But location of the tumor can affect side effects, such as radiation dermatitis. If a patient has a low-lying tumor, if it’s less than six centimeters from the anal verge, the patient is likely to have some skin reaction. It’s good to be proactive if that’s the case,” ONS member Lorraine Drapek, DNP, FNP-BC, AOCNP®, nurse practitioner in the Department of Radiation Oncology at Massachusetts General Hospital in Boston, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radiation side effects in colorectal cancer. Music Credit: “” 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 June 5, 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 side effects of radiation to treat colorectal cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS book: (fifth edition) ONS courses: Clinical Journal of Oncology Nursing articles: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “In recent years, there has been more nonsurgical management of rectal cancer, especially in what we call the low-lying population. This is the population of patients who would likely end up with a permanent colostomy because their cancer is so low in terms of being close to or involving the anal verge. There is now a regimen where these patients can get their chemotherapy followed by their chemoradiation and then be monitored on close surveillance without surgery.” TS 2:23 “Another assessment would be to assess what effects have they had from their chemotherapy that they’re bringing with them. FOLFOX-based treatment is commonly used, and the platinum therapy oxaliplatin often causes peripheral neuropathy. What is the patient having? What are those symptoms like? Are they having peripheral neuropathy? If they are that is likely not going to get better or improve during their whole course of radiation. In fact, sometimes when oxaliplatin therapy stops, the peripheral neuropathy can get worse as patients are going through other treatments.” TS 5:42 “If the patient has a low-lying tumor, if it’s less than six centimeters from the anal verge, the patient is likely to have some skin reaction. It’s good to be proactive if that’s the case. And then proactively minimizing radiation dermatitis effects, such as keeping the area clean, good washing of the area, and prophylactically starting them on or having someone start them on steroid creams a couple of times a day to minimize that radiation dermatitis effect in the long run.” TS 7:25 “I have a sexual health clinic for women with these effects. It’s very important as nurses that if you can develop the comfort to ask patients about their sexual activity—it’s hard, but it really needs to be done. And I will tell you that the healthcare providers are not doing it. They don’t have time, and like us as nurses, we don’t get this in school, and neither do they. The other providers don’t get it in school either, but it’s important. Patients are getting more and more worried about their sexual health. They’re coming to us at a younger age, and this is really, really important to address.” TS 15:35 “I would say that working with your advanced practice providers and education for advanced practice providers has definitely been focusing on [sexual health] more. Your PAs and your NPs—I think they’re going to have the ears and the wherewithal to be able to be your allies and colleagues in this. By and large, it’s my APP colleagues and nursing that I talk to the most about this. … Again, it’s not an easy thing to bring forward, having dilators in place. But I will tell you in the department that I work in, it was me and couple of nurses who pushed this issue with the physicians for two years and finally got it put in place. It can be done. There’s a lot more centers out there doing that.” TS 21:51 /episode/index/show/onsvoice/id/41430320

Episode 417: Pharmacology 101: Oncolytic Viral Therapy 05/29/2026

Episode 417: Pharmacology 101: Oncolytic Viral Therapy “There are a lot of specifics that nurses need to keep in mind as they are administering this herpes simplex modified virus to patients because accidental exposure is of concern both to the patient, to their family members, as well as to healthcare workers. I always recommend nurses wear personal protective equipment, such as a gown, safety glasses, gloves, and/or a face shield,” Heidi Finnes, PharmD, RPh, BCOP, director of clinical ambulatory practice at Mayo Clinic and assistant professor of pharmacy at Mayo Clinic Alix School of Medicine in Rochester, MN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about oncolytic viral therapy. Music Credit: “” 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 May 29, 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 about the use of oncolytic viruses to treat cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS book: (second edition) ONS clinical practice resource: ONS Huddle Card: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “[Oncolytic viruses] can have direct lysis to the tumor cells themselves, or they can cause immunogenic activation. They release tumor-associated antigens and then proinflammatory signals, so think of T cells, natural killer cells, those sorts of things, that can convert to immunologically cold tumors. Those are tumors that are immune silenced into hot tumors which are now immune activated. By doing that, they recruit those T cells and other cells to the area to attack both the primary tumors. But that’s also thought to be how they work on distant or noninjected sites as well. This immunomodulatory capacity has led to the reclassification of oncolytic viruses as a form of cancer immunotherapy. So, think of it kind of similarly to how we think of immune checkpoint inhibitors in recruiting immune cells and leaving our immune system in the on position. This is also kind of a form of immunotherapy.” TS 4:35 “One of the toxicities I know that is of significant concern to patients, family members, and healthcare workers is the incidence of herpes infections. Systemic herpetic infections are extremely rare and usually more common in patients who may be immunocompromised. In patients who also have other immune-related diseases—such as vitiligo, vasculitis, pneumonitis, sometimes worsening psoriasis—because you’re mounting an immune response with these types of things, sometimes you can see a worsening of those types of immune symptoms. But for the most part, these types of side effects are very well tolerated in most patients.” TS 9:07 “Talimogene is generally transmitted via bodily fluids or touch. It’s not airborne. Herpes simplex virus isn’t an airborne type of virus. Another thing to consider is where are you going to inject this? Are you going to do this in your infusion therapy unit? Are you going to do it in a dedicated room? Who’s going to escort the patient to the room? How is the virus going to arrive at the room? How will you clean the room and all of the laboratory equipment or any of the exam tables that may be in there? I think having all of that discussed and assigned mitigates the consternation that can sometimes occur—the fear that occurs with administering a virus that is thought to be fairly communicable.” TS 15:44 “Helping patients understand how this works [is important] because hearing that you’re receiving a virus, particularly a herpes simplex virus, can be scary to a patient. I think understanding that it’s modified or essentially we’re taking the parts out of it so that we can directly inject a portion that recruits immune cells to that area, because the goal is for the oncolytic virus to attack cancer cells and then destroy them by triggering an immune response in the body.” TS 20:51 “Sometimes patients are very concerned about urine in the toilet, bodily fluids, kissing loved ones, holding hands, hugging, you know, am I going to infect my loved one because I’m getting this type of an oncolytic virus therapy? I like to reassure patients that they can continue to hold hands and hug their loved ones as normal. Viral DNA is usually only present on the injection site. And as I mentioned previously, we want to cover that injection site with an occlusive dressing, at least with talimogene, for up to seven days. And particularly, if those injection sites are at all oozing or weeping, active virus is usually only on that injection site itself.” TS 24:14 /episode/index/show/onsvoice/id/41284205

Episode 416: Cancer Treatments for Noncancer Indications: Radiation 05/22/2026

Episode 416: Cancer Treatments for Noncancer Indications: Radiation “When you have benign conditions, we’re actually treating 3 gray, so a significant difference [versus doses of 60 gray for brain cancer]. Typically, when you treat at a high dose, the goal is to destroy tissue, like cancer tissue or cancer cells. But when we give a low dose, the goal is actually to modulate inflammation. And what it does is it slows down those inflammatory cells or those cells that release the chemicals that cause pain and inflammation,” Amanda Meyer, DNP, APRN, CNP, family nurse practitioner in the Department of Radiation Oncology at the Mayo Clinic in Rochester, MN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radiation therapy for noncancer indications. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 22, 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 about the use of radiation to treat noncancerous conditions. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS book: (fifth edition) ONS courses: Clinical Journal of Oncology Nursing articles: ONS Huddle Cards: German Society for Radiation Oncology (DEGRO): To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “We always typically think of it as cancer treatment, but we can use radiation for noncancerous conditions, as well. And radiation was actually used for benign diseases right after the discovery of x-rays. By the 1920s it was used a lot for different types of musculoskeletal, dermatologic issues, and different types of inflammatory conditions. And over time, since the 1920s, we’ve actually really gotten a really good understanding of it.” TS 1:37 “When we’re looking at what are good candidate characteristics, we do typically like older patients, so patients over the age of 65. And the rationale behind that is we know that there is a potential for a secondary risk of a skin cancer about 20 to 30 years after getting low-dose radiation, like a basal cell or squamous cell skin cancer. The older the patient is, the less likely they are to have any adverse effects from that.” TS 8:22 “When we do the low-dose radiation, they’ve tried other measures that haven’t been successful. However, we don’t want a patient who is so severe that they’re ready for surgery, when they’re bone on bone, because we know that radiation isn’t as effective when they are that severe. So there’s this sweet window where low-dose radiation works best in these patients.” TS 9:39 “When we’re treating with a little bit higher dose for like a Dupuytren’s or a Ledderhose, because it’s an anti-proliferative dose, those patients, they do get more skin redness, more dry skin. That’s very temporary, and it resolves within a week or two after treatment. But really, we don’t see any acute side effects. The long-term side effect of the radiation-induced malignancy, again, is a very low—0.05% according to some of the European guidelines.” TS 12:34 “I really wish people appreciated how interdisciplinary this is. We need to get referrals from family medicine and from primary care and internal medicine and pain medicine physicians and inflammatory physicians and podiatry and pain specialists. And we really need to use this multidisciplinary approach to get earlier referrals for patients because there is this sweet window of time where low-dose radiation works the best.” TS 18:40 /episode/index/show/onsvoice/id/41281130

Episode 415: Myelodysplastic Syndrome Treatment Considerations for Oncology Nurses 05/15/2026

Episode 415: Myelodysplastic Syndrome Treatment Considerations for Oncology Nurses “We want to make sure that we discuss the details of the treatment and what treatments there are, whether it’s an oral drug, whether it’s a subcutaneous injection or an IV injection, [the patient’s] potential for responding, whether this treatment is curative or supportive, and what the number of visits are. All of those different pieces of information that go into the decision-making process are really important,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about myelodysplastic syndrome (MDS) treatment considerations. Music Credit: “” 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 May 15, 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 about the treatment considerations for MDS. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS books: (second edition) (third edition) ONS course: ONS Learning Library: ONS Symptom Intervention resources: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “The goals that I try to consolidate to make sure they’re consistent with the patient’s goals are to improve their counts, especially the anemia or cytopenias. If they’re getting blood transfusions, we want to reduce the number of transfusions that they receive because we know that’s linked to reduced overall survival, and it really impacts quality of life. ... And then for high-risk patients, it’s a more serious discussion because we know that they are the ones who can progress to acute myeloid leukemia (AML). And we’re trying to delay progression to AML. That means we’re trying to improve their survival and we’re also trying to manage their cytopenias and decrease their infection risk.” TS 2:28 “If we look at approvals for low-risk disease and high-risk disease, those were really made based on the Revised International Prognostic Scoring System (IPSS-R) and sometimes the International Prognostic Scoring System (IPSS). Under those classification systems, when we think of lower-risk MDS, we think of patients who are primarily anemic but don’t have increased blasts in their bone marrow. ... For higher-risk MDS, we want to have that discussion with those patients because their life expectancy is much shorter than patients with lower-risk MDS. We want to see if hematopoietic stem cell transplant would be something that they would be interested in if they don’t have a lot of comorbidities and are relatively healthy.” TS 11:41 “There are a lot of things to consider—[patients’] blood counts, comorbidities, whether they’re frail, and what their goals are. There are some patients where there’s no way they would want to go through transplant. And some patients want to be cured, so it just depends on your patient.” TS 14:22 “I think of hematopoietic allogeneic transplants as a treatment for more of the patients with higher-risk MDS. ... With the Molecular International Prognostic Scoring System (IPSS-M), a patient can have pretty good blood counts and not have increased blasts in the bone marrow. You could send them for a transplant referral upfront without having to give them additional treatment. ... There is a that said if a patient doesn’t have more than 10% blast, you could refer to transplant as a first option. ... Also, if you had a lower-risk patient who is relatively young and doesn’t have any other treatment options, this would also be a patient that you could refer to transplant to see if we could care for them, and then they wouldn’t have to be getting transfused all the time.” TS 21:12 “I think that we often think low-risk, no treatment needed, but it depends on the person. They often need ongoing supportive care to manage their symptoms even if they’re not getting treatment. And just because we’re not treating them, active observation, bringing them in to see how they’re doing, if they’ve had infections, if their blood counts are changing, that is paying attention to them and doing something. Just because they’re low-risk doesn’t mean they don’t need anything and we can just schedule for a one-year follow-up.” TS 26:30 /episode/index/show/onsvoice/id/41159200

Episode 414: Radiation Site-Specific Side Effects: Lung Cancer 05/08/2026

Episode 414: Radiation Site-Specific Side Effects: Lung Cancer “Skin reactions, such as redness, dryness, and just irritation of the skin, can occur. Since we’re irradiating the lung, we can also cause a cough, and that’s due to the inflammation from the radiation. Patients can also get esophagitis if the tumor that we’re treating is close to the midline of the chest near the esophagus. And probably the most common side effect that we see is fatigue,” ONS member Amy MacRostie, RN, OCN®, radiation oncology nurse at St. Charles Cancer Center in Bend, OR, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radiation side effects in lung cancer. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 8, 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 side effects of radiation to treat lung cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice article: ONS book: (fifth edition) ONS courses: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “The types of radiation that can be used are external beam radiation and stereotactic body radiation treatment, or SBRT. External beam radiation is often used in combination with other treatment modalities, like chemotherapy, immunotherapy, and targeted therapy, to treat these cancers. And SBRT is usually done solo, and it’s a highly precise treatment for inoperable or early-stage lung cancers.” TS 1:52 “[Physicians and] providers can also help prevent side effects by reducing the dose to the heart and reducing the dose to the good lung tissue, if you will, as much as they possibly can. And this is done using intensity-modulated techniques, or IMRT. And that’s where the linear accelerator sculpts the radiation beams conforming to the shape of the tumor itself.” TS 6:37 “I think overall cancer treatment can lead to decreased libido and decreased sexual interest. Depression and fear can definitely play a role in this. And with lung radiation, specifically, fatigue and possibly shortness of breath with the exertion may decrease sexual interest. Nurses and providers should support the patient in their desire or lack thereof in sexual activities. We should have open discussions … and these can take place with patients about intimacy and how that can be approached in a different way that can accommodate for the side effects that the patients might be experiencing.” TS 8:57 “Post-radiation scans will be abnormal. Post-radiation imaging can be misread as a progression of disease or residual disease. And I tell patients, ‘Don’t panic. Talk to your radiation oncologist so they can read the imaging themselves and interpret the results.’ Oftentimes what’s read as progression is radiation treatment sequela of scarring or fibrosis.” TS 11:25 /episode/index/show/onsvoice/id/41157720

Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse’s Role 05/01/2026

Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse’s Role “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 Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about intrarenal administration for upper urothelial tract disease. Music Credit: “” 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 May 1, 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: Nurses caring for people with cancer require knowledge of the different routes for drug administration, including intrarenal administration via a percutaneous nephrostomy. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “In an office setting, it’s not something we can really visualize. Patients will present with hematuria or flank pain, obstructions in the ureter, some hydronephrosis, they may be having a lot of urinary tract infections. And a routine cystoscopy in the office is not going to visualize the ureters. We can do biopsies like a ureteroscopy, a computerized tomography urogram, or a urine cytology. And those are usually the main ways of diagnosing upper tract disease—again, because it’s rare.” TS 2:33 “We ask patients to get into a comfortable position where they can sit or lay for an hour without too much movement. The movement of their body position can interfere with the flow of the medication going in. ... When we’re ready to start, we’re cleaning the ends of the nephrostomy tube and the IV tubing with a chlorhexidine solution. We’re instilling this using micro drip tubing. The tubing has to be microchipped so we can accurately control the flow. The IV bag with medication is hung about 10 inches above kidney level. And the reason we do that is because we do not want to increase the intrarenal pressure. ... We want a slow infusion via gravity over about an hour. We’re watching throughout the procedure to make sure that there’s no leakage, no discomfort, really just watching the patient and having that communication with the patient. Are they feeling anything different? Do we notice a difference in the flow rate? Is it slowing down? And if so, why is it? Did the patient change position? If we have any [instance] where the patient says, ‘I can feel something there,’ or we see leakage, we stop that infusion immediately, emphasizing that it has to be gravity, never on a pump.” TS 7:30 “We go over all the bacillus Calmette-Guérin (BCG) precautions because this is the drug that we’re giving. As if we were doing traditional intravesical therapy such as placing a catheter up into the bladder, we’re still giving patients BCG. So, we need them to follow the special precautions. We ask every patient, regardless of the drug we’re giving them, to sit down to urinate, pour two cups of bleach in the toilet, let it sit for about 15 minutes, then close the lid and flush twice. Even though we’re giving this for upper tract disease, it’s still being excreted into the urine. So, precautions need to be followed. Sitting down to urinate to avoid splashing of the drug, putting the two cups of bleach in every time they urinate for a duration of six hours, closing the lid, and then flushing that toilet twice. The same precautions, whether it’s traditional intravesical or intrarenal.” TS 14:20 “The induction phase is the first six installations. So, the first time we give this drug, we’re doing it once a week for six weeks. And during those six weeks, we’re communicating with the patient. We’ll do a follow-up phone call and ask, ‘How are you feeling? Any issues?’ And we do get to know our patients really well. ... If they call, we’re going to send them for a urine culture and make sure there’s nothing there. ... After those six weeks, we make sure the patient understands that this is not one course and done. We want to continue to do this to give them the best chance at preventing recurrence. After we’ve done those six, we’ll wait about four to six weeks, and then we’ll do a cystoscopy and ureteroscopy in the operating room to make sure we have the response we’re looking for. Again, letting the patients know because sometimes they don’t understand that this is going to continue—it’s not six treatments and done.” TS 23:08 “You can’t think of this as the same as bladder cancer. This is in the upper tract. We can’t approach it as if it was non-muscular invasive bladder cancer. The diagnosis is different. It’s harder to diagnose. Again, we’re not visualizing the ureters in a routine office cystoscopy. ... You can’t resect it out. When I was talking to our surgeon, he said, ‘You can’t resect the urothelial disease in the ureters like you would in a bladder tumor.’ You can’t go and just pick it apart. It’s a little bit more complex than that. You can’t go in and resect out lesions in the ureter itself.” TS 36:20 /episode/index/show/onsvoice/id/40935205

Episode 412: Pharmacology 101: Cytokines 04/24/2026

Episode 412: Pharmacology 101: Cytokines “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, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the cytokine drug class. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours (including 30 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 April 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: Nurses caring for people with cancer require knowledge of cytokines to provide appropriate education and to safely administer related therapies. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS books: (fourth edition) (second edition) Clinical Journal of Oncology Nursing article: ONS Symptom Interventions To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Cytokines are actually among some of the earliest forms of immunotherapy used in the treatment of cancer, and it really goes back to the 1980s and the 1990s. We’re talking therapies like interferon [alpha] or interleukin-2 that were used to stimulate the immune system, with the idea that they would recognize and attack cancer cells, particularly in diseases like metastatic melanoma and renal cell carcinoma. What made these therapies unique was that although the overall response rates were relatively modest, when patients did respond, those responses could be very durable and sometimes long lasting. And that observation was really important for the field of oncology, because it was part of the process that demonstrated that the immune system could potentially control cancer in really meaningful ways.” TS 1:49 “One nice new example of an engineered cytokine is nogapendekin alfa inbakicept, which is quite the tongue twister to say. … This agent is really interesting because it’s an engineered interleukin-15 receptor agonist that works on stimulating natural killer cells and CD8-positive T cells. And what makes this so interesting is that it’s used in combination with a medication that probably some of us are familiar with—good old BCG—for patients specifically with invasive bladder cancer. The other really interesting thing about this new therapy is the fact that it is one of our first ones to be engineered in a combination fashion. So the nogapendekin alfa is combined with a receptor component that is called inbakicept. And what happens is it forms a complex to enhance signaling and prolong the activity of the cytokine.” TS 7:50 “When you’re looking at our therapeutic cytokines, those tend to produce larger-scale systemic inflammatory effects leading to much more global side effect reactions, while your supportive care cytokines are more commonly associated with either bone marrow stimulation effects or hematologic changes.” TS 14:01 “Regardless of what type of cytokine therapy may you be using, across the board, early recognition of the symptoms and proactive supportive care are really important. And this is where many of our oncology nurses play such a critical role in identifying changes that are happening in real time to the patient’s condition and helping to coordinate, relay information to the rest of the providing team so that timely interventions can occur for the best care of the patient.” TS 18:01 “The other fascinating thing about these cytokines is that they’re not being used as monotherapy anymore. They’re now being looked at in combination with other therapies or even other immunotherapies like our checkpoint inhibitors. They’re being looked at in the sense that they may be able to help expand and further activate immune cells that our current therapies rely on. And so it’s really interesting that while cytokines were some of the earliest forms of cancer immunotherapy, they’re now being reimagined as part of modern combination strategies designed to really further help enhance the immune responses against cancer.” TS 29:08 /episode/index/show/onsvoice/id/40800235

Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses 04/17/2026

Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses “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 Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about myelodysplastic syndrome. Music Credit: “” 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 April 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: Nurses caring for people with myelodysplastic syndrome require knowledge of its pathophysiology, the presenting symptoms, and its diagnosis. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS book: (second edition) ONS Clinical Practice resource: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “In the bone marrow maturation process, you have a pluripotent stem cell. You have myeloid and lymphoid, and then on the myeloid side, you make your white blood cells, your red blood cells, and your platelets. And during that maturation process, there’s this problem that arises. It’s called a clonal variation. Or something goes wrong as the cells go through that process year after year. It’s called ineffective hematopoiesis. ... That process of becoming mature, functioning cells, arising from that hematopoietic stem cell is broken, and this leads to low blood counts. Usually, it’s anemia, so the hemoglobin is low. You can see that the mean corpuscular volume (MCV) is really high, and those are clues that a patient might have MDS—anemia with a high MCV.” TS 3:05 “The International Prognostic Scoring System (IPSS) was the first way that we staged MDS into lower-risk and higher-risk disease. Now we have the IPSS-R, which is the revised system. And that was intended to be a way of classifying patients into lower-risk or higher-risk disease, where we talked about the goals being different. And it’s really looking at the depth of the cytopenias, so how low are those neutrophils? How low is the hemoglobin and the platelet level? What percentage of blast does the patient have in their bone marrow? [This] gauges whether they have lower-risk or higher-risk disease. And now that we have the Molecular International Prognostic Scoring System (IPSS-M), we also take into account the variants that a patient has and that can really change whether you think they have lower-risk or higher-risk disease.” TS 8:46 “During a person’s lifetime, if they were a heavy smoker, we always think of lung cancer, but it can actually predispose a person to MDS. If they worked heavily in chemicals. I can remember more than one patient who worked for pesticide companies. Repeated exposure to these things that can affect our blood cells cumulatively, they can make a person more prone to MDS. Also, patients who have family members who have had bone marrow problems.” TS 13:39 “The way I explain it to patients who say, ‘What does dysplasia mean?’ I say, ‘Well, if you had a picture of a face. If the cell has too many eyes, or one eye above the other or below the other, or too many ears, or they’re just disfigured. They don’t look right and they don’t mature normally.’ And so, the descriptions I frequently see are nuclear budding and micromegakaryocytes. Once you read a lot of the reports, you start to pick out, ‘Okay, these are the terms that go along with dysplastic red blood cells or dysplastic megakaryocytes,’ which are your precursors to platelets.” TS 21:28 “The cytogenetics and the variants—that’s a hard concept to explain to patients. And staying current on how we understand the disease and how it evolves. Now we have pre-MDS states called clonal cytopenia of undetermined significance. That was new to me. And then clonal hematopoiesis of indeterminate significance. And some of those clones have other healthcare problems that go along with them.” TS 30:52 /episode/index/show/onsvoice/id/40784490

Episode 410: The Evidence for the Environment’s Impact on Cancer Outcomes 04/10/2026

Episode 410: The Evidence for the Environment’s Impact on Cancer Outcomes “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 Chair in Oncology Nursing at the University of Pittsburgh School of Nursing in Pennsylvania told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the effects of the environment on cancer care and outcomes. Music Credit: “” 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 April 10, 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: Nurses caring for people with cancer require knowledge to recognize and address how environmental factors influence cancer care delivery, patient outcomes, and workforce resilience. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum articles: (ONS white paper) ONS Huddle Card: ONS Congress® session: Supportive Care in Cancer article: by Ayana Elizabeth Johnson (webinar by AnnMarie L. Walton) To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “The process of establishing these research priorities usually happens every three or so years. And there’s a lot of preliminary work of talking to multiple parties of interest regarding what they believe the research priorities are, what nurses are seeing in clinics and in the community, and really multiple opinions regarding where the direction of research for ONS should go. And we heard this time—loud and clear—from researchers, from nurses in clinics and in communities, from scholars, and multiple other interested parties, that the environment in a very broad context was very much a concern and specifically a concern for impact on cancer care delivery, quality, and outcomes.” TS 1:49 “You can take some cancer outcome data and you can take patient data related to home address or zip code or even larger geographic areas and kind of do correlational studies to see ‘Does one impact the other?’ … There’s been a lot of those in the literature. But they are very helpful because they’re starting to define this idea that beyond the idea of just demographics—gender, age, race—that the whole concept of neighborhood and the influences of the neighborhood do impact cancer outcomes. And that’s where we’re seeing the sort of explosion in literature across multiple malignancies, stages of cancer, and across multiple questions—specific kinds of outcomes, everything from quality of life to tumor progression.” TS 8:43 “There is growing literature around how cancer delivery can be better prepared for climate-related disasters. … There’s a good article by Pamela Ginex that was published in Supportive Care in Cancer talking about climate disasters and oncology care. And that was really a systematic review looking at published literature and starting to classify where are the disruptions and how could we think about that from a research perspective. They ended up saying there are these patient-level outcome disruptions that of course include treatment disruption but also include this inability to communicate with the oncology care team, which is quite distressing. And there’s a workforce disruption because there are very distressed clinicians who are experiencing the same climate-related disaster in their own lives and feeling like they are torn between their commitment to work and their commitment to family.” TS 13:25 “After all these years in oncology nursing, I am convinced that we have to get the consideration of neighborhood. I think we do have to get back to the neighborhood level in order to boost the resilience of communities against cancer throughout the cancer trajectory.” TS 31:53 “Let’s take some of this to the community and boost the community in that way. I really feel like we have to think about just boots on the ground outside of the cancer center, instead of just documenting disparities or even doing interventional work, but still within our little ivory towers.” TS 34:21 “You see the work of many in looking at the specific environmental risks to nurses through the toxic chemicals to which were exposed. But then thinking about the people who aren’t as protected as nurses and the environmental workers, who are usually contracted out or not in unions, who don’t have some of the same protections that nurses or other healthcare workers might have, and they are exposed to the chemicals without proper training or sometimes without protection. All of these things are very much worthy of an oncology nursing voice elevating these questions and saying, ‘How can we study this? How can we best mitigate some of these risks?’ Oncology nursing—we have to use our respect and good name in elevating all of these questions.” TS 35:39 /episode/index/show/onsvoice/id/40711460

Episode 409: An Overview of Interventional Oncology for Nurses 04/03/2026

Episode 409: An Overview of Interventional Oncology for Nurses “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 practice providers for the oncology service line at the University of Miami Sylvester Comprehensive Cancer Center in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about interventional oncology. Music Credit: “” 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 April 3, 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 interventional oncology as a treatment modality for cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: (December 2025 supplement) (Radiological Society of North America) To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “In the 1990s, tumor-focused procedures such as embolization and ablation began to emerge, marking a shift toward oncologic applications. The 2000s saw rapid technologic advancements that expanded the scope and volume of oncology-directed interventions, including vascular access device placement, liver-directed transcatheter therapies for tumor control, and more sophisticated ablation modalities. Today, interventional oncology, or IO, extends beyond procedural work, encompassing comprehensive clinical care through dedicated IO clinics that support patient consultations, treatment planning, and postprocedure follow-up.” TS 1:50 “In the immediate postprocedure phase, the IO nurse plays a critical role in patient safety in education, and oftentimes it may not be the same nurse that’s caring for the patient in the procedural environment versus the postprocedural environment. But the role is really about continuous need to assess the patient’s comfort level, to ensure that there is hemodynamic stability of the patient while closely monitoring for complications such as bleeding at the access site—of course, depending on the procedure—if there’s any hematoma formation or changes in vital signs, or if there’s any pain that needs to be addressed. Most importantly is maintaining patient safety in that immediate phase after the procedure.” TS 8:07 “Before an IO procedure, both teams really must review the patient’s clinical status. There has to be a clear understanding of: Is this patient ready to undergo a procedure? Is there any necessary imaging that needs to be done, as well as laboratory review and any systemic treatments, that may affect procedural planning? And oftentimes, in my experience, really, the oncology nurses are the ones really speaking with each other based on what the decision has been from both teams working together and communicating this to the patient.” TS 13:49 “I think the oncology nurse needs to assess the patient’s baseline understanding of interventional oncology. I often began my visits with a simple, open-ended question, ‘Tell me why you’re here today.’ This allowed me to gauge their knowledge of the specialty and the purpose of the visit with the IO team. And in many cases, patients were unfamiliar with interventional oncology, which meant education needed to start with an explanation of what IO is and how it fits into their cancer care journey. Once that foundation was established, I was then able to introduce information about the specific procedure and its role in their overall treatment plan. And we can work together to establish goals of care and health. Having this approach ensured patients were informed, engaged, and better prepared for the procedure ahead.” TS 16:06 “As nurses explore career options, interventional oncology is definitely one to consider. It really unites technology and innovation, and I think that’s where we’re heading with health care, with so much advancement in research and science. There’s definitely a place for oncology nurses in this space, and it would be great to see that continue to flourish.” TS 24:23 /episode/index/show/onsvoice/id/40630850

Episode 408: Radiation Site-Specific Side Effects: Breast Cancer 03/27/2026

Episode 408: Radiation Site-Specific Side Effects: Breast Cancer “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 at ONS, during a conversation about radiation site-specific side effects in breast cancer. Music Credit: “” 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 27, 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 side effects experienced with radiation therapy to the breast. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum articles: ONS books: (fifth edition) ONS/ONCC® courses: ONS Huddle Cards: ONS Guidelines™: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email Highlights From This Episode “The goals of radiation to the breast are typically broken out into three different rationales. Either adjuvant treatment, where the tumor is removed surgically from the breast first and then radiation is delivered to lower the likelihood of return of the cancer. And then the second way it’s given is with a curative intent. That may be for tumors that couldn’t be fully resected, and the hope is to eradicate the tumor that is still present in the tissue. Lastly, it can be given in a palliative fashion where you’re not expecting to completely cure the person of the cancer, but you hope to shrink the tumor enough to relieve symptoms.” TS 1:46 “We really try to focus on patients managing fatigue by ensuring that they’re having an appropriate, balanced diet with proper macro and micronutrients and that they’re having adequate protein intake. We encourage patients to get adequate sleep. There is a culture of people pushing themselves and working into late hours of the night, and this would be quite difficult if you’re experiencing radiation-induced fatigue. If someone is familiar and does regular exercise, we highly encourage them to continue that. If someone has not done much exercise and has slipped into a little bit of deconditioning or they’re older or more frail, we might refer them for physical therapy or strength training to rebuild some of that stamina and energy.” TS 7:56 “One of the key products to use for prevention of radiation dermatitis are silicone patches, and there are many on the market that are worn during the course of radiation or when the skin reaction begins. And they could stay on for several days during treatment, even if you’re gently showering around the area. There are many homeopathic creams made from calendula flower, aloe vera, or some kind of combination of these types of products. The real issue with these products is that many of them aren’t covered by insurance, so patients have to buy them out of pocket, over the counter. For some of our patients who are more financially challenged, it may be a problem. So I think [it’s important] to be familiar with many different products so that patients have access to something that will minimize their skin reaction.” TS 14:48 “After 90 days, it may be more common to see some of the cosmetic changes that can happen in the soft tissue of the breast. One of them is radiation fibrosis, which can be like a diffused scar tissue in the breast. It can sometimes cause hardening, retraction, or asymmetry. Sometimes it can cause a tight feeling where people can’t stretch their arm to the full extent. We also know that there can be slower healing if surgery is done. For people that have tissue expanders or still want to have corrective plastic surgery, we really encourage them to wait at least six months or longer before approaching any of those plastic surgery procedures.” TS 19:55 “Sexual health is such a big topic, but I think that nurses in radiation oncology are in a very good position to discuss that because we see patients for repeated period of time. So, there’s maybe a quicker intimacy or familiarity that happens with the nurses in radiation. Personally, I always bring it up at a follow-up visit, which we do about a month after radiation ends. And it’s kind of because the dust is settling and people are getting back to their lives.” TS 23:53 /episode/index/show/onsvoice/id/40542110

Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy 03/20/2026

Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy “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 Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about CAR T-cell immunotherapy. Music Credit: “” 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 20, 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 CAR T-Cell immunotherapy in the treatment of cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS Voice oncology drug reference sheet: Clinical Journal of Oncology Nursing articles: ONS book: (second edition) ONS Huddle Cards: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “CAR T-cell therapy combines an adoptive cell transfer with genetic engineering. And what that really means is that we are harvesting a patient’s own T cells and then we engineer them with a synthetic receptor that helps them recognize that cancer. And all of this work has evolved through many decades of stepwise advances in how we design and activate the T cells. That led us to several landmark trials and ultimately the first CAR T-cell therapy approved by the U.S. Food and Drug Administration in 2017, which was tisagenlecleucel for pediatric and young adult patients that had acute lymphoblastic leukemia.” TS 3:34 “If a patient has higher disease burden or an inflammatory biology, that does tend to correlate with higher toxicity risk. And then that might influence the way we monitor the patients who are getting the CAR T therapy. And then finally, baseline neurologic examinations, because neurotoxicity can occur with these agents. It’s very important that we as a whole healthcare team really understand what the patient looks like at baseline to be able to determine if they’re having any altered changes or confusion. If I had to summarize it, we want to confirm the target and make sure that we have the right CAR T product for the patient. We want to confirm that the patient, physiologically and mentally, is ready for the CAR T therapy.” TS 10:53 “I think the two [toxicities] that every nurse will hear about almost immediately when talking about CAR T therapy are CRS or ICANS, which stands for immune effector cell–associated neurotoxicity syndrome. ... ICANS can either follow or even occur alongside CRS. And this can present as something as simple as just being slightly confused or altered, leading into progressively more severe elements such as word-finding difficulties, tremors, or changes in handwriting. Or even more severe cases that lead to seizures or decreased levels of consciousness. So, in this setting, neurologic assessments and knowing and understanding what your patient’s baseline neurologic status is is so important. Those are really the two largest side effects that cross the board when it comes to CAR T therapies.” TS 16:02 “In terms of the more practical aspects of administration, this is not a typical medication infusion. CAR T cells are living cells. So the way they are handled and administered is very specific. The majority of CAR T products are given as a single IV infusion. The cells come to us frozen either from a cellular lab or they will come from the pharmacy department. So those cells are typically thawed, and timing is of the essence. You really need to coordinate the timing of [thawing] to when they get infused to your patient. They tend to have a short shelf life once they’re not frozen anymore.” TS 26:34 “Now that therapy has, in many places, transitioned to be administered in the outpatient setting, education becomes absolutely critical. The patient is coming for their daily visit to clinic and then they’re going home. And it’s really up to the caregiver, who is usually not a nurse, who has to recognize early signs of toxicity. They need to be educated about what a fever is, what number constitutes a fever, what does confusion look like, what does hypotension look like? ... Do they have access to a thermometer? If you are asking them to look at blood pressure, do they have access to a blood pressure monitor? And sometimes those can be subtle things that might be overlooked. So, the emphasis in outpatient quality education is teaching those caregivers what to watch for, how to act quickly, and who to call immediately. You need to make sure that they have that information readily available if something happens.” TS 30:55 /episode/index/show/onsvoice/id/40501800

Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices 03/13/2026

Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices “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 Center in Houston, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about drug resistance biomarker testing. This podcast episode is sponsored by AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes This episode is not eligible for NCPD credit. ONS Podcast™ episodes: ONS Voice articles: Clinical Journal of Oncology Nursing article: ONS book: ONS course: American Cancer Society Cancer Action Network: White paper: . To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “We know that biomarkers are playing an ever more important role in cancer care, and really, their use can range anywhere from helping us to confirm a given diagnosis, understand a patient’s cancer susceptibility or risk, evaluate prognosis, as well as personalize treatment recommendations. … But in some cases, though, biomarkers can also help us to avoid therapies that are not likely to work. We also call these drug resistance biomarkers. These are those biomarkers that signify that a tumor is unlikely to respond to a given therapy.” TS 1:50 “Resistance to cancer therapies is one of the most common issues that arises during cancer treatment. Because the populations of cancer cells within a tumor can be very diverse, when a given drug kills the cells that are sensitive to that therapy, it can also eventually leave behind resistant tumor cells, which can grow and multiply over time. So this can ultimately lead to a point where the treatment that was initially effective is no longer able to control the disease.” TS 4:33 “While costs have come down, there can still be a cost associated with biomarker testing, and in some cases, this can be considered a barrier to care. What patients pay out of pocket can vary widely depending on their insurance coverage. So we have some data that was published from the American Cancer Society Cancer Action Network, and this was published a few years ago in 2023, which showed the average allowed unit cost to insurers per biomarker test ranged anywhere from about $79 for patients who were on Medicaid to about $224 for large-group, self-insured patients.” TS 10:03 “There’s research underway that’s looking not only at genomic changes—so DNA changes that impact drug resistance—but how other substances such as RNA and proteins within the cell can also contribute to drug resistance. And this kind of falls into not just genomics but multiomics field. I have no doubt whatsoever that the use of artificial intelligence and machine learning is likely going to play a large role in drug resistance research. And really, these tools can help researchers to analyze complex data sets, identify novel resistance biomarkers, predict resistance patterns, as well as help to develop treatments that may overcome some of those resistance mechanisms.” TS 17:00 /episode/index/show/onsvoice/id/40296175

Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses 03/06/2026

Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses “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®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term multiple myeloma considerations for oncology nurses. Music Credit: “” 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 6, 2027. Ann McNeill is on the speakers’ bureau for Pfizer. This financial relationship has been mitigated. All other 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 management of long-term side effects related to multiple myeloma and treatment. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Oncology Nursing Forum articles: ONS book: (third edition) ONS Huddle Cards: ONS Learning Libraries: ONS Symptom Intervention resources: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email Highlights From This Episode “We do consider myeloma an incurable hematologic malignancy, even though we have had improvements in survival. But just like for any malignancy, our goal is to maximize survival. We want to eliminate as many myeloma cells as we possibly can. And subsequently, we want to improve the quality of life for these patients in the long term. So those are basically our treatment goals. That’s what we think of when we’re treating patients all throughout their treatment journey.” TS 1:39 “It is very typical for patients along their journey to have received several lines of therapy. I think it’s important to realize that the cells acquire new mutations, making them more resistant to these further subsequent lines of therapy. We see quicker, more aggressive relapses in those patients with multiple prior lines of therapy. We can see an increase in the CRAB symptoms, which are the calcium elevations, the renal dysfunction, profound anemia, and even bone disease. We can see a rapid rise in the monoclonal protein in the labs or even a very rapid rise in the involved light chain in that serum free light chain assay, so it’s important to monitor these labs.” TS 9:14 “All oncology nurses are focusing on these survivorship plans now. And I think that’s a great thing when you think about a diagnosis of cancer and a survivorship plan, because it means these patients are living a longer time. We still look at long-term health maintenance guidelines depending on the patient’s sex and their age. ... I think preventing infection is always going to be something absolutely on the forefront in our survivorship plan with myeloma. I mean, myeloma is an immune system malignancy. The treatments that we have given patients can sometimes, especially in later life therapies, further compromise the immune system. So, we’re always looking to prevent serious infection.” TS 12:46 “Patients get treatment, especially induction therapy. They may or may not get transplant. They may have been on a very minor maintenance schedule, depending on their age. And they feel really well. And then they decide not to return for their follow-up because they feel so good. I think nurses are critical in the communication aspect of the patient-provider aspect. So, nurses are really the key means of communication. The providers are absolutely important—the physicians, the nurse practitioners and every other member of the team—but I think the nurses have a really special rapport with patients. They’re usually the ones providing the education on the treatment regimens. They’re managing the toxicity profiles. They’re doing all the coordination of care between visits. They are really going to be the ones telling the patient, ‘Hey, you’re going to feel good and that’s a wonderful thing, but you still need to come once a month or once every six weeks or once every two months for your labs.’” TS 15:17 “It has been amazing. The science, the research, the treatments, the approvals from the U.S. Food and Drug Administration. Survivorship has improved dramatically. Let’s take the first few years of the new century, right? The five-year survival rate was about 38%. If you then jump to 2015–2019, which is still seven plus years ago, it has doubled. So, we’re talking about anywhere from 60%–80% over a five-year survival. So that’s an amazing improvement in their five-year survival rate for myeloma.” TS 23:28 “Survivorship in myeloma begins at diagnosis, not just after treatment. And I think that because it is managed as a chronic, often relapsing disease, it does require lifelong evolving care. Patients should realize that they will know us for the rest of their lives. We will know everything about you. I always tell them, ‘I will know everything about your hobbies, your children, your grandchildren, what you love to do on the weekends.’ It’s very important that that point is made right at diagnosis, not just after so many lines of treatment. It’s very important that we are going to follow these patients throughout their journey.” TS 28:18 /episode/index/show/onsvoice/id/40295970

Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications 02/27/2026

Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications “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, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about education for patients receiving antineoplastic drugs for non-oncology indications. Taylor also spoke with ONS members Lizzy McMahon, BSN, RN, OCN®, and Jennifer Lynch, BSN, RN, TCTCN™, about general antineoplastic treatment education and tailoring education in the stem cell transplantation setting. Music Credit: “” 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 February 27, 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 of best practices for educating patients receiving antineoplastic therapies across oncology, non‑oncology, and stem cell transplant settings. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: Oncology Nursing Forum article: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode McMahon: “A great question would be to ask the patient what they already know and what they’re most concerned about or what their biggest questions are. This way, the nurse can tailor their education to make sure to focus on what the patient doesn’t know yet and what they’re most concerned about, while still touching on all the required education topics. … It’s also important for nurses to continually be assessing the patient’s readiness to learn throughout the education session, looking for nonverbal cues or verbal signs that the patient is overwhelmed or anxious because this is going to interfere with their ability to take in new information.” TS 3:49 Thornberry: “A lot of the education sheets and the products for them explain it like, ‘This is cancer,’ and more of an oncology perspective, so occasionally [non-oncology patients] can show up and be confused by it. I do feel like they come a little bit less prepared than our oncology patients. Our rheumatologists and neurologists, they sure try, but they just don’t have the support in that realm either. They’re full of every question you can imagine. They’ve never been to an infusion room. They don’t know what to bring. Can they drink water and have their meds beforehand? It’s a full gamut of really preparing them to get these for autoimmune or rheumatology-type issues.” TS 14:12 Lynch: “I really want to spend time with those patients to make sure that we are not assuming that they are coming to us with any knowledge or experience. I want them to be able to come to us with questions and trust their healthcare team and really sit down with them and say, ‘Okay, you don’t have cancer, but we’re using the word chemotherapy where we’re talking about cancer drugs.’… And we’re going to probably spend more time going over some of the basics about blood stem cells, types of cells that they grow into, how your body fights infection, what they’re going to be at risk for. The side effects can be pretty scary when you’re talking about them, especially back to back. So making sure that we are delivering the information that doesn’t put them in a panic mode… A lot of reassurance, as well, and just taking into consideration that, yes, this might have this whole other layer of anxiety to it because of the unknown.” TS 32:22 /episode/index/show/onsvoice/id/40179575

Episode 403: Pharmacology 101: Checkpoint Inhibitors 02/20/2026

Episode 403: Pharmacology 101: Checkpoint Inhibitors “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 cell transplants,” Kelsey Finch, PharmD, BCOP, oncology pharmacist practitioner at Columbus Regional Health in Indiana, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about checkpoint inhibitors. Music Credit: “” 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 20, 2027. Kelsey Finch has disclosed a speakers bureau relationship with AstraZeneca. This financial relationship has 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 an increase in knowledge related to checkpoint inhibitors in the treatment of cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS Voice oncology drug reference sheets: ONS books: (second edition) (second edition) ONS course: Clinical Journal of Oncology Nursing articles: ONS Huddle Cards: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email Highlights From This Episode “Before immune checkpoint blockade, the two-year overall survival rate in metastatic melanoma was hovering around 10%. After these agents came to market, depending on the trial and the agents used, that number actually increased to about 50%–65%. So, five times the amount of patients were actually living at the two-year mark. Not surprisingly, studies then exploded across several tumor types, leading to approvals in all sorts of cancers, mostly in the solid tumor. But there are a couple hematologic as well. Lung cancer, kidney cancer, head and neck, Hodgkin lymphoma, hepatocellular, the list goes on. So, it’s really just transforming the stage IV setting across all tumors, specifically from uniformly fatal prognosis to one where durable responses and long-term survival is also possible.” TS 3:03 “There are four different mechanisms officially being used in therapies that are approved by the U.S. Food and Drug Administration (FDA). Those are cytotoxic T-lymphocyte–associated protein 4, programmed cell death protein 1, and programmed cell death ligand 1, which I’m counting as two different mechanisms, even though they somewhat work together. And lymphocyte-activation gene 3 is the fourth one that’s in there. So, all these mechanisms impact the T cell in our immune system. The T cell is traditionally responsible for protecting our body from harmful things like bacteria, viruses, and cancer. When the tumor binds to cytotoxic T-lymphocyte–associated protein 4 receptors, that happens on the T cell itself. And that inhibits the activation of the T cells, essentially allowing that tumor to then live. So when developing medications that block this receptor, they noted an added benefit that it actually increased the T-cell proliferation as well as keeping that T cell active. So not only are we not blocking the T cells, we’re making them more productive.” TS 5:38 “If you have a chance of any sort of tissue rejection, specifically with allogeneic stem cell transplants or where we see that focusing on it, there’s a little bit of controversy, mixed bag on opinions as far as autologous stem cell transplants. But it’s best to at least exercise a little bit of caution. If they have a chance of organ rejection, is that worth the risk of the therapy that we’re looking to give? And then, patients with HIV, any sort of immunologic concerns at baseline that we could potentially worsen.” TS 14:37 “As a rule of thumb, with immune checkpoint blockade, regardless of what mechanism you’re looking at, if something in your body can get inflamed, that can wind up as an adverse event. So, whenever I talk to my patients, the key word is anything ending in ‘-itis.’ ... The most common adverse events that we end up seeing are dermatitis and hypothyroidism. Immune checkpoint blockade can cause both hyper- and hypothyroidism. Very often, we actually start in the hyper- and then end up, for lack of better words, burning out the thyroid, ultimately leading to a sustained hypothyroidism.” TS 18:34 “The half-life of immune checkpoint inhibitors is usually around 30 days, meaning that once these agents are given, the drug will be in the patient’s system for up to five months. Specifically, it will probably build month to month, so often we don’t even see a lot of our adverse events until month three or four. Usually, when we’re that far into treatment, we’re not looking for new adverse events in things like chemotherapy. But these drugs do build over time.” TS 24:28 “As far as safe handling is concerned, these agents are not chemotherapy. That makes drug compounding and administration pretty straightforward. When looking at the follow-up care, the most important thing, in my opinion, is to engage in meaningful dialogue with your patients. A lot of the side effects can be nonspecific. So, really listening to the patient and evaluating changes in their lifestyle, I think it’ll get you far. We usually hark in on the new, worsening, or persistent whenever we’re talking to patients because they’ll be looking for things as well. So, just having a dialogue of how their life has changed can certainly help.” TS 26:17 /episode/index/show/onsvoice/id/40098870

Episode 402: Radiation Site-Specific Side Effects: Head and Neck Cancer 02/13/2026

Episode 402: Radiation Site-Specific Side Effects: Head and Neck Cancer “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 of oncology nursing practice at ONS, during a conversation about side effects of radiation for head and neck cancer. Music Credit: “” 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 13, 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 radiation side effects in people with head and neck cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS book: (fifth edition) ONS courses: Clinical Journal of Oncology Nursing articles: ONCC: American Cancer Society CA: A Cancer Journal for Clinicians article: National Cancer Institute: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Many tumors in the region are very radiosensitive, and radiation can be used either as definitive treatment or after surgery to reduce the risk of reoccurrence, but in many cases, radiation is combined with chemotherapy to improve local control. Because so many vital structures are located in this small complex area, radiation allows us to treat the cancer while minimizing the need for extensive or disfiguring surgery.” TS 2:40 “The most common acute side effects of head and neck radiation: effects to the mouth, the throat, the skin, and the energy level. Patients often experience a mucositis, pain or sore throat, difficulty swallowing, dry mouth, or thick saliva, and taste changes. Skin irritation and redness in the treatment field is also common and can progress to dry and moist desquamation. Fatigue is another frequent side effect and tends to build as treatment progresses. Emotional and psychological distress are also very common in this patient population and can have an impact on daily function and quality of life. Side effects usually develop gradually, often beginning in the second and third week of radiation and may be more severe or have an earlier onset in patients receiving concurrent chemotherapy.” TS 4:02 “Pain management is essential so patients can continue eating and drinking. Supporting the energy level and maintaining hydration are also key, as fatigue and dehydration can significantly worsen other side effects. Oral care protocols help manage mucositis and nutrition support may include supplements or enteral feeding if needed.” TS 11:24 “Sexual health might not be the first thing nurses think of in regard to head and neck radiation. … But even though radiation for head and neck cancer doesn’t involve the reproductive organs, it can still have a significant impact on sexual health and intimacy. Like fatigue, pain, dry mouth, changes in speech and visible changes in appearance can all affect body image and relationships.” TS 14:52 “One of the common misconceptions is that side effects end when radiation ends. In reality, some effects peak afterward or become long term. Xerostomia, or dry mouth, and taste changes are good examples. While some patients improve, others adjust to a new normal where dry mouth and altered taste are permanent.” TS 19:53 /episode/index/show/onsvoice/id/39935130

Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses 02/06/2026

Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses “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 Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma treatment considerations. Music Credit: “” 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 6, 2027. Ann McNeill has disclosed a speakers bureau relationship with Pfizer. This financial relationship has 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 an increase in knowledge related to the treatment of multiple myeloma. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS Voice oncology drug reference sheets: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS books: (third edition) (third edition) ONS course: ONS Huddle Cards: International Myeloma Foundation: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Typically for our first-line therapies, we use certain classes of drugs and some of them are proteasome inhibitors like bortezomib and carfilzomib. We also have IMiDs or immunomodulatory agents like thalidomide, lenalidomide, and pomalidomide. We have monoclonal antibodies, anti-CD38 monoclonal antibodies. Of course, we can never talk about treatment for myeloma without mentioning dexamethasone. It is an integral part of our treatment regimen. Most of our frontline therapies now are not just a single agent. They’re not even doublets anymore. Typically, they’re triplet therapies. And now in 2026, it’s leaning more toward quadruplet therapies. By that, I mean you’re taking a proteasome inhibitor, an immunomodulatory drug, dexamethasone, and an anti-CD38 monoclonal antibody all together to present patients with a good chance their induction therapy will lead to a good chance of them responding to treatment.” TS 4:25 “[With] myeloma labs, there should be some indication after each cycle of therapy that the treatment is working. So, you don’t have to do a whole myeloma panel, but maybe getting a monoclonal protein spike, maybe getting a free light chain assay, or maybe an immunoglobulin G or immunoglobulin A level, just to see if the treatment is working. So, those labs are crucial to determine whether the therapies are working. And again, the lab improvements usually correlate with the clinical presentation of the patient.” TS 11:01 “There are active clinical trials ongoing with drugs like cell mods. Cell mods are the new oral anticancer agents for myeloma that have shown great promise with efficacy and safety profiles. And then there are other combinations that are showing a lot of promise. So, drugs that are already approved by the U.S. Food and Drug Administration (FDA). And I’m talking about pairing anti-CD38 monoclonal antibodies with bispecific T-cell engagers. If you do that, there has been some evidence that these combinations are very efficacious and responses are durable. And there are ongoing clinical trials and studies being done right now to see if these can be FDA-approved to pinpoint where they are as far as in comparison to other treatments.” TS 20:10 “I always tell patients to try to participate in safe, and I want to stress safe, physical activity. So, I tell patients, the more you sit on the couch or you sit in the chair for most of the day, that unfortunately will make your pain worse. So, trying to get up and about and doing some physical activity, such as getting a physical therapy evaluation and a treatment program, no matter how passive or mild or gentle it is, can really help these patients with bone pain.” TS 26:10 “I think it’s important to realize that myeloma has had amazing advances in science, research and treatments. I think that all of these things coming together, all the science and clinical trials and everything like that, has led to a significant increase in overall survival of our patients, which ultimately is a great thing. We want patients to live longer and they’re living longer with a very good quality of life. So, I think it’s important to realize that myeloma is very well studied, very well researched, and it’s still ongoing with many, many clinical trials.” TS 36:04 /episode/index/show/onsvoice/id/39895875

Episode 400: Pharmacology 101: Radioimmunoconjugates 01/30/2026

Episode 400: Pharmacology 101: Radioimmunoconjugates “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 conversation about radioimmunoconjugates. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 30, 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 in the history of, the mechanism of action of, and the use of radioimmunoconjugates in the treatment of cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS Voice oncology drug reference sheets: ONS books: (second edition) (fifth edition) ONS courses: Clinical Journal of Oncology Nursing articles: ONS Huddle Cards: ONS Learning Libraries: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email Highlights From This Episode “Radioimmunoconjugates are a specialized subset of radiopharmaceuticals designed to combine the specificity of monoclonal antibodies with the cytotoxic power of radiation. ... Early development focused on B-cell malignancies, particularly non-Hodgkin lymphoma.” TS 1:51 “An important concept for nurses to understand is the crossfire effect, where radiation can affect nearby tumor cells, even though not every cell expressed has the target antigen. This helps explain why these agents can be effective even in heterogeneous tumors.” TS 3:40 “At present, 90 Y-ibritumomab tiuxetan is the only radioimmunoconjugate approved by the U.S. Food and Drug Administration (FDA) in clinical use. Historically, iodine-131 tositumomab played a major role in establishing these therapy classes, but it’s also useful to contrast radioimmunoconjugates with other radiopharmaceuticals, such as iodine-131 therapies, which a lot of places do at this time, used for thyroid diseases, or radium 223, used for metastatic prostate cancer. Unlike those agents, radioimmunoconjugates rely on antibody-mediated targeted rather than physiologic uptake or bone affinity.” TS 4:55 “I just try to explain to [patients] that radiation exposure is like being next to a flame. The further you are away, the less heat you get, the less exposure you get. These patients can be radioactive for three days, seven days—it just depends on how fast they excrete it through their bodies with half-life exposure.” TS 9:33 “While only one agent is currently approved, the principles established by radioimmunoconjugates continue to guide development for newer targeted radiopharmaceuticals. Emerging agents aim to improve targeting, reduce toxicity, and expand indications beyond hematologic malignancies. This evolution underscores the importance of nursing education in this rapidly changing field.” TS 10:41 “Radioimmunoconjugates represent an important bridge between traditional oncology treatments and the future of targeted therapies. Oncology nurses play a vital role in ensuring safe delivery, patient understanding, and collaboration between multidisciplinary teams. So, it’s very important to educate and also stay up to date on evidence-based practices.” TS 13:12 /episode/index/show/onsvoice/id/39895625

Episode 399: National Hazardous Drug Exposure Registry 01/23/2026

Episode 399: National Hazardous Drug Exposure Registry “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 health director of the division of occupational and environmental medicine at the University of Maryland School of Medicine in Baltimore, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry. Music Credit: “” 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 23, 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 in the incidence of hazardous drug exposure and the tracking and reporting of healthcare worker exposures. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS books: (fourth edition) ONS course: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum articles: Other ONS resources: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email Highlights From This Episode “We thought that in order to answer some of the unclear questions about health risk, we would set up an exposure registry, in this case, for oncology personnel who handle the drugs. This would then create a cohort that we could ask questions to. For example, we could try to characterize whether there is a cancer excess in this group. Or characterize the reproductive abnormalities in excess that people are experiencing.” TS 6:21 “It’s sort of counterintuitive that the healthcare industry, whose mission itself is care of the sick, is a high-hazard industry. We typically think about the risk as being from infectious diseases, and certainly we’ve all lived in our practice lifetime through some examples of that. Even before COVID-19, some of us were doing preparation for Ebola and that sort of thing. So, we’re kind of used to that. But the hazards that you kind of grew up with, we’ve routinized or normalized handling group one, human carcinogens, which a number of these drugs are—it’s just something we do every day. Well, it is, but we have to do it with respect and with care every day. And I think sometimes in that routineness of it, we have sort of lost sight of the vigilance that we need to maintain.” TS 11:19 “It’s very easy in the life cycle of a drug in an organization to do something that doesn’t just impact you, but unknowingly, you’ve contaminated a surface for somebody who comes behind you. Who maybe doesn’t have plastic protective equipment on because something that got contaminated shouldn’t have been contaminated in the first place. If we could all be thinking of it as more of a team sport, especially in terms of safe handling, that our disposition and drug handling affects not just us and our health, but those of our colleagues.” TS 24:47 “For the job history pieces, we ask what year you started, what year you stopped, and we ask about estimations of handling. So we’ll be able to come up with either a duration or some kind of metric for the intensity and duration of your handling history, which will then permit us to sort the population who completed the survey into sort of low, medium, high. And we’ll see whether the health outcomes that are being reported are influenced by that drug handling history.” TS 27:45 “The idea that we aren’t exposed to the same therapeutic dose we give to our patients is absolutely true. However, the dosing schedule to them versus us is very different, and we are exposed frequently, if not daily, to very small concentrations. They don’t reach a cytotoxic dose necessarily, but we do know from a lot of studies that either ourselves or our colleagues are taking up drug from contaminated work environments. And you’ve probably seen there is an awful lot of intermediate evidence looking at genotoxic insult in pharmacists and nurses who handle the drugs. So clearly we’re showing uptake and we're showing that there are biologically plausible, concerning measures that are taking place in us. So, I think that we need to come back and circle around the idea that we need to have deep respect for the toxicity of these agents.” TS 35:03 /episode/index/show/onsvoice/id/39732105

Episode 398: An Overview of Multiple Myeloma for Oncology Nurses 01/16/2026

Episode 398: An Overview of Multiple Myeloma for Oncology Nurses “[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 Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma. Music Credit: “” 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 16, 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 pathophysiology and diagnosis of multiple myeloma. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS books: (second edition) (third edition) Clinical Journal of Oncology Nursing articles: Other ONS resources: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Epidemiologically, myeloma is a cancer of older adults. The median age is about 69. It is more common in men than women. It’s a ratio of about three men to two women that are diagnosed. It is much more common in people of African American descent with increasing global incidence linked to aging populations. Although, the highest rates are in high-income countries. So, if we look at some of the risk factors, and several have been identified, including MGUS. MGUS is a benign precursor of myeloma, and it stands for monoclonal gammopathy of undetermined significance. Older age is also a risk factor, although we do see patients that are younger who are diagnosed with myeloma.” TS 1:54 “Bone pain, specifically in the back, and fatigue, are very common symptoms that relate to things that are going on behind the scenes with myeloma. But also, patients can be bothered by frequent and long-lasting infections. So, they find that they get sick more frequently than their family and friends, and they take a longer time to recover. That could also be a presenting sign. I think there can be some presenting signs and symptoms related to electrolyte abnormalities, especially in later stages. They might be nauseated, vomiting, or constipated. Also, signs and symptoms related to cytopenias. You have to remember that this is a bone marrow cancer. So, we do have some problem with development of normal blood cells. So, we can see not only infections, but bleeding issues related to thrombocytopenia and factors related to anemia from low red blood cell counts.” TS 7:15 “About 20%–25% of our patients who are diagnosed are asymptomatic. They have no symptoms. They’re living their lives, they’re going to work or they’re traveling, playing golf on the weekends, taking care of their children or grandchildren. They are just living their lives. And at times, they go to the primary care physician and then they’re referred to a hematologist-oncologist, and they’re pretty surprised when they’re sent to a cancer center. The way they are diagnosed in this matter is that their routine lab work, the complete blood cell count may be normal, there may be some slight differences in their hemoglobin. But what we see in the chemistry, the complete metabolic panel, is an elevation in their total protein and or an elevation of the total globulins.” TS 9:22 “The bone marrow biopsy serves many purposes. You want to determine the percentage of bone marrow plasma cells. So, you want to get the degree of plasmacytosis. And then you want to do really specific tests on those plasma cells. So, you want to isolate the malignant plasma cells and determine, via analysis. So, we do the karyotype, chromosomal studies, fluorescence in situ hybridization (FISH) studies, immunohistochemistry studies, and molecular studies. All of these studies are looking for specific genetic changes in the myeloma cells—looking for translocations or deletions. And it’s very important to get that information because we can put patients in a category of having standard-risk disease versus high-risk disease. And that can give us a better picture of what this patient’s journey with myeloma may look like.” TS 13:41 “When I used to work in lymphoma, I spoke with the physicians who were lymphoma specialists, and they said that they foresee a future in having these assays that detect circulating tumor cells actually take the place of imaging studies like restaging positron-emission tomography (PET), computed tomography (CT) scans. So, it’s really amazing, these tests that are on the market now and maybe not as widespread as we’d like, but there’s a lot of nice assays out there that will become more popular and used more commonplace in the future that I think are going to help identify myeloma more precisely. ... If you think about myeloma, even with measurable residual disease (MRD), MRD for leukemia, for lymphoma, you take a blood sample, you test it for MRD. For myeloma, you need a bone marrow biopsy. You need a bone marrow sample. You can’t do MRD on a blood sample for myeloma. Not yet. But if we perfect these assays and we can eventually detect this, then you’re looking at a whole new ballgame. You can even perfect your MRD testing as well. So, it’s a very exciting time for some of these heme malignancies.” TS 28:09 /episode/index/show/onsvoice/id/39677595

Episode 397: Cancer Symptom Management Basics: Ototoxicity 01/09/2026

Episode 397: Cancer Symptom Management Basics: Ototoxicity “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: “” 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 . ONS Podcast™ ONS Voice articles: ONS book: (fourth edition) American Cancer Society resources: American Society of Clinical Oncology (ASCO) Annual Meeting abstract: Children’s Oncology Group supportive care endorsed guideline: Ear and Hearing article: (IOMG) World Health Organization initiative: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . 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 /episode/index/show/onsvoice/id/39445270

Episode 396: Nursing Considerations From the ONS/ASCO Extravasation Guideline 01/02/2026

Episode 396: Nursing Considerations From the ONS/ASCO Extravasation Guideline “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: “” 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 . ONS Podcast™ episodes: ONS Voice articles: ONS books: (fourth edition) (second edition) (fourth edition) ONS courses: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum article: ONS huddle ONS position statements: American Society of Clinical Oncology (ASCO) Podcast: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . 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 /episode/index/show/onsvoice/id/39414455

Episode 395: Pharmacology 101: Monoclonal Antibodies 12/26/2025

Episode 395: Pharmacology 101: Monoclonal Antibodies “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, 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 nursing practice at ONS, during a conversation about monoclonal antibodies. Music Credit: “” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) (including 45 minutes of pharmacotherapeutic content) by listening to the full recording and completing an evaluation at courses.ons.org by December 26, 2026. 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 in the history of, the mechanism of action of, and the use of monoclonal antibodies in the treatment of cancer. Episode Notes . ONS Podcast™ episodes: ONS Voice articles: ONS Voice drug reference sheets: ONS book: (second edition) ONS course: Clinical Journal of Oncology Nursing articles: Oncology Nursing Forum articles: ONS huddle cards: Other ONS resources: Antibodies article: Cureus article: Cancer Immunology, Immunotherapy article: Future Oncology article: To discuss the information in this episode with other oncology nurses, visit the . To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the . To provide feedback or otherwise reach ONS about the podcast, email . Highlights From This Episode “Prior to monoclonal antibodies, all we really had were these toxic chemotherapies or toxic radiation, so it was recognized how great it would be if we could have a treatment that was much more specific to the tumor cells and have agents that have less toxicities. These advancements in monoclonal antibody production began in the 1980s. ... Eventually, we had the first monoclonal antibody that was approved by the U.S. Food and Drug Administration (FDA) for an oncologic indication, rituximab.” TS 4:14 “Nowadays, we do have treatments that are also considered tumor-agnostic. This is when a patient has a certain biomarker, then that treatment can be given and FDA approval was given, regardless what type of tumor the patient has. We typically see these kinds of tumor-agnostic therapies more so in patients who have recurrent or advanced diseases in solid tumors. One monoclonal antibody example that comes to mind is dostarlimab. That’s a checkpoint inhibitor that’s approved for patients who are deficient in mismatch repair mechanism.” TS 23:48 “Our immune system constantly has this surveillance system and it’s able to recognize foreign pathogens, abnormal cells, and even precancerous cells. And they’re able to eliminate them before they become cancerous. But on the flip side, one of the regulatory mechanisms that we have so our immune system doesn’t attack itself is the presence of checkpoints. When these checkpoints bind to their ligands, this can then act as an off switch so that, again, our immune system is not going to attack itself. But then the tumor cells can take advantage of this and actually use this mechanism to evade the immune system. So, when we’re giving a checkpoint inhibitor, now we’re removing that off switch. As a consequence, common adverse effects can include things like immune mediated adverse events. These most commonly affect the skin, gastrointestinal tract, and liver. Essentially, this can cause any ‘-itis’ you can think of.” TS 26:36 “Looking at strategies to prevent infusion reactions, one example is the use of premedication. If premedication is recommended, this typically includes any combination of antipyretics, which is typically acetaminophen. Antihistamine, which is typically an H1 antagonist like diphenhydramine. Although, there could be cases where we want to substitute this agent because maybe the patient has been tolerating therapy okay, and they’re having a lot of side effects. So, we might use a second-generation antihistamine in some cases. The premedication may be given with or without some kind of steroid, whether that’s methylprednisolone, hydrocortisone, or dexamethasone.” TS 29:53 “We tend to think of monoclonal antibody usage to be primary oncology, but that’s not really the case. The first monoclonal antibodies that were developed were not for oncologic indications, they were for transplant indication for cardiac indication. So, they’re really diversely utilized across all specialties and medicines. We have monoclonal antibodies for hyperlipidemia, for neurology, for rheumatology, so the uses are so very expansive across all specialties.” TS 41:01 /episode/index/show/onsvoice/id/39413815

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