The ONS Podcast

Oncology Nursing Society
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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

  1. 16h ago

    Episode 431: Oncologic Emergencies 101: Urinary Obstruction

    "Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you're having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed," ONS member Brenda S. Nettles, DNP, MS, ACNP-BC, AOCNP, CNE, assistant professor at the Johns Hopkins School of Nursing and nurse practitioner at Johns Hopkins Hospital in Baltimore, MD, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about urinary obstructions. Music Credit: "Fireflies and Stardust" 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 September 4, 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 relating to urinary obstruction as an oncologic emergency. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Oncologic Emergencies 101 series Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis Episode 394: Prostate Cancer Survivorship Considerations for Nurses Episode 390: Prostate Cancer Treatment Considerations for Nurses Episode 387: Prostate Cancer Screening, Early Detection, and Disparities ONS Voice articles: A Primer on Urothelial Cancer Oncology Urgent Care Provides the Right Place, Right Time, and Right Treatment for Patients Experiencing Cancer-Related Emergencies In the Event of an Oncologic Emergency, Make Sure You're Prepared to Deliver Compassionate, Life-Saving Care ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging ONS course: ONS Oncologic Emergencies™ ONS Oncologic Emergencies Learning Library American Cancer Society anatomy galleries: Female Genitourinary System Male Genitourinary System To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "As far as diagnoses go, I think that the ones that we see most common are impacted by the actual genitourinary system itself being impacted, so your patients with prostate cancer and patients with bladder cancer are definitely the ones that we see most often. But you'll see that it's also in individuals that have a diagnosis of either mucinous neoplasms or invasive peritoneal disease that invades all the cavities of the body—and also your sarcomas, because they also will actually the involve different parts of the renal system as part of their spread pattern." TS 3:55 "The first thing you want to do is try to eliminate the causative factor. So what's causing the obstruction? If there's something that's limiting flow because of the compression from the outside of the ureter or compressing around the kidney itself that they can't drain adequately, then you can look at ways to manage that by inserting a nephrostomy tube into the kidney. You can also put in ureteral stents to help alleviate the pressure from drainage from the kidney to the ureter and into the bladder." TS 7:20 "It's very common when people have a partial obstruction to have still some degree of urinary output. But the key thing is looking at, over time, how that may change. So if they do develop some progressive symptoms of the flank pain, and then also renal function begins to get a little bit lower and lower over time. Hematuria or signs of infection—those are again that next-level discussion that needs to be had about what gets evaluated next to confirm a possible obstruction." TS 10:00 "The biggest misconception, I believe, would be that you have time to figure it out. And the individual that already has immunocompromised states and also possible decline in baseline renal function have very low thresholds for us to really wait on these things too long. It's always better to err on the side of caution and do at least the due diligence of minimal evaluation by looking at the individual's vital signs and looking at their ability to still have urine output. Then if that's now compromised, work further into the process in a more timely manner." TS 13:47 "It's always good to have a refresher about how to manage different types of urinary diversion systems, so check with your facility in regards to what they carry for nephrostomy tube devices and the maintenance plans they have for those as far as frequency of flushing. So you can be a problem solver for your individual that has these diversion devices place for urinary obstructions." TS 16:19

  2. Aug 28

    Episode 430: Leadership Unlocked: Is It Your Time to Serve?

    "If you are considering board service, I would say take the leap. Start with your local chapter. It will give you some valuable skills that will help prepare you when you are applying for your national level. And I always say, if you want to do it, just do it because what's the worst that can happen? They can say no, but that doesn't mean that you will never serve on a board. I always tell people delayed is not denied," Cassandra Green, DNP, RN, OCN®, ONS member and past president of the Oncology Nursing Certification Corporation (ONCC) Board of Directors, told Evelyn Wempe, DNP, MBA, APRN, ACNP-BC, AOCNP®, CRN, NEA-BC, chair of the ONS Leadership Succession Committee (formerly known as the Leadership Development Committee), during a conversation about service on a board of directors. Wempe spoke with Green and ONS members Kristin Ferguson, DNP, MBA, RN, OCN®, CGNC, former treasurer and director-at-large on the ONS Board of Directors, and Yanka Campbell, DNP, RN, CPHQ, AGPCNP-BC, CNE, member of the Oncology Nursing Foundation (ONF) Board of Directors, about their experiences with board service. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 28, 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 serving on a board of directors for a professional organization. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Meet the ONS Board of Directors series Episode 342: What It's Like to Serve on the Leadership Development Committee ONS Voice articles: Could Today Be the Start of Your ONS Leadership Journey? Nursing Leadership Unlocked Leading With Purpose Creates a Vision for the Future of Oncology Nursing ONS courses: A Guide to Chapter Leadership: Chapter President Training Board Leadership: Nurses in Governance Clinical Journal of Oncology Nursing article: Rearview Mirror Leadership: Looking Backward to Move Forward ONS Board Self-Assessment ONS Leadership ONCC Board of Directors ONF Leadership Your Roadmap to Future Service on the ONS Board of Directors ONS Leadership Learning Library To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode Campbell: "Joining a board was a natural next step for me to maintain my connection to bedside nursing that I've loved for so many years, and to find a way to give back to advanced practice nurses as well in this role. The Oncology Nursing Society and Foundation were especially meaningful for me because I knew firsthand the importance of having scholarship, research, funding, and leadership development programs that can really change the trajectory of a nurse's career. I realized I wanted to help shape the opportunities that were available to me for future nurses, and I just did not want to continue to do that through one-on-one mentorships, which I have done extensively throughout my career, but find a way to help more broadly toward guiding organizational mission and strategic objectives." TS 7:20 Green: "Everyone was so welcoming on the board. Everyone was so friendly. One of the first things I remember our executive director Tony Ellis telling me is, 'Most of our new board members are really quiet and reserved at our first meeting. They just kind of keep things to themselves. They don't ask a lot of questions.' I don't know if they were prepared for me because I came in with guns a-blazing, and I had lots of questions. I was not quiet. I was very involved and very vocal. I still am, but that was one of the best experiences ever. Before that, I had never really been in a board setting other than my local chapter, and even then, I was just starting to be in that setting because I was the president of my local chapter and on the [ONCC] Board of Directors at the same time." TS 10:29 Ferguson: "A nonclinical mentor I would absolutely identify would be Alec Stone, who used to be the ONS director of public affairs. … He helped me to learn a lot about health policy and advocacy and the impact a nurse's voice can have. Learning how to speak about my experiences in health care in public by doing programs like the Nurses in Washington Internship … or ONS's Capitol Hill Days ended up giving me a lot more confidence that I didn't know I would have in expressing my point of view and being very open and collegial and expressing my opinions. … This really lent itself well to my future board experience because, as Cassandra mentioned, board members have to speak their mind and speak up at the meetings." TS 12:11 Campbell: "One of the most unexpected benefits was when I reached out to my executive leadership team at the Kimmel Cancer Center at Johns Hopkins and said, 'I'm being considered to serve on the ONF Board. This is going to require me taking time away from work to attend meetings, to attend some in-person meetings. And then it would be really wonderful at the institution if I'm able to also financially impact the nurses who need to benefit from what I've benefited from in my career.' Usually when you have those conversations, you are expecting to present a deck of PowerPoint slides to make your case, but the answer from my leadership team in participating in ONF and supporting the Board was an immediate yes. It was 'Yes, when can you start? Yes, what can we do to support you?' And really making sure that I had dedicated time to be fully present." TS 14:15 Ferguson: "There are many skills and experiences that can lend themselves to being a strong board member. … The ability to speak your mind clearly and express your thoughts, which really boils down to strong communication skills. We are lucky in our careers. We all have worked as nurses in different settings and health care, and nurses are naturally skilled and good at communication. We learn strategies like SBAR—situation, background assessment, recommendation. Nurses every day are communicating in their places of work, oftentimes with patients who are sick and need education, or perhaps with new nurses they're teaching or mentoring. And they are communicating with non-nurses, as well, and nonpatients, so clinical roles and nonclinical roles. So nurses already have a good understanding of best practices when it comes to communication, and this can lend itself well to any board position." TS 21:04 Green: "When you [come into a] leadership role, I think that's when we learn most about ourselves and what we expect. And be the leader type of leader that you want to be and the type of leader that you would like to work with so that you can make your experience valuable and pleasurable." TS 28:57

  3. Aug 21

    Episode 429: Radiation Site-Specific Side Effects: CNS Cancers

    "They're really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we're using the masks on the table, and those masks are very tight and hold their heads very, very still. So they'll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they'll come to me and they'll say, 'This really hasn't been as bad as I thought it was going to be,'" ONS member Catherine McCluskey, BSN, RN, OCN®, ROCN™, radiation oncology staff nurse at Atrium Health Wake Forest Baptist in Winston-Salem, NC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, who was the manager of oncology nursing practice at ONS at the time of the recording, during a conversation about radiation side effects in central nervous system (CNS) cancers. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 21, 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 CNS cancer. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Radiation Site-Specific Side Effects series Episode 306: Cancer Symptom Management Basics: CNS Toxicities ONS Voice articles: Augmented Reality Simulations Reduce Patient Anxiety by Teaching Them About Radiation Therapy CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says Here's What the Updated CTCAE Version 6.0 Means for Oncology Nurses Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education Hyperbaric Oxygen Therapy Shows Promise for Certain Radiation Side Effects ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition) ONS courses: Indications of Targeted Radiotherapy to the Brain and Spine: 2025 ONS Congress® Session ONS ROCN™ Certification Review™ ONS/ONCC® Radiation Therapy Certificate™ Supporting Radiation Side Effect Management Through ONS Evidence-Based Resources: 2025 ONS Congress® Session Clinical Journal of Oncology Nursing articles: Implementing a Standardized Educational Tool for Patients With Brain Tumors Undergoing Concurrent Temozolomide and Radiation Therapy Radiation Necrosis: A Differential Diagnosis Dilemma The Neurocognitive Late Effects of Cranial Radiation Therapy: The Often-Unrecognized Outcomes Oncology Nursing Forum article: Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy ONS Huddle Cards: External Beam Radiation Proton Therapy Proton Therapy Radiation ONS Guidelines™ and Symptom Management Resources Cognitive impairment Fatigue Mucositis Radiodermatitis ONCC resources: Big List of CE Radiation Oncology Certified Nurse (ROCN™) Common Terminology Criteria for Adverse Events (CTCAE v6.0) Patient Health Questionnaire (PHQ-9 and PHQ-2) To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "With primary tumors—glioblastomas, astrocytoma, all of those types of cancerous primary CNS tumors, the tumors are not very well-defined. They have little tentacles that kind of go out, so doing something like Gamma Knife, which is very precise, is not as effective as an external beam because the external beam will deliver radiation to all those little tentacles that are out there in the brain. And with Gamma Knife, you really can't effectively do that." TS 2:34 "When we're doing radiation to the brain, fortunately there aren't that many acute toxicities involved. Sometimes they'll have some mild dermatitis. Usually, it's not very significant. They, like everyone else who gets radiation, will have fatigue. Usually once we get to the end of the second week of radiation, into the third week for our patients with primary CNS tumors—the hair loss—they'll start to notice hair loss just in the treatment area. But those are typical, the things that we've seen most. Sometimes we'll have patients who will experience some nausea, maybe a few headaches, but really the acute toxicities are not severe typically with our patients with brain tumors." TS 8:30 "[For] the fatigue, I tell patients to just listen to their bodies. We don't want them to be sedentary, and we want them to go out and continue living their lives. But I do warn them that the fatigue is pretty much common to all patients receiving radiation at various degrees, depending on the patient. I just tell them to do what they feel like doing, and then when they're tired to rest, and if they find themselves having a nap in the afternoon, that's okay." TS 13:51 "What I find with these patients in particular is that a lot of times, their first symptoms related to any type of cancer are CNS symptoms from brain metastasis. Our patients with lung cancer or melanoma—they come in through the emergency room for altered mental status or seizures or something like that. They find a mass in their brain, and then they find a mass on their lung, or they find masses everywhere. Typically, they want to treat the brain masses first before they start them on any kind of systemic treatment. And so, they'll come to us, and they're in shock. Everything's happened very quickly. They haven't had a chance to really catch their breath. They're overwhelmed. And so I try to make sure they understand that everyone that they see here is part of their team and is with them through this journey and they're not alone." TS 25:36 "A couple of years ago, ONS put out an email asking for people to volunteer to do a delineation study about the feasibility of doing a radiation oncology certified nursing exam. And I, just on a whim, responded to that email. It's not something I've ever done before, and thinking that I would not be put on the team. … And I thought, 'I don't have enough experience, I don't know what I'm doing, and they won't choose me.' And lo and behold, they put me on this role delineation study. … I have met so many incredible nurses with all kinds of experience. I've learned so much. It has opened up a lot of things for me and it's been really exciting, so all I can do is say take advantage of those opportunities when they come. Don't think that you don't know enough, because you know more than you think you do." TS 32:38

  4. Aug 14

    Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses

    "Measurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments," ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about chronic lymphocytic leukemia (CLL) treatment considerations for oncology nurses. Music Credit: "Fireflies and Stardust" 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 August 14, 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 treatment of chronic lymphocytic leukemia. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 184: Oncologic Emergencies 101: Tumor Lysis Syndrome ONS Voice articles: Fixed-Duration Therapy for CLL May Lower Cardiovascular Risks and Costs Less Than Continuous Treatment Individuals With CLL Face Increased Risk for Skin Cancer Master Hypersensitivity Reactions With These Strategies for Prevention and Management Patients With CLL Report Worse QoL and Other Factors Clinical Journal of Oncology Nursing articles:  Acalabrutinib: Nursing Considerations for Use in Patients With Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Pseudohyperkalemia in Chronic Lymphocytic Leukemia: An Often Overlooked Clinical Entity Richter Transformation Arising From Chronic Lymphocytic Leukemia Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia ONS book: Site-Specific Cancer Series: Leukemia (first edition) ONS symptom management resources:  Fatigue Prevention of Bleeding Prevention of Infection: General Blood Cancer United: Chronic Lymphocytic Leukemia Treatment CLL Society: Patient Education Toolkit Lymphoma Research Foundation: Lymphoma Treatments Patient education sheets Acalabrutinib Ibrutinib Pirtobrutinib To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Blood work is a really nice way to evaluate if there is progression of the disease. And we evaluate their blood counts, specifically that complete blood count with a differential. We anticipate an elevated white count, and we anticipate that the absolute lymphocyte count is going to be elevated. That's characteristic of the disease. But what evolves and happens is that those numbers can rapidly change and what we get concerned about is if that white count—and the percentage of the absolute lymphocyte count specifically—starts to increase and double quickly." TS 5:52 "There are some components that help clinicians decide if we expect these things, this cadence of change to happen more readily, or if we feel really comfortable that the biology of the variants contributing to the type of CLL that each patient may have, they may not have that progression as quickly or at all. And so that kind of helps us in that follow-up and cadence. Oftentimes, we're checking blood work every three or six months. Some patients are on an annual interval of visits depending on that active surveillance. I think the other piece is that we have a relatively low threshold when there is a change in symptoms to just recheck those blood tests. It's nice that we can have a pretty readily available blood test to be able to give us a lot of information for these patients." TS 9:45 "When we think about CLL therapy, the old tried and true [treatments] still work: so, rituximab and obinutuzumab. And then we kind of start to think about pathways and the way, the mechanisms of which these treatments are integrated. We think about different pathways of how we can induce cell death, but also what are the potential side effects? What are the potential interactions?" TS 19:35 "I think a lot of this is about really having a clear understanding of the patient's goals and really being able to understand and align. I think we have a lot more data to provide guidance for those patients that really are wanting to know: What is my chance of overall survival? If I do this, does this mean that I don't need to ever be on treatment again? If I do it this way, does it mean that I have to come into clinic every week, or does it mean that I have to come in every week but I'm done? I do one year of treatment, and I don't have to think about treatment for a really long time based on some of these components that we can take into consideration." TS 24:36 "When we think about the B-cell lymphoma 2 (BCL-2) inhibitors, with venetoclax, I think the biggest component we think about is tumor lysis syndrome. It's so effective that these cancer cells release all of those electrolytes, potassium, phosphorus; you can see a rise in the lactate dehydrogenase and uric acid because those cells are breaking down. And so subsequently, that leads us to the consideration of, is the patient's kidney function able to clear it? And so a lot of frequent lab monitoring, a lot of hydration, supportive care with medications like ursodiol or allopurinol to really improve the ability to clear that cellular waste product so that it doesn't cause an oncologic emergency." TS 34:11

  5. Aug 7

    Episode 427: Pharmacology 101: Resistance Pathways

    "A good way of thinking about this is this is the survival of the fittest clone. There could be a portion of a cancer that naturally has some resistance or ability to survive a particular drug. And over time, as the other cells around it are dying off, that particular clone is able to replicate and continue to survive in the face of that drug therapy and eventually take over as being the fittest clone. At that point, we're often seeing disease progression," Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services at the Allegheny Health Network Cancer Institute in Pittsburgh, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about resistance pathways.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD), including 30 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by August 7, 2027. Roman has served on advisory boards for Genetech, Pfizer, Regeneron, and Daiichi Sankyo and received honoraria payments from Pharmacy Times and Decera for faculty lectures. These financial relationships have been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report increased knowledge related to resistance pathways in oncology care. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Pharmacology 101 series Episode 423: Pharmacology 101: Interaction Pathways Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices ONS Voice articles: Predictive and Diagnostic Biomarkers Scientists Identify Protein Implicated in Tumor Growth, Treatment Resistance ONS book: Guide to Cancer Immunotherapy (second edition) Genomics and Precision Oncology Learning Library ONS Biomarker Database Pharmacogenomics Huddle Card CancerQuest: Cancer Drug Resistance National Comprehensive Cancer Network OncoKB.org Research To Practice To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "As we look at drug resistance, this is the concept that cancer cells are no longer able to respond to a cancer treatment. The downstream of this is that we could end up with progression of the disease and need to look at alternative therapies that may be beneficial for the patient. This is unfortunately a very common phenomenon. Drug resistance is a major cause of treatment failure and poor patient outcomes with treatments. Unfortunately, this is an issue we see that increases over time on treatment." TS 2:29 "Genetics play a really big role in drug resistance. We know that drug resistance can be due to different things. It could be epigenetics. It could be the tumor microenvironment factors. But genetics often play a very big role in resistance pathways. It's generally considered to be a critical contributor to resistance, particularly in the way of acquired variants to drug targets or amplifications of certain oncogenes that can lead cancers to have progression. A well-known genetic alteration is the BRCA1/BRCA2 variant that helps to make the cancer more efficient at fixing DNA damage. So we're trying to get DNA damage with chemotherapy, and this particular variant helps at fixing that damage to allow the cancer to progress. So that is one genetic variant we see that plays a big role in a number of different cancers." TS 4:51 "These pathways are not mutually exclusive. Oftentimes we have multiple resistance pathways involved. I think it's important to understand some of those individually, but kind of thinking about this as we might be facing multiple resistance pathways. ... We can see resistance mechanisms that vary based on the type of treatment we use, for example, traditional cytotoxic chemotherapy. We may be more likely to see some resistance mechanisms that are working at DNA: repairing broken DNA or working on those efflux pumps that are being used to push chemotherapy out of cells. If we're talking more about the targeted therapies such as tyrosine kinase inhibitors or monoclonal antibodies, we may be more likely to see resistance mechanisms that are what we discussed with that drug target alteration: changing the way that the target agents are able to bind to the tumor cells to activate or inactivate pathways so we may see some changes there." TS 12:39 "One way to overcome this and to help to decrease the resistance from developing is using combination therapy: drugs that are targeting different pathways at once or potentially using combinations with things like chemotherapy in addition to immunotherapy. In this way, as we're getting these different targets, we can hopefully decrease the mechanism of resistance that may be developing." TS 14:48 "Biomarker testing is an incredibly important part of our practice. In many situations now, we are getting upfront, comprehensive biomarker testing to identify whether the patient may have any of those intrinsic or primary resistance mechanisms that might make it so a patient is never going to respond to a particular type of treatment. And in that case, we can spare the patient from the potential toxicities of that treatment if we don't think that there's going to be benefit there. So I think that that has become a really important way that we can tailor patients for understanding what treatments are going to be more effective. And then after that, there's usually additional biomarker testing that may be warranted at the time of progression in certain types of cancer. And that really helps us to understand that acquired resistance that might be developing." TS 17:32 "Nurses are really helpful with filling in the gaps and bringing back patient concerns that might be shared with them. And these might be early signs of progression. Better understanding how our patients are feeling and what's going on with them may help us to identify a patient that we need to do some additional testing for to understand whether there is drug resistance ongoing and potential progression of disease." TS 21:52

  6. Jul 31

    Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology

    "When people with PTSD [post-traumatic stress disorder] get quite avoidant—and that can be expressed in so many different ways—the implications can be really profound. I think an important invitation to oncologists and oncology nurses and primary care providers who care for people battling cancer is let's explore what's underneath these avoidant behaviors. Is it a very practical thing? Or is it that underneath this avoidant behavior is really profound fear?" James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about addressing medical trauma in oncology. Music Credit: "Fireflies and Stardust" 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 31, 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 medical trauma in oncology care. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 421: Medical Trauma in Oncology Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care Episode 264: Stop the Stressors and Improve Your Mental Health as a Nurse ONS Voice articles: Help Caregivers Control the Chronic Stress of Cancer Care and Manage PTSD [post-traumatic stress disorder] Past Trauma Lowers Hope, QOL, and Coping Ability During Cancer Managing Cancer-Related PTSD Starts With Acknowledgement Moral Injury and Trauma in Nursing Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress Clinical Journal of Oncology Nursing articles: How Can a Trauma-Informed Care Approach Be Applied to Patients With Gynecologic Cancer? Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach Oncology Nursing Forum articles: Post-Traumatic Distress and Symptom Experience in Patients With Head and Neck Cancer–Related Tracheostomy and Family Caregivers The Effect of Neuroticism, Fear of Progression, and Self-Efficacy on Post-Traumatic Growth in Patients With Lung Cancer Undergoing Chemotherapy The Relationship Between Colorectal Cancer Survivors' Positive Psychology, Symptom Characteristics, and Prior Trauma During Acute Cancer Survivorship ONS course: Psychosocial Dimensions of Cancer Care™ ONS Huddle Card: Coping Screening tools Clinician-Administered PTSD Scale for DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, 5th edition] (CAPS-5) Hospital Anxiety and Depression Scale Primary Care PTSD Screen for DSM-5 PTSD Checklist for DSM-5 Trauma Screening Questionnaire International Society for Traumatic Stress Studies: Free Resources PESI Reclaiming Your Life From Medical Trauma by James C. Jackson To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "For many people who have been traumatized, if they can avoid it, they will. They may not avoid the annual evaluation that is so hugely consequential—they might not avoid that. But they may well avoid a routine visit for a checkup to their oncologist. They very well may avoid a visit with a psychologist who is wanting them to talk about hard things. They may avoid visiting a friend in the hospital because it reminds them of really upsetting things. So, this issue of adherence and compliance is a really big problem." TS 3:19 "Screening tools for things like PTSD can be very useful. They're quite practical, and they're appropriate to use. I really like something called the Post-Traumatic Stress Disorder Checklist. ... Using it is going to be very straightforward. You're going to want to map it onto a 30-day window, and you're going to employ it with patients. It's a 20-item self-report. It assesses 20 DSM-5 symptoms of PTSD. It's not diagnostic, but if people score in this range of 30, 31, 33, we typically are going to believe that that is very suggestive of significant PTSD." TS 9:17 "One of the things we should be doing all the time is modeling and attempting to normalize this idea of being open about mental health difficulties. When I say modeling, this is a complicated issue. ... I'm very open talking about my own battles with mental health. And in some ways, that invites my patients to do the same. I don't recommend necessarily that a nurse says, 'Oh, by the way, I have PTSD. I'm going to tell you about mine. I want you to tell me about yours.' That's a boundary issue. But I think it does behoove us as clinicians to create a culture as much as we're able, where we can talk about mental health difficulties in a matter-of-fact way, acknowledging that mental health is health. These tools, to me, go a long way in that direction." TS 13:41 "The survivorship process is ongoing. I think a nurse can assist a patient in so many ways longitudinally over time. ... One of those ways is to continue checking on mental health outcomes in patients. Continuing to check on mental health outcomes, continuing to explore them, and continuing to invite patients to talk about things that other people might not be asking about. It's easy for family members to assume, 'Hey, you know, you're cancer free now. You look fine, so you must be fine.' It's very possible that the patients we're talking about are not fine. They're far from fine. For that oncology nurse at a follow-up clinic or in an oncology setting to talk about this, continuing to affirm that it would be okay for patients to struggle, continuing to put this issue on a front burner—I think that's really important." TS 21:17 "I'm aware of nurse-led support groups where nurses can talk very freely about their own challenges, in a safe space. ... Working to build cultures in the context of the intensive care unit, let's say, where we have a lot of patients with cancer that prioritize well-being nurse driven programs. ...  The bottom line is if there is a warning light that is blinking, nurses need to attend to that. And in attending to it, they're going to be more present for their patient. They're going to be better able to support their patient. They're going to be better able to support each other. And I think often, in the culture of nursing and psychology, too, people just put their head down, their shoulder down, and they just plow through in ways that are really counter to their mental health." TS 29:56 "The truth is medical trauma can be well-managed. It's not simple. It's not always intuitive. There are all sorts of caveats with regard to this, but the truth is people with medical trauma can live really rich and meaningful lives. ... So, the default setting, I think, should be not one of pessimism. It should be that people with medical trauma can and do get better. If you are a patient with medical trauma and you are in my purview, until proven differently, I'm going to assume that you can get better too." TS 36:28

  7. Jul 24

    Episode 425: How AI Can Help Healthcare Organizations Improve the Cancer Experience

    "In oncology specifically, where care is complex, artificial intelligence (AI) can really synthesize large volumes of clinical information, flag risks such as treatment complications, and support adherence to evidence-based pathways. For nurses specifically, this enables them more time for direct patient care, clinical judgment, and care coordination, and really practice to the top of their license while reducing repetitive time and administrative tasks," Jenn Frith, DNP, RN, OCN®, NE-BC, associate vice president of clinical operations at Duke Cancer Institute in Durham, NC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS. Weimer spoke with Frith and Emily Norboge, director of clinical and research informatics at Duke Cancer Institute, about how AI can help healthcare organizations improve the cancer experience.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 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: Learners will report an increase in knowledge related to the use of artificial intelligence in oncology nursing practice. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 284: How AI Is Influencing Cancer Care and Oncology Nursing Episode 281: Nursing's Role in AI in Health Care ONS Voice articles: Human Connection Creates the Power Behind AI in Nursing If You're Using AI in Health Care, Your Patients Want to Know Majority of Adults Use AI, But Most Distrust Accuracy of Health Information Nurses Are Key to Quality for AI Tools in Oncology Care One-Third of Hospitals Have Integrated Generative AI Into EHRs, With More to Follow Clinical Journal of Oncology Nursing articles: A Case for Caution: Patient Use of Artificial Intelligence Artificial Intelligence in Oncology Nursing: Preparing the Workforce for the Future Artificial Intelligence: Basics, Impact, and How Nurses Can Contribute Integrating Artificial Intelligence Into Cancer Care: Enhancing Nursing Practice and Bridging Disparities Oncology Nursing Forum article: Artificial Intelligence for Oncology Nursing Authors: Potential Utility and Concerns About Large Language Model Chatbots To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode Norboge: "Our AI voice agent has a series of workflows that it can execute. ... If a patient needs help with medical paperwork, the agent will walk the patient through how to do that paperwork. If a patient has a question that they need sent to their provider, it can document that and then send a message to the provider. There's a series of workflows so it can route to scheduling. It can answer information about test results that is compliant with our policy around test results. The goal of that agent is that it will handle all of those administrative-type tasks that don't necessarily require a nurse to fill." TS 5:44 Norboge: "When [patients] call the nurse triage line, the nurse will have to say, 'I understand you want your test results. I can contact your provider and have them reach out to you about your results.' But that's kind of where it ends. What we worked out with the agent is if a patient calls and says, 'I really want my test results,' they will in a very nice, standard way, say something similar. You know, 'I'm not authorized to discuss your test results with you, but I'd be happy to send a message to your provider and ask them to call you.' But then the agent goes one step further and says, 'Are you experiencing anxiety about your test results? If so, I can transfer you to the nurse to discuss support for a potential referral to family medical therapy if you would like help managing that anxiety.' In a clear, helpful way, it can define and help a patient with their needs and not just have a standard of 'this is our policy and I can't share it with you.'" TS 11:14 Frith: "Really, transparency is the key. The patient should understand that AI is used more as an enhancement, but not to replace the human connection. That's not the goal. The nurses can explain that the tools will help ensure accuracy, timeliness, and safety while allowing more time for the direct interaction of the nurse. I think framing AI as an additional layer of support rather than a decision maker helps build trust. And I think maintaining strong communication and presence at the bedside just reinforces that care remains fundamentally human." TS 15:32 Frith: "I think AI in oncology is going to continue to advance in our predictive analytics, personal care planning, and probably real-time decision support. I think we'll see a greater integration into symptom management, some early detection of complications, and longitudinal care coordination across our settings. I think nurses will continue to increasingly use AI to anticipate patient needs and prioritize care. I think the role of the nurse won't diminish. Rather, it will become more elevated in allowing them to practice to scope of practice." TS 19:58 Frith: "AI represents a meaningful opportunity to strengthen oncology nursing practice by reducing burden and enhancing the clinical insight. It needs to be a very thoughtful implementation. We talked about having strong governance and continued investment in the nursing workforce. I want to reinforce that oncology care remains deeply human, and AI should only be viewed as a tool that enables the nurses to do what they do best, which I feel is deliver safe, compassionate, and high-quality specialized care to our most vulnerable patients." TS 27:31

  8. Jul 17

    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: "Fireflies and Stardust" 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  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Radiation Site-Specific Side Effects series Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices Episode 298: Radiation Oncology: Nursing's Essential Roles ONS Voice articles: Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition) ONS courses: Nurse Navigation and Care During Brachytherapy for Cervical Cancer: 2025 ONS Bridge™ Session ONS ROCN™ Certification Review™ ONS/ONCC® Radiation Therapy Certificate™ Clinical Journal of Oncology Nursing articles: Updated Interventions for Radiation-Induced Diarrhea: Putting Evidence Into Practice With the Oncology Nursing Society Genitourinary Distress: Common Side Effect Sexual Dysfunction: Common Side Effect Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers Oncology Nursing Forum article: Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer ONS Guidelines™ and Symptom Management Resources: Radiodermatitis Radiation-Induced Diarrhea Brachytherapy Huddle Card American Brachytherapy Society American Society for Radiation Oncology (ASTRO) European Society for Radiotherapy and Oncology (ESTRO) GEC-ESTRO Committee International Gynecologic Cancer Society Nursing Certificate Program To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "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

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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

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  • Creator
    Oncology Nursing Society
  • Years Active
    2017 - 2026
  • Episodes
    434
  • Rating
    Clean
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    © Copyright 2025
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    The ONS Podcast