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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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
Copyright: © Copyright 2017
"When we're talking about the role of nurses in addressing these challenges, they play a critical role because of when they actually get to see patients. And so, if we can help with early identification and assessment, really finding out, using financial screening tools to identify any patients that might be at risk, early on, of financial toxicity, that can really allow for timely interventions," Sarah Paul, LCSW, OSW-C, senior director of social work at CancerCare in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about financial toxicity in adolescent and young adult (AYA) cancer survivors.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to financial toxicity in the adolescent and young adult population.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"For nurses that are caring for AYA patients, it's really important to not only be aware of financial toxicity but know how to assess for financial toxicity because of the pivotal stage that these patients are at in their life. They often don't have the financial stability or insurance coverage that adults who are maybe middle age or even in the older adult population might have." TS 2:11
"The idea of [AYAs] not really understanding insurance coverage—I think it's really important that as a team, we simplify some of this complex information, breaking it down into more manageable steps and providing that guidance on the documents and all the information that's needed to apply [for financial assistance]." TS 8:59
"We see significant impacts in the AYA community, especially those that are in school or at the early stages of their career, because putting a job or school on hold to focus on treatment can have long-term effects. So, we see a couple of things. In education, we see academic delays; interrupting education can delay graduation or achievement of certain educational milestones, which would affect their ability to pursue higher education or even specialized training for their career. We also see, which is very difficult, loss of scholarships or financial aid. Some AYAs are starting school. It's based on a scholarship or a grant or financial aid, and they can't meet those full-time enrollment requirements or be able to maintain the GPA that they need to stay in the program. We see people losing their scholarships, and this is not their fault." TS 10:11
"Down the road, you have this stress leading to chronic stress. We know that constant worry about finances can create a chronic stress environment. That is going to impact mental health across the board, which can lead to increased irritability, feelings of sadness, or even conflict among family members. So when we talk about managing these dynamics, we really want to focus on the importance of open communication because a lot of times we see families avoid discussing financial issues to shield each other from that additional stress." TS 18:06
"One of the challenges that we face with this population is that we might assume that if they're not talking about it, if an AYA is not bringing up finances, that it's not an issue. And so sometimes even our own assumptions or assumptions of healthcare professionals that they don't even need to ask, 'How are finances going? Are you working currently? Do you feel financially stable? Are you insured?' Often, maybe there's not room for those questions. Maybe the appointments are too rushed. … Healthcare professionals could maybe take a pause to evaluate their own hidden or implicit bias, reflecting on their own experience, really trying to become aware of the assumptions they might have about this population." TS 32:46
"At the beginning, like when you first meet someone before they've even started anything, kind of get a baseline of 'What's your ability to complete your daily activities? How is your coordination? How's your speech now? How is your writing ability?' up front before we start anything that could be toxic. And then prior to every treatment, I tend to look at their gait, watch them walk in or walk out of the office, to see if they're changing at all," Colleen Erb, MSN, CRNP, ACNP-BC, AOCNP®, hematology and oncology nurse practitioner at Jefferson Health Asplundh Cancer Pavilion in Willow Grove, PA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about central nervous system toxicity.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to CNS toxicities.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Biotherapy, immunotherapy, and cellular therapy can cause changes in cognitive function and personality, even without other signs of obvious neurotoxicity. Things like cytokines, whether it's infused or as a result of side effects, can bypass the blood-brain barrier and can also alter that vascular permeability to allow other substances to kind of cross the barrier and can also alter your hypothalamic activity." TS 2:26
"There's definitely an effect on patients who are older. You know, there's less pliability, less ability of their nervous system to sort of rebound from an insult in some cases. And I think there's more exposure. There's more risk of coexisting conditions, things like diabetes or thyroid issues. There's also higher risk of impaired liver and renal function or dehydration or polypharmacy-type things. So I think there's just a lot of sort of inherent risks as people get older and have more coexisting conditions." TS 5:33
"[Their caregiver says] they used to read all the time—and if you ask the patients, they're like, "Oh, well, I can't focus on the words because they all seem too blurry." … But when you, if you ask them specifically, "Is your vision blurry?" they'll say no. Then when you really get down to it, that caregiver piece I think is really crucial in this kind of toxicity, because it's the little things that if you catch them when they're little things, then won't lead to big things." TS 11:00
"A couple of things I think are really important when you look at this class of drug: It developed by a concerted effort in cancer drug development to look at new agents that would be effective based on the mechanism. And then once they found a drug in this class that was beneficial, they further modified it to try to get better efficacy and less toxicity," Rowena "Moe" Schwartz, PharmD, BCOP, FHOPA, professor of pharmacy practice at James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the nitrosoureas drug class.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to nitrosourea administration.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"With the nitrosoureas, there's something really interesting because there's another mechanism that has been identified. And that is that when you put these nitrosoureas in the body, they break down into intermediates, and one of them is an isocyanate. … These isocyanates, what they do is they inhibit DNA repair, therefore have an impact on cells that are damaged. You can think of it as the second mechanism, and people that work in the neuro-oncology space think of this when they think of drugs like lomustine in brain cancer, how that drug decreases the DNA repair protein O6-methylguanine-DNA methyltransferase." TS 4:11
"These drugs are very lipophilic, meaning they cross the blood-brain barrier. That's why we use them in brain tumors, so that's one of the key things. That's also one of the toxicities we see when drugs cross blood-brain barrier; we see neurotoxicity. So that's one to at least always consider but also the benefit of it crossing over and being able to treat cancers within the CNS." TS 8:19
"As a group, these drugs are alkylating agents, so definitely the safe handling is essential. And with DNA-damaging agents, that means anybody who is going to come in contact with these drugs. So, carmustine is given intravenously. Lomustine or CCNU, those are capsules. So handling is different depending on the agents." TS 12:45
"The thing with the lomustine or the CCNU capsules, the thing that's really important here is that the dosing is really different than how we normally give oral medications. And so, it's really important that patients are aware of exactly how much they take and not that they don't repeat the dose every day. So I think just like with other oral regimens that are not daily, we really have to make sure patients are aware of the specifics of how they take the drug." TS 14:25
"The prescribing information is really a reliable data-driven and comprehensively reviewed tool. That's not just for healthcare providers when writing a prescription, but also, for example, it is a tool that can be used to generate educational content for healthcare systems as they update formularies and create drug information," Elizabeth Everhart, MSN, RN, ACNP, associate director for labeling at the U.S. Food and Drug Administration (FDA) in Silver Spring, MD, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about drug package inserts and labeling.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to FDA drug labeling.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Nurses can be involved in several ways in creating the labeling. They can be members of the FDA multidisciplinary team that reviews the information submitted by the drug maker. Also in the review and development of the patient package insert or medication guide or the instructions for use that are used to help a healthcare practitioner, patients, or family members use the drug safely and accurately." TS 2:08
"[Nurses] can use the sections to guide their teaching and instruction to patients, particularly about dosing and any tests that will be done to monitor for adverse reactions and any needed changes in the dosing, like whether they need to hold the medication or take less of it. They can also use the information to describe what the expected and serious adverse reactions for the drug are and how frequently they occurred in clinical trials." TS 9:12
"The patient package inserts and medication guides that I mentioned are written in patient-friendly language and are good resources for nurses to use to educate patients and their caregivers or family members about what the product is used for, what its main and most serious side effects are, as well as what to expect in terms of the need for any special tests." TS 11:04
"In the FDA's public Prescribing Information Resources page, there are several excellent resources for healthcare providers to learn more about specific sections of the label, as well as to find good educational material for patients and their caregivers. There are also several presentations and videos available related to many sections of the label that are excellent resources for oncology nurses." TS 14:26
"First, you want to refer patients to an eye care provider prior to initiating therapy, and I think communication at this point is really important. You need to tell the eye care provider why they're being referred, what treatment they're getting, the most common ocular toxicities, and also what needs to be done at every visit. They need to do a visual acuity; they need to do a slit-lamp eye exam. And these eye care providers need to know that ahead of time, so they're doing everything at that visit," Courtney Arn, APRN-CNP, nurse practitioner at the Ohio State University James Cancer Hospital in Columbus, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ocular toxicities and their management in cancer care.
The advertising messages in this episode are paid for by Dartmouth Hitchcock Cancer Center.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"The most common ocular toxicities that we see with cancer treatments currently are vision impairment, which can include decreased visual acuity or blurred vision. We also see keratopathy or keratitis, very common to have dry eyes, photophobia, eye pain. Sometimes patients can develop cataracts, conjunctivitis, or even blepharitis, which is inflammation of the eyelid." TS 2:27
"Fortunately, most of the ocular toxicities that develop when being treated with these treatments are short term, and so most of them are reversible. And they actually resolve relatively quickly after stopping treatment that's causing the ocular toxicity. So usually within one to two months, the ocular toxicities have significantly improved or resolved." TS 4:55
"Sometimes patients come in and you're asking them, 'Are you having any symptoms, or do you have any blurred vision?' And they'll say, you know, 'I haven't been able to see my computer as well,' or 'I've noticed when driving, I can't read the road sign.' And what I really hear often is watching TV, they can't see the scores of sports games at the bottom of the screen." TS 7:43
"The nurses are very important in this process from the beginning of doing the patient education prior to them starting therapy, helping with the referral process to getting them in, making sure the patients have their eye drops, making sure they know how to use their eye drops, making sure they're aware of the signs and symptoms to be calling and reporting, and then also identifying at their visits, too, if they're having any new symptoms. So they definitely play a heavy, heavy role in this process." TS 14:22
"We've seen over and over from an access standpoint how that makes a difference, then especially when you're looking across racial disparities, ethnic disparities, geographic disparities, that having that person who can break down those barriers then is a great equalizer in that process," Bonny Morris, PhD, MSPH, RN, senior director of navigation at the American Cancer Society, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about addressing disparities in cancer care through patient navigation and new rules from the Centers for Medicare and Medicaid Services (CMS) on principal illness navigation.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the role of the oncology navigator.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"When you get hit with that diagnosis, it's like time stops. And even if the person that's delivering that news—they're trying to provide the best communication possible—but you just don't hear anything else. And you're overwhelmed trying to process everything and trying to just figure out, what is that next step?" TS 8:52
"There's the person providing the navigation services, and then there's the billing practitioner who then is submitting the codes that allow for the reimbursement. . . . So you have the person providing navigation services who may be an oncology nurse. It may be a health worker. It may be a patient navigator. It could be an ambulatory nurse. So it's dependent upon these services being provided and not the title, and CMS is clear about that. And it describes within the final rule the different activities that can be applied and how they relate to then competencies that the person providing navigation services should either be trained or certified in." TS 16:53
[American Cancer Society has] a training program to support. We have implementation programs that we're supporting that we've built out. And so it's really trying to be responsive to the needs of those who are boots on the ground implementing these codes. And how can we make it easier? Because we know that patients deserve this. So if we're able to now have this more sustainable pathway, let's make it easier to get to that point." TS 20:10
"So for the patient consent process, it can be done verbally, as long as it's documented that it took place, because there is that 20% cost sharing that the patient could receive a bill for if they don't have additional coverage for that. And I worry that that could increase disparities, truthfully, because it's going to be the subset of the population that then needs it the most, that then could say no because of the concern over that additional copay. I think that is something that we need to watch very carefully and continue to advocate for alternatives around and how we can support patients in continuing to have equitable access regardless of the ability to pay for that portion of navigation. Because we've never done that. We've never charged patients for navigation until now." TS 21:22
One of the things that [American Cancer Society] is committed to is continuing to keep our training relevant, updated year after year, with having annual refreshers, having curriculum that is responsive—we know that oncology landscape is ever-changing, right? So how do we stay abreast of that as professionals? And working with ONS to make sure that we're keeping all of those hot topics infused within that curriculum in a way that is practical and meaningful for the professional. They need to digest that information and then run with it. ONS is a fabulous partner with that." TS 39:02
"Social work was involved because we could be radiation gung-ho, ready to go; chemo can be ready, but whoops, this patient doesn't have a ride. It can be little things like that, you know, where we kind of forget. That's why you need kind of a multidisciplinary approach. If it's not your social worker, your navigator is going to know more and be like, 'This patient needs a ride. I'm working on gas cards.' Something like that can also halt a patient starting [treatment]," ONS member John Hollman, RN, BSN, OCN®, senior nurse manager of radiation oncology at AdventHealth Cancer Institute in Orlando, FL, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about care coordination between radiation oncology and other oncology subspecialties.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning objective: Learners will report an increase in knowledge related to coordination of care to assist with the management of radiation-related side effects.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Skin reaction is a big thing in our field for breast cancer. Managing it with lotions, creams, and stuff like that is temporary. To something more complicated, like the head and neck cancer patients with base of the tongue, where the beam is directed straight at that area of the body, which is very delicate, as we know, very, very, very tough treatment. You know, anything from esophagitis to dysphagia, dry mouth, no taste. Salivary glands are affected. So it really kind of depends, obviously, where we aim the machine." TS 2:04
"I think it really determines on how that radiation nurse knows how radiation affects the cells that we treat. So, for instance, I always tell my patients when I'm educating them for head and neck, and I know they're going to be getting concurrent cisplatin or something like that once a week, I'm going to tell them, like, 'The majority of your acute side effects are us. Like, the chemo is going to work as a sensitizer. You're going to have fluids that you're going to be needing, but the difficulty swallowing, you know, all that stuff is our fault.'" TS 6:12
"If your med-onc is not affiliated with your rad-onc site, that can be a horrible barrier to try to break through because you don't know anybody in that office. You identify yourself on the phone as someone from a competing company. . . . But it's just breaking through that, and it just takes that nurse's initiative and, hopefully, physician coordination as well, to work on, rad-onc between med-onc and getting that to kind of facilitate that." TS 11:29
"Social work was involved because we could be radiation gung-ho, ready to go; chemo can be ready, but whoops, this patient doesn't have a ride. It can be little things like that, you know, where we kind of forget. That's why you need kind of a multidisciplinary approach. If it's not your social worker, your navigator is going to know more and be like, 'This patient needs a ride. I'm working on gas cards.' Something like that can also halt a patient starting [treatment]." TS 20:52
"I love the ONS radiation communities. We do a lot of idea sharing on communities. A rad-onc nurse from New York can post something like, 'Hey, what are you guys doing for this side effect? We're not having any luck with this.' And you get some buy-in. And as long as the nurses remember evidence-based practice is always key. You know, just because you use one lotion, it doesn't mean, it's going to be good for everybody. I like to see the evidence behind it." TS 22:42
"With the ever-evolving radiopharms that are coming out, you know, that we're doing here, too, it's turning more into nurses are actually giving the treatment. And that's what I'm speaking on in Congress, is a nurse's evolving role in radiation and radiopharms especially. It's a huge breakthrough. It's the future pretty much." TS 24:19
"Trying to give them as much autonomy as possible is really important. I always like to ask, 'Would you like to have a conversation? Do you think that you can handle a conversation about advance care planning?' Or 'What you would want someone to do for you if you're not able to speak for yourself?' They may say no, you know, and we have to respect that too," Mandi Zucker, LSW, CT, executive director of End of Life Choices New York in New York City, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about end-of-life and advance care planning for adolescents and young adults with cancer.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to advance care planning with the adolescent and young adult cancer population.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"There's a saying in this field: It's never too early to have the conversation until it's too late. And like I said, when my children turned 18, we completed advance care plans with each of them. … Thankfully, they were, and they still are, healthy, and they didn't need an advance care plan imminently, but that's actually the perfect time to do it. So, we had this conversation when there was no emotionality really attached to it, and that's the best time." TS 7:31
"So, trying to give them as much autonomy as possible is really important. I always like to ask, 'Would you like to have a conversation? Do you think that you can handle a conversation about advance care planning?' Or 'What you would want someone to do for you if you're not able to speak for yourself?' They may say no, you know, and we have to respect that too." TS 11:28
"I like to use an acronym called WAIT, W-A-I-T—Why am I talking? And frequently, I talk because I'm nervous. I'm so anxious at such, you know? Exactly. Just because we have a little training in this doesn't make it an easy conversation to have. So I often notice that when I'm feeling anxious, I fill the room with words. So saying to yourself, 'Wait, why am I talking?' And if you realize 'I'm talking because I'm nervous; I'm uncomfortable with this conversation,' remind yourself to stop because a little silence is not bad. It actually gives the patient a little time to think about the question." TS 12:25
"Some young adults are very on top of this planning. You know, I think it's slow progress, but there has been some progress in that young adults are much more comfortable than a lot of us older people in having really difficult conversations. So we're the ones that are afraid to bring it up, but some of them are much more comfortable. So we have to remember that each of these people are individuals, and they may be very on top of this kind of planning or feel more comfortable having the conversations than we are. So it's important that we follow their lead and not make assumptions that because they're young, that they haven't thought about their own death." TS 16:44
"I think a great question to ask them is just like, 'What is your understanding of your diagnosis and prognosis?' Because they may have heard it already. They may not have absorbed all of the information. They may not be ready to talk about it. So asking them what's their understanding—if they say, 'I'm dying; I know that,' that makes the conversation a little bit easier, right?" TS 18:30
I actually think [it's] more important—the healthcare proxy—than the forms, because you're never going to be able to possibly come up with every single scenario that could happen. So you're not going to be able to document like, 'If this happens, do this,' for everything—but having a healthcare proxy who you've had conversations with about what your values are, not necessarily about every scenario." TS 25:19
"Whatever your value is, you want to be able to have that conversation with your healthcare proxy so they can speak—I'm not even going to say for you—I'm going to say as you, so they can really advocate for you as if they were you and making sure your values and wishes are respected." TS 25:54
"I can't stress enough how often I get questions about, 'Is this the paclitaxel doing this? Is this the docetaxel doing this?' And coming up with strategies to kind of help get our patients through with supportive care is important. It's a really big opportunity for pharmacists and our nurses to really provide it and help our patients get through and show the knowledge that we have and to help them," Dane Fritzsche, PharmD, BCOP, oncology informatics pharmacist at the Fred Hutchinson Cancer Center and University of Washington Medicine in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the plant alkaloid drug class.
You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to plant alkaloids.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"An alkaloid is an organic compound, so think carbon-based ring structure. The only thing special about alkaloid is that it has to contain at least one nitrogen atom." TS 1:43
"Plant alkaloids are just alkaloids derived from plants itself, so think like the roots, stems, leaves, bark, and things like that. Each of these agents we'll discuss today are unique, but broadly speaking, all of them are extracted, at least when they were first discovered, from a plant source. And they are typically biosynthesized by these plants for defensive purposes." TS 2:01
"Broadly speaking, [plant alkaloids] are cell cycle–specific agents. They do, depending on the compound, impact different parts of the cell cycle. Topoisomerase inhibitors is an example, so think irinotecan, which is a topoisomerase I inhibitor. There's topoisomerase II inhibitors, like etoposide being a good example. These impact the S phase in your cell cycle, so the synthesis of the DNA. Topoisomerase kind of helps unwind DNA and stabilize that as it's being replicated." TS 3:36
"Again, these plant alkaloids kind of fall into your typical chemotherapy side effects, so we're thinking rapidly dividing cells. Our bone marrow—so is it lowering our red blood cells, our white blood cells, our platelets? And then it can also affect our GI [gastrointestinal] tract, whether it causes diarrhea in some cases; in some other cases, it can actually cause the other way and cause severe constipation. And then a lot of these agents do lead to hair loss." TS 5:28
"The last thing I want to touch on with paclitaxel is neuropathy, or your pins and needles, tingling in the tips of your hands and toes. That is the most common one. That's a sensory neuropathy. But we also can see motor neuropathies with this agent, where the patients start to struggle with their fine motor skills, like buttoning shirts, using pencils, things like that. This is a cumulative dose effect with paclitaxel. So if patients are on multiple, multiple, multiple cycles, we definitely start to ask, you know, how that's going. And we expect at some point this is going to become an issue as therapy continues." TS 9:26
"The last class we are going to touch on for more agent specifics is our vinca alkaloids. I think the biggest takeaway and something that was just kind of hammered into my brain during residency and during pharmacy school is that these agents should never be in a syringe, and that's because they are fatal if they're accidentally given intrathecally." TS 11:41
Neuropathy-wise, it's challenging, and it's something that throughout my whole career with patient care, it constantly comes up. And there's really no one great solution to it. There's many different guidelines out there and papers out there that recommend some stepwise approaches. At the end of the day, too, we have to think about, what are our goals with our patients? How much is this limiting? TS 16:44
"Unfortunately, these hypersensitivity reactions are somewhat routine because we have lots of patients getting these medications, and they're not uncommon, like you said. It's really just that team-based approach. And since they are routine, we're all pretty comfortable at handling these." TS 22:51
"I've always appreciated just our team-based collaboration. My clinical nurse coordinators that I worked with very closely are all kind of our number-one go-to for our patients. So I mentioned anything that's happening, any questions you have, reach out to your doctors or nurse here. They know everything. And when they don't know everything, then they know who to reach out to." TS 28:59
"You have to remember a lot of these agents have very agent-specific side effects. So don't just think you know them all just because you know it's a plant alkaloid. Remember and do your due diligence and dive into each drug." TS 33:27
"We are there for whatever issue, whether it's skin management or helping just cheer them on and manage small things or big things, you know, to get them through these treatments. And then as a patient completes the treatment, we continue the nurse education and [managing] the late toxicities," Michele "Michi" Gray, RN, radiation oncology care coordinator at the Cleveland Clinic in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what you should know about nursing's important role in radiation oncology.
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Music Credit: "Fireflies and Stardust" by Kevin MacLeod
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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 knowledge of the radiation oncology nurse role.
Episode Notes
Oncology Nursing Podcast:
ONS Voice article: The Intersection of Radiation and Medical Oncology Nursing
ONS course: ONS/ONCC Radiation Therapy Certificate Course
ONS book:Manual for Radiation Oncology Nursing Practice and Education(fifth edition)
ONS Huddle Card: Radiation
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Highlights From Today's Episode
"There's many different forms of therapeutic radiation. External beam radiation is probably the most common type of radiation therapy used in cancer treatments. Using x-rays and gamma rays are types of external beam, and that is the most common and what everybody thinks of when we talk about radiation therapy. Also, particles would be another type. Particles would be electrons and protons. Then there's brachytherapy. That's internal radiation, which is a technique that is sealed radioactive sources placed directly into or adjacent to the tumor." TS 3:13
"First step [in the treatment coordination process] is that consult—getting the patients in the door. Quite honestly, this consult can be a long day for the patients. They may just have a consult with the radiation oncologist. [But if they're coming from a distance,] they might seeing a multidisciplinary clinic, so they are seeing all the physicians all in one day: the medical oncologist, the radiation oncologist, a surgeon." TS 6:31
"We have a clinic team that oversees a lot of the clinical nursing side of things with rooming and then anesthesia recovery and things like that. And then we have the nursing working with the physicians and care coordination. We kind of have two different nursing roles within the Cleveland Clinic. So, education from both sides, you know, doing education, providing care for the patients and the patients' families." TS 16:28
"This is one of the many phone calls that we get, I should say, almost daily. We get several phone calls from patients who say, 'I've looked at my chart, I don't see my radiation treatment. Why are they no longer there? I don't see them. What's going on?' And it is because your radiation treatments ... do not interface with [the electronic health record]. You will be given a handout when you come because there is an issue with the system we use. We use a different system for the computerized radiation treatment, and then we use a different system for our computer charting. And they do not interface, they do not like each other. So, all of their radiation treatments do not show up in their [electronic health record]. They do not show up in their computer system." TS 19:09
"Within the first two weeks, at least at the Cleveland Clinic, our plan is to give those patients a call back, see how they're doing, how they're doing with their side effects. Have they got scheduled for their follow-up? Do a check-in. Some of our patients have tox visits at six weeks with their nurse care coordinators, and that's just to check and see if they're having any lingering side effects, as well. And then we continue to get calls." TS 26:31
"Listening to tumor board if you have the patience, so you know what patients that are going to be coming down the pike, because you've heard all the physicians discussing these cases. So, you know the plan because you've heard the surgeon, the radiation oncologist, the medical oncologist discuss the case. So, you know kind of what the plan is, then you can kind of get an idea, 'Hey, I this one might be coming to me soon, and maybe I should be watching out for this patient or discussing this with my physician if I haven't seen it.'" TS 34:46
"In reality, it can be those days afterward, after they finish, that actually can be the worst. Letting the patients know that and that we're still only a phone call away and, you know, we're there for them. So, you know, continuing to educate also on when to call us—when to call, when to show up in clinic. We're there. We will get them an appointment. We will get them hydrated. We will do whatever they need." TS 39:16
"Radiation therapy is not only used to treat cancers and malignant conditions. It is also used to treat quite a few benign conditions: arthritic knees, V-tach [ventricular tachycardia] in cardiac patients, Dupuytren's contractures—if you've watched the commercials that they're showing all over now—so, the Dupuytren's contractures of the hands and even plantar warts. So we use a lot of radiation therapy to treat these benign conditions, so it's not just malignant cancers." TS 42:42