ONS member Ellyn Matthews, PhD, RN, AOCNS®, CBSM, FAAN, professor at Regis University School of Nursing in Denver and member of the High Plains ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss cognitive behavioral interventions, how they can help patients with cancer, and why oncology nurses are ideally positioned to deliver them. Ellyn and her colleagues have evaluated cognitive behavioral therapy for insomnia in rural breast cancer survivors, delivered both in person and via telehealth. Her team published the study  findings in the Oncology Nursing Forum, which we’ve linked in the episode notes.  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. Episode Notes Check out these resources from today’s episode:  The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.  ONS Voice article: How Can Cognitive Behavioral Therapy Help Patients With Cancer Manage Insomnia?  Oncology Nursing Forum article: Cognitive Behavioral Therapy for Insomnia Outcomes in Women After Primary Breast Cancer Treatment: A Randomized, Controlled Trial  Oncology Nursing Forum article: Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors  ONS Putting Evidence Into Practice (PEP) resources: Cognitive Behavioral Interventions and Approaches  ONS video: Oncology Nurse Cognitive Behavior Interventions  AARP article: How to Find the Right Therapist  Hospital Anxiety and Depression Scale  National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients  To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email  pubONSVoice@ons.org.

Episode 166: Cognitive Behavioral Interventions Help Patients With a Spectrum of Cancer Symptoms

Where ONS Voices Talk Cancer. 

Join oncology nurses as they sit down to discuss the topics important to nursing practice and treating patients with cancer.

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Health & Fitness

 Episode 310: Pharmacology 101: Androgen Receptor Inhibitors and Antiandrogens  “The things that I think creep up are things that unfortunately are quite common, and that’s hot flashes. I’ve had patients say that those are just overwhelming, and they want to go off therapy because of it. So I think talking about pharmacologic management, as well as lifestyle management, of hot flashes, are equally as important,” 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 androgen receptor inhibitor and antiandrogen drug classes.  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 myoutcomes.ons.org by May 3, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.  Learning outcome: Learners will report an increase in knowledge related to androgen receptor inhibitors and antiandrogens.  Episode Notes    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:   Pharmacology 101 series  Episode 242: Oncology Pharmacology 2023: Today’s Treatments and Tomorrow’s Breakthroughs  Episode 194: Sex Is a Component of Patient-Centered Care  Episode 113: Manage Cancer-Related Hot Flashes With ONS Guidelines™   ONS Voice articles:   Oncology Drug Reference Sheet: Darolutamide  Oncology Drug Reference Sheet: Relugolix  Genetic Disorder Reference Sheet: HOXB13  Sexual Considerations for Patients With Cancer  Nursing Considerations for Prostate Cancer Survivorship Care  Exercise Before ADT Treatment Reduces Rate of Side Effects   ONS books:   Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)  Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)   Oncology Nursing Forum articles:  An Exploratory Study of Cognitive Function and Central Adiposity in Men Receiving Androgen Deprivation Therapy for Prostate Cancer Management of Androgen Deprivation Therapy–Associated Hot Flashes in Men With Prostate Cancer   Clinical Journal of Oncology Nursing articles:  Hot Flashes: Clinical Summary of the ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer Hot Flashes: Common Side Effect Genitourinary Distress: Common Side Effect   ONS Guidelines™ and Symptom Interventions  Fatigue  Hot Flashes  Oral Anticancer Medication   ONS Huddle Cards:  Altered Body Image Hormone Therapy Sexuality    ONS Cancer of the Genitourinary Tract Learning Library Cancer Research article:  Studies on Prostatic Cancer. I. The Effect of Castration, of Estrogen and of Androgen Injection on Serum Phosphatases in Metastatic Carcinoma of the Prostate   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 androgen deprivation therapy is either orchiectomy, which we tend not to use as much anymore; LHRH agonists, meaning that they act like LHRH…and then now LHRH antagonists are taking an increased role because we now have an oral drug that is an LHRH antagonist.” TS 3:44  “When you give an LHRH agonist, you initially have an increase in testosterone, but over time you cause a decrease in the ability of the pituitary to produce luteinizing hormone. Therefore, you get decreased stimulation in the testes to produce androgens. So when you think of an LHRH agonist, by continual use, what you do—you get an initial surge and then a decrease overall if patients stay on the drug. And so LHRH agonists—leuprolide, goserelin, triptorelin—those are agents that are agonist. LHRH antagonists have a direct effect to block the receptor and decrease release of luteinizing hormone and follicle-stimulating hormone, ultimately decreasing testosterone. LHRH antagonists don't have that surge of testosterone. They have an immediate effect of decreasing testosterone.” TS 4:41  “In terms of the LHRH antagonists, we’ve only had one drug for a while that’s an antagonist. That’s degarelix. Recently there was the approval of relugolix, which is an oral LHRH antagonist. And that has shown to have great effect in a noninferiority trial in terms to the LHRH agonists. And also there’s some benefit with decreased cardiovascular risk with that drug. So I think this is the drug we’re starting to see more and more.” TS 7:01  “The other thing with abiraterone acetate, it is recommended by labeling to take on an empty stomach at least an hour before two hours after a meal. But there is data that you can use a lower dose with a low-fat meal, and so you will see many providers providing a lower dose, often to get around the cost issue sometime around the pill burden. And that needs to be taken with a low-fat meal. So I have patients who are on the lower dose. We’ve talked about taking it with a low-fat meal. Now specialty pharmacy has talked about it. And then they read stuff that’s online or in the literature and they’re like, ‘Oh, I shouldn’t be taking this with any food at all.’ So it’s really important to make sure that you educate patients how to take the medication and warn them if there’s different instruction out there than what you’re giving.” TS 16:47  “Adherence to the schedule—a lot of times people are getting LHRH agonists every three months. … Maybe you’re going to miss it this month. You miss one dose—that’s six months. So it’s really important that if people are going to not be able to get their injection, that they call, and it’s rescheduled, and they have a mechanism to make sure that you don’t lose people to follow up. So adherence to all therapy—essential.” TS 21:27

Episode 310: Pharmacology 101: Androgen Receptor Inhibitors and Antiandrogens

 “It was really the ability to be able to connect with many individuals from my profession. Reflecting on what initially drew me to ONS Congress, I can’t help but reminisce about my first time attending in 2002. I was going down memory lane the other day and found some pictures from my first time attending. As I reflected, I could not help but feel immensely grateful for the support and education I received as a novice nurse during that time from attending Congress,” Jessica MacIntyre, DNP, MBA, APRN, AOCNP®, 2024–2026 ONS president, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about ONS Congress. Taylor spoke with several 2024 ONS Congress attendees, asking the question “What brought you to ONS Congress?” Listen to their stories and learn how the conference has affected their careers in this special episode.  Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0   Episode Notes    Information on submitting an abstract to ONS Congress  Oncology Nursing Foundation ONS Congress Scholarships Oncology Nursing Podcast episodes:  Episode 258: ONS Through the Ages: Stories From the Early Days With Cindi Cantril and George Hill Episode 160: Build Innovative Staff Education Tools and Resources Episode 191: Explore Orientation Opportunities for New-to-Practice Nurses   ONS Voice articles:   Our Unified Voices Can Improve Cancer Survivorship Care  Personalized Patient Education: Ensure Effective, Inclusive, and Equitable Patient Education With These Five Strategies   ONS Congress presentations from episode guests  The Nurse as an Effective Educator: Facilitating Patient-Centered Learning (Beau Amaya) Powerful Outcomes From Nurse and Patient Policy Advocacy (Gilanie De Castro) Back to Basics: Utilizing Huddles to Emphasize Standard Care and Maintenance of Central Venous Catheters in an Effort to Reduce CLABSI (Erin Hillmon) Enhancing Triage Precision: Nurse Navigation's Impact on a Lymphedema Program (Jessica MacIntyre) Implementing a Graduate Nurse Residency Program (Leah Scaramuzzo)     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  “What I want to accomplish is really to contribute significantly to an organization that has contributed so greatly to me. And until you go to Congress, you don’t fully realize the ripple effect that ONS has on the field of oncology nursing. They really are a cornerstone to our profession. So when I volunteer with ONS, I feel like I’m serving the oncology nursing community as a whole, and I’m so grateful to get to do that on a national level.” (Stacey Clements, BSN, RN) TS 3:35  “What is bringing me to Congress is to talk about patient education, health literacy, ways that we can improve the patient experience and help them understanding. And I think this is such an important topic because it’s what we do at the core of nursing. We really teach patients and their caregivers how to take care of themselves. And sometimes we forget that it’s not just a checklist to get the education done. It’s really learning what the patient needs, what they need to think about—some consideration about what may be affecting the way that they’re retaining information. Then hopefully I can give some tools and have some discussion with many different nurses across the U.S.” (Beau Amaya, MS, RN, OCN®) TS 5:04  “Why I am so excited to attend Congress is that it really gives us an opportunity to work together with our colleagues, learn what each other is doing, and kind of leverage our collective wisdom. So this way we work smarter instead of harder.” (Leah Scaramuzzo, MSN, RN, MEDSURG-BC, AOCN®) TS 7:58  “I was a scholarship recipient, which I was super excited to receive this year for the Congress 2024 in D.C. … Out of COVID, we all were virtual, so I wanted to able to see people in person and attend a national event. Also, I’m looking forward to reigniting my passion for oncology nursing because you kind of get burned out after a while in this field.” (Brenda Marsolek, BSN, RN, OCN®) TS 9:14  “I’m also really excited to share my role as a nurse resident. I hear a lot that new nurses shouldn’t be hired in oncology or it’s difficult to hire them. And I did it. I successfully did it with the help of [Leah and Brenda]. And so, I think other people can do that as well and that we can have new grad nurses have really healthy careers in oncology in the future.” (Brandy Thornberry, ASN, RN, OCN®) TS 10:38  “I chose to be a presenter this year because I always enjoyed listening to the presentations that everyone else brings to Congress. I always learned so much. I wanted the opportunity to be able to share one of the projects I did last year that had great results attached to it, so that hopefully others can listen to my presentation and maybe take something away from it back to their own centers.” (Erin Hillmon, MSN, RN, BMTCN®) TS 11:28  “Nurses can find ways to engage in shaping health policy. Many nurses don’t recognize the connection between health policy and the bedside. Policies beyond one’s institutions or organizations have a direct impact on how we nurses practice. And my goal is to empower nurses to understand that because of our professional experience, education, and interactions with those populations who we care for, we are really poised to influence and shape health policy.” (Gilanie De Castro, MSN, RN, OCN®, NE-BC, CNML) TS 14:38  “The big thing I want to let everybody know about Congress is that there’s so much to learn, and there’s so much experience that every attendee brings. No matter what level of education you have, what setting you work in, what kind of patients you take care of, everybody has something that they can bring to the table. It doesn’t matter where you learn this information either. There’s lots of sessions, posters, and networking roundtables. What I’ve learned in these few years is really just embracing what Congress can bring to everybody. So for anybody that’s on the fence, I’d urge you to take that leap and register. Attending Congress is a decision you won’t regret.” (Holly Tenaglia, DNP, APRN, AGCNS-BC, OCN®) TS 19:47

Episode 309: What Brings You to ONS Congress®?

“One of the things that I know Dr. [Tom] Connor worked on very heavily in his career is the long-term impact on the health of nurses and other exposed healthcare workers. We definitely need more longitudinal studies, which are difficult to do. And it’s not something that you see every day where I talk to chemo nurses and said, ‘Hey, I’ve been in this 20 years. It hasn't bothered me at all.’ Well, until it does. Therefore, it’s so important when we’re training incoming nurses—how very important it is to start with these practices early in the career and throughout the career,” Charlotte A. Smith, RPh, MS, senior regulatory advisor at Waste Management PharmEcology Services in Milwaukee, WI, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about hazardous drug and waste disposal.  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 myoutcomes.ons.org by April 19, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.  Learning outcome:  Learners will report an increase in knowledge related to hazardous drugs and hazardous waste.  Episode Notes    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:   Episode 209: Updates in Chemo PPE and Safe Handling Episode 142: The How-To of Home Infusions   ONS Voice articles:   Two Oncology Nurses Implement Process to Allow Patients to Disconnect Pumps From the Comfort of Their Own Homes  The Oncology Nurse’s Role in Oral Anticancer Therapies  Strategies to Promote Safe Medication Administration Practices    ONS Safe Handling of Hazardous Drugs Learning Library ONS position statement:  Infusion of Antineoplastic Therapies in the Home ONS book:  Safe Handling of Hazardous Drugs (fourth edition) ONS course: Safe Handling Basics Clinical Journal of Oncology Nursing articles:  Environmental Risk Factors: The Role of Oncology Nurses in Assessing and Reducing the Risk for Exposure Oral Chemotherapy: A Home Safety Educational Framework for Healthcare Providers, Patients, and Caregivers Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste Reconciliation and Disposal of Oral Medication: Creating a Safe Process for Clinical Research Personnel   Pharmacy Practice News article:  Applying NIOSH Hazardous Drug Assessment of Risk Principles To Home Healthcare (by Charlotte Smith and Tom Connor) Books mentioned in this episode:  Silent Spring by Rachel Carson  Our Stolen Future by Theo Colborn, Diane Dumanoski, and John Peterson Myers Generations at Risk by Ted Schettler, Gina Solomon, Maria Valenti, and Annette Huddle   Drug Enforcement Agency: National Prescription Drug Takeback Day Environmental Protection Agency:  Final Rule: Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine MD Anderson Cancer Center:  Chemotherapy at Home: 9 Things to Know (patient resource) Memorial Sloan Kettering Cancer Center:  Safe Handling of Chemotherapy and Biotherapy at Home (patient resource) National Institute for Occupational Safety and Health:  Hazardous Drugs in Healthcare Settings Managing Hazardous Drug Exposures: Information for Healthcare Settings NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016     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  “A hazardous waste is a chemical, some of which are drugs, that EPA has determined is hazardous to the environment. Hazardous waste may be listed waste, which are given actual numbers, or they may be characteristic waste, which meets certain levels of concern, such as ignitability or toxicity. Only a small percentage of drug waste meets the EPA’s definition of hazardous waste, including a number of chemotherapy drugs.” TS 2:09  “The poster child for hazardous waste is warfarin, which, as you may be aware, is not only appropriate for managing clotting time but is also available commercially as rat poison. This is an example of how chemicals can serve more than one purpose and why dosage and regulation are so important.” TS 4:04  “Some of your listeners may have been around long enough to remember the book Silent Spring, by Rachel Carson, in which she eloquently exposed the risks to many species by the widespread use of DDT, an insecticide, at that time. More recently, the book Our Stolen Future by Theo Colborn, a pharmacist, Diane Dumanoski, and John Peterson Myers, raised the specter of the effects of endocrine disruption on wildlife and humans. The effects of drugs like diethylstilbestrol, or DES, once given during pregnancy, on the fetus, impacted the risk of cancer and other untoward effects in the offspring. The book remains a dramatic reminder of the risk of exposure to hazardous chemicals, including drugs.” TS 9:37  “Providing a homecare checklist for both the nurse and the patient and family is a simple way to keep track of all areas that need to be covered. For example, who in the household may be at most risk from exposure? This list includes infants, elderly family members, caregivers, pregnant family members, even pets. Is there a secure area to store the drug that cannot be reached by children?” TS 14:21  “I think what happens—we become so into our routine that what we do on a daily basis, we just kind of go through and do it without always thinking about it. And we can forget that not everyone has the same context of understanding these risks that the medications have to both the environment and the individual exposed to them. And I know it’s challenging to put on all the gowns and the gloves and whatnot. And, you know, it gets in the way of doing their job. It's important to educate each individual potentially exposed to these drugs, as if they do not have the understanding that we do. So embedding those consistent safety practices into daily routine is so imperative to ensure safe handling of hazardous drugs and then the proper disposal of hazardous waste pharmaceuticals.” TS 18:55

Episode 308: Hazardous Drugs and Hazardous Waste: Personal, Patient, and Environmental Safety

 “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   Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by April 12, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of 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    Complete this evaluation for free NCPD. Oncology Nursing Podcast episodes:   Episode 300: AYAs With Cancer: End-of-Life Care Planning  Episode 294: AYAs With Cancer: Clinical Trial Enrollment Barriers and Facilitators  Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care  Episode 276: Support Young Families During a Parent’s Cancer Journey  Episode 62: Financial Toxicity Legislation   ONS Voice articles:  AYA Cancer Survivorship: Younger Survivors Face Different Challenges and Prefer More Casual Support Programs  Nursing Considerations for Adolescent and Young Adult Cancer Survivorship Care  How to Support Adolescents and Young Adults With Cancer at the End of Life  LGB AYA Patients With Cancer Have High Burden of Chronic Conditions in Survivorship  AYA Champions Clinic Fills Gaps in Care and Addresses Unmet Needs   ONS book:  Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition) Clinical Journal of Oncology Nursing articles:  Two Case Reports on Financial Toxicity and Healthcare Transitions in Adolescent and Young Adult Cancer Survivors Crucial Conversations: Addressing Informational Needs of Adolescents and Young Adults Diagnosed With Cancer A Nurse-Pharmacist Collaborative Approach to Reducing Financial Toxicity in Cancer Care   Oncology Nursing Forum article: A Brief Screening Tool for Assessment of Financial Toxicity ONS Financial Toxicity Huddle Card ONS Nurse Navigation Learning Library Adolescent and Young Adult Cancer Awareness Week American Society of Clinical Oncology CancerCare Got Transition National Comprehensive Cancer Network Patient Advocate Foundation Triage Cancer  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

Episode 307: AYAs With Cancer: Financial Toxicity

 “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   Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by April 5, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of 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    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:  Episode 303: Cancer Symptom Management Basics: Ocular Toxicities Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy Episode 278: Cancer Symptom Management Basics: Hepatic Complications Episode 269: Cancer Symptom Management Basics: Gastrointestinal Complications Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 250: Cancer Symptom Management Basics: Dermatologic Complications Episode 244: Cancer Symptom Management Basics: Cardiovascular Complications   ONS Voice articles:   Cognitive Impairment Is Much More Than “Chemo Brain”  When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve  An Oncology Nurse’s Guide to Bispecific Antibodies  CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says   ONS courses:   Essentials in Advanced Practice Symptom Management  Treatment and Symptom Management—Oncology RN  Nursing Considerations for CAR T-Cell Therapy for Patients With Hematologic Malignancies: Patient Education and Symptom Management   ONS books:   Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)  Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)  Core Curriculum for Oncology Nursing (seventh edition)   Clinical Journal of Oncology Nursing articles:  Associated Toxicities: Assessment and Management Related to CAR T-Cell Therapy Dronabinol Therapy: Central Nervous System Adverse Events in Adults With Primary Brain Tumors Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients   ONS Huddle Card:  Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS) American Society of Clinical Oncology (ASCO)   Nervous System Side Effects Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline     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   

Episode 166: Cognitive Behavioral Interventions Help Patients With a Spectrum of Cancer Symptoms

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