“When someone is faced with a cancer diagnosis, you want to really try to work to make that patient an active part of their care team. Understand that there are things out of their control, but there are also things that are within their control. You can teach them how to manage fatigue associated with anemia, or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best,” ONS member Kimberly Miller, BSN, RN, BMTCN®, transplant case manager at Nebraska Medicine in Omaha, and member of the Metro Omaha ONS Chapter, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, during a conversation about nursing management of cancer-related hematologic complications. This episode is part of a series about cancer symptom management basics. The others are linked in the episode notes. 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: The learner will report an increase in knowledge related to hematologic complications.

Episode Notes

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Previous Oncology Nursing Podcast episodes on cancer symptom management basics
• Additional Oncology Nursing Podcast episodes:
  • Episode 181: Oncologic Emergencies 101: Febrile Neutropenia
  • Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis
  • Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis
  • Episode 234: Oncologic Emergencies 101: Thrombotic Thrombocytopenia Purpura
• ONS book: Cancer Basics (third edition)
• ONS course: Cancer Basics
• ONS Symptom Interventions for Prevention of Bleeding
• American Cancer Society patient education handouts:
  • Low Red Blood Cell Counts (Anemia)
  • Low Platelet Count (Bleeding)
  • Low White Blood Cell Counts (Neutropenia)
• American Society of Clinical Oncology Answers fact sheets
• Centers for Disease Control and Prevention patient education on neutropenia
• Leukemia and Lymphoma Society patient education

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 [email protected].

Highlights From Today’s Episode

“The biggest complication is infection. You do not have the ability to present with the normal signs and symptoms of infection. You’re not going to have redness and swelling and drainage. You’re going to have more fever, hypertension, dysuria, shortness of breath, or cough.” Timestamp (TS) 07:22

“Some patients get really nervous if their blood counts get to a certain point. I find that we just try to explain to them, ‘We’re watching your labs very frequently, we see you several times a week, these are the complications that can happen,’ and talk them through the rationale for not giving a lot of maybe not necessary transfusions.” TS 15:15

“In general, the guidelines are if you expect a patient to have severe prolonged neutropenia, lasting greater than seven days, then you would want to consider giving them an antibiotic to help prevent neutropenic fever. . . . A high-risk patient would benefit from that.” TS 17:23

“Myelosuppression can delay chemotherapy, so patients who are getting treatment for their cancer may experience delays in their next cycle, they may have dose reduction, they may have to discontinue that chemotherapy if they have severe myelosuppression. That could affect their outcomes as far as their cancer treatment goes. Patients who are anemic—if you are fatigued and your legs feel heavy and you feel dizzy when you get up and you fall and your platelets are low as well, that leads to an increased risk of bleeding, and really a decrease in quality of life.” TS 23:30

“Myelosuppresion and cancer treatment in general does carry other toxicities besides the physical: emotional, mental, financial, and social.” TS 25:33

“For a patient with cancer, from diagnosis on, there’s a lot that they can’t control. When you’re faced with that diagnosis, you want to really try to work to make that patient an active part of their care team. So, I think it’s important to talk with a patient—understand that there are things out of their control, but there are things that are within their control. You can teach them how to manage fatigue associated with anemia or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best. Anything that you can let the patient have control over because their life has just changed dramatically.” TS 29:03

“Oncology nurses are wonderful at looking at the patient as a whole person. Keep in mind that there are financial toxicities as well as physical, emotional, and mental. So, it might create a bigger team of people that need to step in and help the patient find the resources that they need to be successful. Also, don’t forget about the caregivers.” TS 33:47