Hypercalcemia of malignancy (HCM) affects about 30% of all patients with cancer. Patients with breast cancer that has metastasized to bone and patients with squamous cell lung cancer together account for more than half of all HCM cases. ONS member Marcelle Kaplan, RN, MS, CNS, CBCN®–Emeritus, AOCN®–Emeritus, breast oncology clinical specialist and member of the Long Island/Queens ONS Chapter, and Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, discuss hypercalcemia of malignancy and its current treatment strategies. This episode is part of a series about oncologic emergencies; the other episodes are 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.  Previous Oncology Nursing Podcast episodes on oncologic emergencies  ONS Voice article: Diagnose and Treat Hypercalcemia of Malignancy  ONS Voice article: Oncology Nurses’ Role in Recognizing and Addressing Oncologic Emergencies  Clinical Journal of Oncology Nursing article: Hypercalcemia of Malignancy: Part I  Clinical Journal of Oncology Nursing article: Hypercalcemia of Malignancy: Part II  ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)  ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies  ONS course: Treatment and Symptom Management—Oncology RN ONS Huddle Cards™ Journal of Oncology Practice article: Cancer-related hypercalcemia  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 192: Oncologic Emergencies 101: Hypercalcemia of Malignancy

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 “Transfusion safety is really a registered nurse activity, and I just continue to reiterate the blessing of nursing assessment, getting those vitals before the transfusion, and then monitoring them closely and stopping the transfusion if they have a reaction, because that’s really an assessment, and we can’t delegate that to nonlicensed staff. And so that’s really why we just celebrate that nurses have such a great role in transfusion safety,” Renee LeBlanc, BSN, RN, manager of the infusion services office at Fred Hutchinson Cancer Center in Seattle, WA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about administration of plasma and cryoprecipitate.  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 myoutcomes.ons.org by May 31, 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 plasma and cryoprecipitate administration.  Episode Notes    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:  Episode 234: Oncologic Emergencies 101: Thrombotic Thrombocytopenia Purpura Episode 228: Oncologic Emergencies 101: Disseminated Intravascular Coagulation Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome   ONS Voice articles:   Nursing Considerations for Adverse Events From CAR T-Cell Therapy  Manage Thrombosis in Patients With Cancer   ONS courses:   Essentials in Oncologic Emergencies for the Advanced Practice Provider Oncologic Emergencies   ONS book:  Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Journal of Oncology Nursing article: STAT: Cytokine Release Syndrome ONS Huddle Cards   Cytokine Release Syndrome  Disseminated Intravascular Coagulation   AABB (Association for the Advancement of Blood and Biotherapies, formerly American Association of Blood Banks) American Association of Clinical Oncology Blood Bank Guy (Joe Chaffin, MD) Joint Commission:  Patient Blood Management Certification Review Process Guide 2021   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  “Plasma is indicated for massive transfusions and emergent reversal of warfarin therapy–related intracranial hemorrhage. Nurses may also see plasma ordered pre-op for multiple coagulation deficiencies or factor XI deficiency.” TS 2:58  “Surgical centers performing procedures with large-volume blood loss would be a prime location for staff to be experts in transfusing plasma and cryo. Nurses caring for patients with cytokine release syndrome may be familiar with monitoring for hypofibrinogenemia. Cryoprecipitate in this setting may be given more prophylactically than for a patient who’s actively bleeding or having a procedure.” TS 6:48  “Plasma coagulation factors have a short half-life. Transfusing as close to the procedure will ensure the highest level of factor activity at the time of the procedure. Nurses can ensure best outcomes through care coordination and timing the transfusions as close to the procedure as possible. So we don’t want to start transfusing plasma at midnight if the factors are going to be expiring and their procedure isn’t until 9:00 in the morning.” TS 10:40  “One of the questions that I get sometimes, especially with plasma, is, ‘I don’t have time to be at the bedside for 15 minutes for four units.’ Remember that each unit is a different donor, and what they eat, what kind of antibodies they have, whether they were pregnant—it’s all part of that experience. It’s not the same plasma product given four different times or three different times. And so just really drawing nurses into the value of being at the bedside for that first 15 minutes of that final determination of acceptability and tolerance.” TS 14:20   

Episode 314: Plasma and Cryoprecipitate Administration: The Oncology Nurse’s Role

 “Of all the eight different pulmonary toxicities you and I have talked about over these two different podcasts, they’re all very different etiologies and treatments. So, we went everywhere from infection and good stewardship with antibiotics to pulmonary GVHD to diffuse alveolar hemorrhage. And I think that’s what’s the hardest part for us as nurses. It’s not just one thing that’s causing it, and there’s multiple different ways to treat these things,” Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about pulmonary toxicities in cancer treatment.  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 24, 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 pulmonary complications in people with cancer.  Episode Notes   Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:   Episode 295: Cancer Symptom Management Basics: Pulmonary Embolism, Pneumonitis, and Pleural Effusion  Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies  Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond  Oncologic Emergencies 101 series   ONS Voice articles:   Pneumonitis With Immunotherapy Treatment  The Case of the Post-Transplant Pulmonary Problem  How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer   ONS courses:   Essentials in Oncologic Emergencies for the Advanced Practice Provider Oncologic Emergencies  Treatment and Symptom Management—Oncology RN   ONS books:   Understanding and Managing Oncologic Emergencies: A Resource for Nurses  (third edition)  Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)   Clinical Journal of Oncology Nursing article: Influenza Adherence Tool Kit: Implementation and Evaluation Among Allogeneic Hematopoietic Transplantation Recipients Oncology Nursing Forum articles:  Community Respiratory Virus Infection in Hematopoietic Stem Cell Transplantation Recipients and Household Member Characteristics Emergence of Stereotactic Body Radiation Therapy  Multifactorial Model of Dyspnea in Patients With Cancer   ONS Huddle Cards:   Hematopoietic Stem Cell Transplantation Proton therapy Radiation Sepsis    ONS Guidelines™ and Symptom Interventions: Dyspnea American Cancer Society patient resources:   Shortness of Breath  Infections in People With Cancer   American Lung Association   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  “[Intensity-modulated radiation therapy] is a type of radiation that can really take into account certain movements. And this is particularly important with the lungs, because we can’t necessarily have patients hold their breath for a long period of time, so the chest rises and falls and the heart beats while you're trying to do radiation to the lungs. So with IMRT, they can simulate that, so that the beam is going to follow that specific movement in that patient. That’s really helpful because then, hopefully, we’re going to keep that radiation dose mostly on cancer tissue and not on healthy tissue. And thus, that should reduce the amount of radiation that’s to the healthy tissue and hopefully reduce pneumonitis.” TS 3:44  “Proton beam radiation is something that we’ve described in the past as radiation that will typically have an entrance dose but not an exit dose, so minimizing toxicity by hopefully around 50%. … If you’re doing proton beam therapy, that radiation is designed to only have an entrance dose from either the back or the front or the side, whichever way they’re going, but then hopefully stop on a dime at that tumor so that they’re only really getting the entrance dose of that radiation. … So in turn, especially if you’re doing that to the lungs, that should minimize dose of radiation to healthy lung tissue.” TS 5:03  “If they’re having a fever, low blood count, thick ugly mucus, this often, typically can be infection as well. And then get a chest x-ray because, a lot of times I’ve been saying for a lot of these things, we need a CT scan to see this. Actually, infection is probably best noted on a chest x-ray because this is something that will consolidate.” TS 18:58  “[Tumors] may be directly invading a vessel. They may directly be invading the bronchus where there’s a lot of capillaries or there’s a lot of blood vessels that can break and then cause them to cough up blood. You can have tumors or prior treatment that then cause a bronchial fistula that then can cause bleeding. Patients with squamous cell carcinoma of the lung are much more likely to have hemoptysis and pulmonary hemorrhage than patients with adenocarcinoma, though it definitely can happen with adenocarcinoma as well.” TS 22:00  “One of the best treatments for tumor-direct hemorrhage is radiation. This is where radiation can be very helpful for these patients. It’s one of the first things that we do. We’re going to go in with radiation, shrink that tumor really fast to get it away from those vessels, so patients stop bleeding.” TS 27:17

Episode 313: Cancer Symptom Management Basics: Other Pulmonary Complications

 “I think a virtual nurse can have the same sort of presence that a bedside nurse does. I like to think of a virtual nurse as pulling up a virtual chair next to that patient and spending time to ask questions and engage with them,” Laura Gartner, DNP, MS, RN, NEA-BC, associate chief nursing informatics officer for inpatient shared services and north region at Jefferson Health in the Philadelphia, PA, area told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about virtual nursing care.  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 17, 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 virtual nursing.  Episode Notes    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:   Episode 282: Telehealth-Based Oncology Palliative Care Episode 136: Nurse Innovators Use Telehealth to Improve Adult and Pediatric Symptom Reporting Episode 109: Is Telehealth the Future of Cancer Care?   ONS Voice articles:   How’s Your Video Telehealth ‘Webside Manner’?  Innovative Solutions to Maximize Oncology Nurse Staffing During a Nursing Shortage  Personalized Patient Education: Ensure Effective, Inclusive, and Equitable Patient Education With These Five Strategies  Telehealth: The Future Is Now for Patient-Centered Care   ONS book:  Telephone Triage for Oncology Nurses (third edition) Clinical Journal of Oncology Nursing articles:  Nursing Telemedicine Educational Encounters: Improved Patient Satisfaction in Radiation Therapy Clinics Oncology Nurse Navigation: Expansion of the Navigator Role Through Telehealth Telehealth Use in Rural North Carolina Counties: Perceptions Among Patients With Acute Myeloid Leukemia Telemedicine Versus Clinic Visit: A Pilot Study of Patient Satisfaction and Recall of Diet and Exercise Recommendations From Survivorship Care Plans   Oncology Nursing Forum articles:  A Telemedicine-Delivered Nursing Intervention for Cancer-Related Distress in Rural Survivors Breast Cancer Survivors' Satisfaction and Information Recall of Telehealth Survivorship Care Plan Appointments During the COVID-19 Pandemic Rural Cancer Survivors' Perceptions of a Nurse-Led Telehealth Intervention to Manage Cancer-Related Distress Telenursing Interventions for Patients With Cancer Receiving Chemotherapy: A Scoping Review   ONS Clinical Practice Resource:  Racial Disparities in Cancer Care: Telehealth and Clinical Trial Options Jefferson Health press release:  Jefferson Health Launches Virtual Nurse 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  “I think that the virtual nurse plays a really important role in nurse staffing shortages. With this shortage, we need to get creative and think outside the box so that we can facilitate nurse wellness, work-life balance, and satisfaction and make our hospitals the place that nurses want to work. I firmly believe that nothing can replace the physical touch, but there are so many things a nurse does every day that can be done by somebody remotely that can reduce the workload of that bedside nurse.” TS 3:28  “About eight nurses between these two floors have volunteered to take on this role as a virtual nurse, and so they will come right from that floor. But there’s a lot of conversation about whether you should use staff from the floor, if you should use other people, things along those lines. But right now, we really hope and think that the nurses we’ve identified for this phase have a relationship with these units. They know how the units work, and that might help get everybody working together.” TS 6:37  “We found that it was really important to have a virtual knock for the patient so that you’re not just popping into a room and taking a patient off guard. Privacy features for the patient—so if there’s a camera pointing at the patient all the time, that gives a patient a little unease. ‘Is somebody watching me?’ And when we weren’t really watching them all the time; it was intermittent care, so having a camera turn away from the patient when it’s off or have a clear indicator that it’s not on.” TS 11:57  “In terms of lessons learned with the virtual staff…I don’t think that you can just take any nurse off the floor and put them behind a camera. There is a bit of a ‘webside manner,’ if you will. People need to be comfortable doing things remotely where they can’t touch the patient, or having a conversation with somebody through a camera might not be a skill that everybody has or is comfortable doing.” TS 13:39 “I don’t think a virtual nurse can replace that physical touch. What I see a virtual nurse is, is another member of the care team whose care complements the care the bedside nurse is providing. I don’t think that we should be looking to remove resources from the bedside with this nursing shortage but rather evaluate what our nurses are doing, identify if there’s tasks that someone else can do for them so that they can focus on the patient. And there are plenty of things that a virtual nurse could do so that the bedside nurse can spend more time doing quality work with that patient.” TS 21:40

Episode 312: Virtual Nursing in Health Care

 “Chemotherapy exposure during the first trimester is contraindicated and increases the risk of spontaneous abortion, fetal death, and major congenital malformations. Second- and third-trimester exposure may affect some body systems still developing and can still result in fetal growth restriction, low birth weight, and preterm labor. Yet, I do want to stress that pregnancy can remain a possibility,” Kelsey Miller, MSN, RN, AGCNS-BC, OCN®, clinical nurse specialist in oncology and infusion therapy at Reading Hospital in West Reading, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about policies and procedures for pregnancy testing during cancer treatment.  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 myoutcomes.ons.org by May 10, 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 pregnancy screening procedures during cancer treatment.  Episode Notes    Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes:   Episode 217: Support Pregnant and Postpartum Patients During Cancer Diagnosis and Treatment  Episode 208: How to Have Fertility Preservation Conversations With Your Patients   ONS Voice article:  The Case of the Pregnancy Predicament ONS book:  Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition) Clinical Journal of Oncology Nursing articles:  Pregnancy and Cancer Treatment: Developing a Standardized Testing Policy and Procedure Unintended Pregnancy: A Systematic Review of Contraception Use and Counseling in Women With Cancer   ONS Huddle Cards   Fertility Preservation Sexuality   ONS Congress® abstract: System Approach to Fertility Preservation and Pregnancy Status During Active Cancer Treatment (by Kelsey Miller and Ainsley Hartman) ECHO program (Enriching Communication Skills for Health Professionals in Oncofertility) Journal of the National Comprehensive Cancer Network article: Pregnancy Screening in Patients With Cancer   National Comprehensive Cancer Network Guidelines: Adolescent and Young Adult (AYA) Oncology   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  “It’s really crucial to identify [pregnancy] prior to treatment, as this should be considered a patient safety ‘never’ event. We know that exposure to chemotherapy or radiation can cause mutagenic changes in reproductive cells and teratogenic effects in a developing fetus. Women of childbearing potential should have a documented pregnancy test prior to beginning cancer treatment due to the adverse effects of chemotherapy and radiation on a developing fetus.” TS 1:42  “We had a fertility risk checklist that was based off American Society of Clinical Oncology standards, that was not fully operationalized nor built into physician workflows. The checklist was a way of documenting that risks of infertility, fertility preservation, and contraception was discussed, as well as an attestation that referral to a reproductive endocrinologist was made if needed. I had a physician partner at the time who said the only way to get the providers to fill out this checklist is to make it a hard stop, so that’s what we did. The fertility risk checklist is now a hard stop by means of an order validation that will pop up when the provider goes to sign the oncology treatment plan, and it will say, ‘Orders cannot be signed unless the fertility risk checklist is complete.’” TS 9:27  “Whenever I develop teams, I like to share a common vision. We’re all here for patient safety, and we want to prevent harm by pregnancy screening these patients that could potentially become pregnant during cancer treatment.” TS 13:20  “There’s a misconception that all cancer therapy will render patients infertile, and this is not the case. Even though chemotherapy and radiation reduce fertility and may cause premature ovarian failure, many patients still remain fertile. And we know from research that physical intimacy remains important during cancer treatment, and unintended pregnancies may occur.” TS 18:13

Episode 311: Standardized Pregnancy Testing Processes in Cancer Care

 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 192: Oncologic Emergencies 101: Hypercalcemia of Malignancy

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