"Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it's really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the 'so what': We are the first line of defense," ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer Institute in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ototoxicity in cancer 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 courses.ons.org by January 9, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the management of ototoxicity after chemotherapy treatment.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ Cancer Symptom Management Basics series
• ONS Voice articles:
• Oncology Drug Reference Sheet: Cisplatin
• Oncology Drug Reference Sheet: Carboplatin
• Oncology Drug Reference Sheet: Oxaliplatin
• FDA Approves Sodium Thiosulfate for Cisplatin-Associated Ototoxicity in Pediatric Patients
• ONS book: Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)
• American Cancer Society resources:
• 4 Causes of Hearing Problems for Cancer Survivors
• Cancer Survivors Network
• American Speech-Language-Hearing Association (ASHA)
• Hearing Loss: An Under-Recognized Side Effect of Cancer Treatment
• Embedded Ear Care: Audiology on the Cancer Treatment Team
• American Society of Clinical Oncology (ASCO) Annual Meeting abstract: Innovative Infusion Center Assessments of Chemotherapy-Induced Neurotoxicities: A Pilot Study Supporting Early and Routine Screenings as Part of Survivorship Programs
• Children's Oncology Group supportive care endorsed guideline: Prevention of Cisplatin-Induced Ototoxicity in Children and Adolescents With Cancer: A Clinical Practice Guideline
• Ear and Hearing article: Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment
• International Ototoxicity Management Group (IOMG)
• IOMG Wikiversity page
• Shoebox hearing assessments
• World Health Organization initiative: Make Listening Safe

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 [email protected].

Highlights From This Episode

"At different pitches, the eardrums move faster or slower, signaling the inner ear, or the cochlea—the thing that looks like a snail in the pictures. The cochlea has fluid and hair cells inside of it that receive movements from the eardrum. The hair cells change the movement into electrical signals that actually go to the auditory nerves or the cranial nerve VIII." TS 2:15

"Ototoxicity is an umbrella term for some sort of exposure to a toxin that causes damage to the inner ear. These toxins can be in the environment, such as loud or different noises, or they can be from medications, including antibiotics or commonly cancer treatments, such as radiation chemotherapy. Some common chemotherapies can be platinum-based chemotherapies like cisplatin or carboplatin. And then what patients are experiencing if they have ototoxicity can be hearing loss." TS 3:15

"The hypothesized mechanism of action is that the chemicals like the platinum compound in cisplatin … that platinum compound travels through our bloodstream. Since chemotherapy is systemic, it'll go to the inner ear, and it gets stuck there by binding to the cellular DNA in that cochlea, or that snail-looking image. That initiates the release of the reactive oxygen species, which are really trying to help clean it out, but releases such high levels that it ends up causing damage to those inner ear hairs. These inner ear hairs cannot regenerate themselves, so then they're permanently damaged. And remember we said that those hairs send electrical signals to the brain that recognize sound. So that function is permanently gone once those hair cells are damaged." TS 7:10

"I definitely think this is a huge interdisciplinary collaborative effort. As nurses and advanced providers, we're assessing and providing education. Our medical oncologists are doing those dose modifications and submitting those audiology referrals. The radiation oncologists are very important to know about this—maybe dose localization awareness. Maybe they do some changes with the doses. And then our audiologists and [ear, nose, and throat physicians], they can do that diagnostic confirmation and any rehabilitation measurements and really monitor them throughout their journey as well. And nurse navigators play a huge part in making sure those patients get those referrals, because a lot of the time the audiologists aren't in the cancer clinic, so they may have to go to another location or may need help coordinating with all their appointments that they have." TS 22:28

"We had a really innovative way of monitoring the hearing that a couple other studies have also tested. It's a remote point-of-care hearing screen. It was on [a tablet] with calibrated headphones. And then it's a paid-for subscription to an audiology testing platform. … Myself, along with a couple of other nurses, were trained how to use this testing device with the tablet and the headphones and the software program. And it was a quick down-and-dirty portable hearing assessment for patients. So anyone who was new to cisplatin, never gotten cisplatin treatment before, was enrolled into the study, and they received a hearing test every time that they came for chemo, and we gave it to them during their hydration." TS 28:59

"We proposed a concept to the American Society of Clinical Oncology (ASCO), recognizing that extravasation management requires significant interdisciplinary collaboration and rapid action. There can occasionally be uncertainty or lack of clear guidance when an extravasation event occurs, and our objective was to look at this evidence with the expert panel to create a resource to support oncology teams overall. We hope that the guideline can help mitigate harm and improve patient outcomes," Caroline Clark, MSN, APRN, AGCNS-BC, OCN®, EBP-C, director of guidelines and quality at ONS, told Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS®, VA-BC, oncology clinical specialist at ONS, during a conversation about the ONS/ASCO Guideline on the Management of Antineoplastic Extravasation.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 2, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the management of antineoplastic extravasation.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS/ASCO Guideline on the Management of Antineoplastic Extravasation
• ONS Podcast™ episodes:
  • Episode 391: Pharmacology 101: Antibody–Drug Conjugates
  • Episode 335: Ultrasound-Guided IV Placement in the Oncology Setting
  • Episode 145: Administer Taxane Chemotherapies With Confidence
  • Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments
• ONS Voice articles:
  • Access Devices and Central Lines: New Evidence and Innovations Are Changing Practice, but Individual Patient Needs Always Come First
  • New Extravasation Guidelines Provide Recommendations for Protecting Patients and Standardizing Care
  • Standardizing Venous Access Assessment and Validating Safe Chemo Administration Drastically Lowers Rates of Adverse Venous Events
  • This Organization's Program Trains Non-Oncology Nurses to Deliver Antineoplastic Agents Safely
• ONS books:
  • Access Device Guidelines: Recommendations for Nursing Practice and Education (fourth edition)
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
• ONS courses:
  • Complications of Vascular Access Devices (VAD) and IV Therapy
  • ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
  • ONS Oncology Treatment Modalities
• Clinical Journal of Oncology Nursing articles:
  • Chemotherapy Extravasation: Incidence of and Factors Associated With Events in a Community Cancer Center
  • Standardized Venous Access Assessment and Safe Chemotherapy Administration to Reduce Adverse Venous Events
• Oncology Nursing Forum article: Management of Extravasation of Antineoplastic Agents in Patients Undergoing Treatment for Cancer: A Systematic Review
• ONS huddle cards:
  • Antineoplastic Administration
  • Chemotherapy
  • Immunotherapy
  • Implanted Venous Port
• ONS position statements:
  • Administration (Infusion and Injection) of Antineoplastic Therapies in the Home
  • Education of the Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies
• ONS Guidelines™ for Extravasation Management
• ONS Oncologic Emergencies Learning Library
• ONS/ASCO Algorithm on the Management of Antineoplastic Extravasation of Vesicant or Irritant With Vesicant Properties in Adults
• American Society of Clinical Oncology (ASCO) Podcast: Management of Antineoplastic Extravasation: ONS-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 [email protected].

Highlights From This Episode

"The focus of this guideline was specifically on intravenous antineoplastic extravasation or when a vesicant or an irritant with vesicant properties leaks out of the vascular space. This can cause an injury to the patient that's influenced by several factors including the specific drug that was involved in the extravasation, whether it was DNA binding, how much extravasated, the affected area, and individual patient characteristics." TS 1:48

"The panel identified and ranked outcomes that mattered most with extravasation. Not surprising, one of the first was tissue necrosis. Like, 'How are we going to prevent tissue necrosis and preserve tissue?' The next were pain, quality of life, delays in cancer treatment: How is an extravasation going to delay cancer treatment that's vital to the patient? Is an extravasation also going to result in hospitalization or additional surgical interventions that would be burdensome to the patient? ... We had a systematic review team that then went in and summarized the data, and the panel applied the grading of recommendations, assessment, development, and evaluation (GRADE) criteria, grading quality of evidence and weighing factors like patient preferences, cost, and feasibility of an intervention. From there, they developed their recommendations." TS 7:35

"The panel, from the onset, wanted to make sure we had something visual for our readers to reference. They combined evidence from the systematic review, other scholarly sources, and their real-world clinical experience to make this one-page supplementary algorithm. They wanted it to be comprehensive and easy to follow, and they included not only those acute management steps but also guidance on 'How do I document this and what are the objective and subjective assessment factors to look at? What am I going to tell the patient?' In practice, for use of that, I would compare it to your current processes and identify any gaps to inform policies in your individual organizations." TS 16:34

"The guidelines don't take place of clinician expertise; they're not intended to cover every situation, but a situation that keeps coming up that we should talk about as a limitation, is we're seeing these case reports of tissue injury with antibody–drug conjugate extravasation. There's still not enough evidence to inform care around the use of antidotes with those agents, so this still needs to be addressed on a case-by-case basis. We still need publication of those case studies, what was done, and outcomes to help inform direction." TS 19:24

"Beyond the acute management is to ensure thorough documentation regarding extravasation. Whether you're on electronic documentation or on paper, are the prompts there for the nurse to capture all of the factors that should be captured regarding that extravasation? The size, the measurement, the patient's complaints. Is there redness? Things like that. And then within the teams, everyone should know where to find that initial extravasation assessment so that later on, if they're in a different clinic, they have something to go by to see how the extravasation is healing or progressing. ... I think there's an importance here, too, to our novice oncology nurses and their preceptors. This could be anxiety-provoking for the whole team and the patient, so we want to increase confidence in management. So, I think using these resources for onboarding novice oncology nurses is important." TS 22:34

"They [monoclonal antibodies] are able to cause tumor cell death by binding to and blocking to necessary growth factor signaling pathways for tumor cell survival. That's going to be dependent on the target of the antibody, but I'll give an example of epidermal growth factor, or EGFR. This is overexpressed in several different kinds of cancers where activation of this growth factor increases the amount of proliferation and migration of cancer cells. So, if we bind to it and block to it, then that would help halt these pathways and stop cancer cell growth," Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about monoclonal antibodies.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.75 contact hours of nursing continuing professional development (NCPD) (including 45 minutes of pharmacotherapeutic content) by listening to the full recording and completing an evaluation at courses.ons.org by December 26, 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 nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge in the history of, the mechanism of action of, and the use of monoclonal antibodies in the treatment of cancer.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Pharmacology 101 series
  • Episode 391: Pharmacology 101: Antibody–Drug Conjugates
  • Episode 383: Pharmacology 101: Bispecific Antibodies
  • Episode 375: Pharmacology 101: VEGF Inhibitors
  • Episode 338: High-Volume Subcutaneous Injections: The Oncology Nurse's Role
  • Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction
  • Episode 275: Bispecific Monoclonal Antibodies in Hematologic Cancers and Solid Tumors
• ONS Voice articles:
  • An Oncology Nursing Overview of Biosimilars
  • Make Subcutaneous Administration More Comfortable for Your Patients
  • Oncology Nurses' Role in Translating Biomarker Testing Results
  • Reduce Chair Time by as Much as 16 Minutes by Priming IVs With Drug
  • Shorter Administration Times Still Require High-Acuity Care
  • The Names of Targeted Therapies Give Clues to How They Work
• ONS Voice drug reference sheets:
  • Datopotamab deruxtecan-dlnk
  • Enfortumab vedotin
  • Margetuximab-cmkb
  • Mirvetuximab soravtansine-gynx
  • Nivolumab and hyaluronidase-nvhy
  • Nivolumab and relatlimab-rmbw
  • Pembrolizumab and berahyaluronidase alfa-pmph
  • Retifanlimab-dlwr
• ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
• ONS course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
• Clinical Journal of Oncology Nursing articles:
  • Bolusing IV Administration Sets With Monoclonal Antibodies Reduces Cost and Chair Time: A Randomized Controlled Trial
  • Management of Immunotherapy Infusion Reactions
  • Nurse-Led Grading of Antineoplastic Infusion-Related Reactions: A Call to Action
  • Safety and Adverse Event Management of VEGFR-TKIs in Patients With Metastatic Renal Cell Carcinoma
• Oncology Nursing Forum articles:
  • Administration of Subcutaneous Monoclonal Antibodies in Patients With Cancer
  • Depressive Symptoms and Quality of Life Associated With the Use of Monoclonal Antibodies in Breast Cancer Treatment
• ONS huddle cards:
  • Bispecifics
  • Checkpoint Inhibitors
  • Monoclonal Antibodies
• Other ONS resources:
  • Biomarker Database
  • Bispecific Antibodies video
• Patient Education Sheets
• Antibodies article: A Comprehensive Review About the Use of Monoclonal Antibodies in Cancer Therapy
• Cureus article: A Comprehensive Review of Monoclonal Antibodies in Modern Medicine: Tracing the Evolution of a Revolutionary Therapeutic Approach
• Association of Cancer Care Centers (ACCC) homepage
• Cancer Immunology, Immunotherapy article: Therapeutic Antibodies in Oncology: An Immunopharmacological Overview
• Drugs@FDA package inserts
• Future Oncology article: Biosimilars: What the Oncologist Should Know
• Hematology/Oncology Pharmacy Association homepage
• National Comprehensive Cancer Network homepage
• Network for Collaborative Oncology Development and Advancement (NCODA) subcutaneous therapy article
• Oncolink: Side Effects of Immunotherapy
• World Health Organization: New International Nonproprietary Names (INN) Monoclonal Antibody Nomenclature Scheme

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 [email protected].

Highlights From This Episode

"Prior to monoclonal antibodies, all we really had were these toxic chemotherapies or toxic radiation, so it was recognized how great it would be if we could have a treatment that was much more specific to the tumor cells and have agents that have less toxicities. These advancements in monoclonal antibody production began in the 1980s. ... Eventually, we had the first monoclonal antibody that was approved by the U.S. Food and Drug Administration (FDA) for an oncologic indication, rituximab." TS 4:14

"Nowadays, we do have treatments that are also considered tumor-agnostic. This is when a patient has a certain biomarker, then that treatment can be given and FDA approval was given, regardless what type of tumor the patient has. We typically see these kinds of tumor-agnostic therapies more so in patients who have recurrent or advanced diseases in solid tumors. One monoclonal antibody example that comes to mind is dostarlimab. That's a checkpoint inhibitor that's approved for patients who are deficient in mismatch repair mechanism." TS 23:48

"Our immune system constantly has this surveillance system and it's able to recognize foreign pathogens, abnormal cells, and even precancerous cells. And they're able to eliminate them before they become cancerous. But on the flip side, one of the regulatory mechanisms that we have so our immune system doesn't attack itself is the presence of checkpoints. When these checkpoints bind to their ligands, this can then act as an off switch so that, again, our immune system is not going to attack itself. But then the tumor cells can take advantage of this and actually use this mechanism to evade the immune system. So, when we're giving a checkpoint inhibitor, now we're removing that off switch. As a consequence, common adverse effects can include things like immune mediated adverse events. These most commonly affect the skin, gastrointestinal tract, and liver. Essentially, this can cause any '-itis' you can think of." TS 26:36

"Looking at strategies to prevent infusion reactions, one example is the use of premedication. If premedication is recommended, this typically includes any combination of antipyretics, which is typically acetaminophen. Antihistamine, which is typically an H1 antagonist like diphenhydramine. Although, there could be cases where we want to substitute this agent because maybe the patient has been tolerating therapy okay, and they're having a lot of side effects. So, we might use a second-generation antihistamine in some cases. The premedication may be given with or without some kind of steroid, whether that's methylprednisolone, hydrocortisone, or dexamethasone." TS 29:53

"We tend to think of monoclonal antibody usage to be primary oncology, but that's not really the case. The first monoclonal antibodies that were developed were not for oncologic indications, they were for transplant indication for cardiac indication. So, they're really diversely utilized across all specialties and medicines. We have monoclonal antibodies for hyperlipidemia, for neurology, for rheumatology, so the uses are so very expansive across all specialties." TS 41:01

"The thought of recurrence is also a psychosocial issue for our patients. They're being monitored very closely for five years, so there's always that thought in the back of their head, 'What if the cancer comes back? What are the next steps? What am I going to do next?' It's really important that we have conversations with patients and their families about where they're at, what we're looking for, and reassure them that we'll be with them during this journey and help them through whatever next steps happen," ONS member Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, manager of clinical education and clinical nurse specialist at Karmanos Cancer Institute in Detroit, MI, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about prostate cancer survivorship considerations for nurses.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by December 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 nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to survivorship nursing considerations for people with prostate cancer.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Episode 390: Prostate Cancer Treatment Considerations for Nurses
  • Episode 387: Prostate Cancer Screening, Early Detection, and Disparities
  • Episode 201: Which Survivorship Care Model Is Right for Your Patient?
  • Episode 194: Sex Is a Component of Patient-Centered Care
• ONS Voice articles:
  • APRNs Collaborate With PCPs on Shared Survivorship Care Models
  • Exercise Before ADT Treatment Reduces Rate of Side Effects
  • Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer
  • Here Are the Current Nutrition and Physical Activity Recommendations for Cancer Survivors
  • Nursing Considerations for Prostate Cancer Survivorship Care
  • Regular Physical Activity and Healthy Diet Lower Risk of All-Cause and Cardiac Mortality in Prostate Cancer Survivors
  • Sexual Considerations for Patients With Cancer
  • Sleep Disturbance Is Part of a Behavioral Symptom Cluster in Prostate Cancer Survivors
• ONS course: Essentials in Survivorship Care for the Advanced Practice Provider
• Clinical Journal of Oncology Nursing articles:
  • A Patient-Specific, Goal-Oriented Exercise Algorithm for Men Receiving Androgen Deprivation Therapy
  • Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery
  • Prostate Cancer: Survivorship Care Case Study, Care Plan, and Commentaries
  • The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population
• Oncology Nursing Forum articles:
  • A Qualitative Exploration of Prostate Cancer Survivors Experiencing Psychological Distress: Loss of Self, Function, Connection, and Control
  • Identification of Symptom Profiles in Prostate Cancer Survivors
  • Sleep Hygiene Education, ReadiWatch™ Actigraphy, and Telehealth Cognitive Behavioral Training for Insomnia for People With Prostate Cancer
  • Understanding Men's Experiences With Prostate Cancer Stigma: A Qualitative Study
• Other ONS resources:
  • Late Effects of Cancer Treatment Huddle Card
  • Survivorship Care Plan Huddle Card
  • Survivorship Learning Library
• American Cancer Society (ACS): Living as a Prostate Cancer Survivor
• ACS prostate cancer survivorship studies

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 [email protected].

Highlights From This Episode

"Some of the most common late side effects [are] urinary, bowel, and sexual dysfunction issues. For urinary effects, it can include urgency and frequency, some incontinence, or a weak or slow urine stream that frequently bothers the patient after treatment. Bowel effects can happen such as constipation, diarrhea, or inflammation of the rectum, which can lead to bleeding or mucus discharge. And then erectile dysfunction is another side effect that patients with prostate cancer often deal with and have to work with their physicians on, depending on what they want with that function. Fatigue, lymphedema, and skin changes can also occur after treatment." TS 1:40

"If we can catch [prostate cancer] and take care of it at an early stage, overall survival is about 90%. If the disease is localized, it's 99%. If we can take out the prostate, radiate the prostate, we can do something with that—localized, 99% survival rate. If there's regional metastasis, it's about 90%. And if there's distant metastasis, it's about 30% survival." TS 3:55

"Prostate cancer recurs in about 20%–30% of patients within the first five years of initial treatment. ... There's not a lot of research out there that shows what can reduce risk, but what has been shown to be effective is regular exercise, quitting smoking, and eating a healthy diet. ... It's really important for our patients to understand the importance of having follow-up visits so that we can catch a recurrence quickly instead of waiting years down the road. Prostate cancer is usually a slow-growing disease, so if we can pick it up quickly in those revisits, we can start another treatment for the patient." TS 6:00

"Sexuality is not something many people are comfortable discussing, but we really need to talk with patients and let them know that this is normal. It is normal that you may have some sexual dysfunction. It's normal that you may not feel the way you did before. Talk to us about it, let us know where you're at, let us know what your goals are, because there are a lot of things we can do. There are medications we can use for impedance. There are devices and implants available to help the patient to support them and give them whatever their goal is for their sexuality." TS 9:41

"Providing survivorship care plans are important for these patients—something that can be sent off to everyone else that's caring for that patient. You have your primary care physician, urologist, oncologist, the oncology nurse, maybe a navigator, and [others] who are looking into this patient. So, giving that patient a survivor care plan and putting it with their files to include a summary of the treatment received, because most of the time a patient is not going to remember exactly what they received. A suggested schedule for follow-up exams—so again, if a primary care provider is not used to dealing with a patient with prostate cancer, they have something to go off of. A schedule of other tests they may need in the future including screening for other types of cancer. Are they a smoker? Do they need lung screening? Do they need any other screenings related to types of cancers? And then a list of possible late or long-term side effects." TS 15:16

"I think a lot of people know about the long-term sexual effects, but what we don't really talk about is the effect that it has on the patient's self-image. How they define themselves, how they look, their body image, their self-image. It's really important that we continue to discuss it with patients and make them comfortable when discussing their sexuality and their goals for sexuality. They may be having these self-image issues after treatment that they're just not telling us about and that can affect their quality of life." TS 18:38

"I'll go back to the backpack analogy. When your kids come home with a backpack, all of a sudden their homework is not on the desk where it's supposed to be. It's in the kitchen; it kind of spreads all over the place, but it's still in the house. When we give antibody–drug conjugates (ADCs), the chemotherapy does go in, but then it can kind of permeate out of the cell membrane and something right next to it—another cancer cell that might not look exactly like the cancer cell that the chemotherapy was delivered into—is affected and the chemotherapy goes over to that cancer cell and kills it," ONS member Marisha Pasteris, OCN®, office practice nurse in the breast medicine service at Memorial Sloan Kettering Cancer Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ADCs in metastatic breast cancer.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

This podcast is sponsored by Gilead and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Episode Notes

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
  • Episode 391: Pharmacology 101: Antibody–Drug Conjugates
  • Episode 378: Considerations for Adolescent and Young Adult Patients With Metastatic Breast Cancer
  • Episode 368: Best Practices for Challenging Patient Conversations in Metastatic Breast Cancer
  • Episode 350: Breast Cancer Treatment Considerations for Nurses
  • Episode 303: Cancer Symptom Management Basics: Ocular Toxicities
• ONS Voice articles:
  • An Oncology Nurse's Guide to Cancer-Related Ocular Toxicities
  • Black Patients With Metastatic Breast Cancer Are Less Informed About Their Clinical Trial Options
  • Communication Case Study: Talking to Patients About Progressive Metastatic Breast Cancer
  • What Is HER2-Low Breast Cancer?
• ONS Voice drug reference sheets:
  • Belantamab mafodotin-blmf
  • Datopotamab deruxtecan-dlnk
  • Enfortumab vedotin-ejfv
  • Fam-trastuzumab deruxtecan-nxki
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Guide to Breast Care for Oncology Nurses
  • Guide to Cancer Immunotherapy (second edition)
• ONS courses:
  • ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
  • ONS/ONCC® Chemotherapy Immunotherapy Certificate™
• Clinical Journal of Oncology Nursing article:
  • Antibody–Drug Conjugates and Ocular Toxicity: Nursing, Patient, and Organizational Implications for Care
  • The Association Between Hormone Receptor Status and End-of-Life Care Among Patients With Metastatic Breast Cancer
• Oncology Nursing Forum article: Impact of Race and Area Deprivation on Triple-Negative Metastatic Breast Cancer Outcomes
• ONS huddle cards:
  • Altered Body Image Huddle Card
  • Chemotherapy Huddle Card
  • Targeted Therapy Huddle Card
• Foundations of Antibody–Drug Conjugate Use in Metastatic Breast Cancer: A Case Study
• ONS Biomarker Database (refine by breast cancer)
• ONS Breast Cancer Learning Library
• American Society of Clinical Oncology (ASCO) homepage
• Drugs@FDA package inserts
• National Comprehensive Cancer Network homepage
• Susan G. Komen metastatic breast cancer page

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 [email protected].

Highlights From This Episode

"What an ADC is doing is taking the antibody and linking it to a cytotoxic chemotherapy with the idea of delivering it directly into the cell. How I explain this to new nurses or patients is a backpack analogy. If we think of it as a HER2 molecule wearing a chemo backpack, it's going to find the HER2 receptor attached to it and then drop the chemotherapy into the cell via the backpack. Similar to how we come home from work, we open the key to our door, we're carrying all of our items, and then we drop our own personal items in our house." TS 2:30

"The reason that so many patients with metastatic breast cancer are able to receive ADC therapy is because they are targeting two very common antibodies that we see in breast cancer. One is HER2 and the other is trophoblast cell surface antigen 2 (TROP2). These are seen across the board. We see these on triple-negative breast cancers, hormone receptor–positive cancers, and HER2-positive breast cancers. And now we have a new way to talk about HER2, which is a HER2-low. ... Recently, we have found that patients who express low levels of HER2 are able to receive ADC therapy, specifically fam-trastuzumab deruxtecan." TS 4:21

"Another [ADC] that has just been approved is datopotamab deruxtecan. This is another ADC that targets the TROP2 receptor on a cancer cell. This one carries a lot of side effects. I mentioned earlier that you need an ophthalmology clearance because there is a lot of ocular toxicity around this one. We see a lot of blepharitis, conjunctivitis, there can be blurred vision. Another thing we monitor on this one is mucositis. In the package insert, there's a recommendation for using ice chips while receiving the treatment. ... Then in the HER2-positive and HER2-low space is the big one, which is fam-trastuzumab deruxtecan. This was approved in 2019 for the HER2-positive patients, then more recently in the HER2-low [patients]. The big [side effect] with this one is interstitial lung disease." TS 10:11

"Interstitial lung disease is an inflammation or a little bit of fibrosis within the lung that causes an impaired exchange between the oxygen and carbon dioxide. This was seen in the clinical trials, specifically around fam-trastuzumab deruxtecan. During the trials, they had a very small percentage, I think it was 1%, that died due to interstitial lung disease. So, this is a very important side effect for us as nurses to be aware of. It typically presents in patients like a dyspnea. A lot of times, it's like, 'Well, I used to be able to walk my kid to the bus stop, but now when I walk there, I feel really short of breath.' Or 'I've had this dry cough for the past couple weeks and I've tried medications, but haven't had that relieved.' So, we really need to be aware of that because early intervention in interstitial lung disease is key." TS 12:57

"ADCs are toxic drugs. They have the benefit of being targeted, but we know that they carry a lot of side effects. ... Their specificity makes them so wonderful and we've seen amazing responses to these drugs. But also, we want patients to be safe. We want to give these drugs safely. So, we have to assess our patients and make sure that this is an appropriate patient to give this therapy to. I think that's an open conversation that clinicians need to have with patients regarding these drugs." TS 18:08

"Working as an oncology infusion nurse, being oncology certified, attending chapter meetings, going to ONS Congress® has really taught me plenty. But being an oncology patient taught me way more. I know firsthand the fears 'you have cancer' brings. Then going through further testing, CT scans, MRIs, genetics, the whole preparation for surgery was something I never considered when I treated a breast cancer patient," ONS member Catherine Parsons, RN, OCN®, told Valerie Burger, MA, MS, RN, OCN®, CPN, member of the ONS 50th anniversary planning committee, during a conversation about her experience being an oncology nurse and cancer survivor. Burger spoke with Parsons and ONS members Margaret Hopkins, MSN, RN, OCN®, HNB-BC, and Afton Dickerson, MSN, AGACNP-BCP, CBCN®, AOCNP®, CGRA, about how cancer survivorship has shaped their careers as oncology nurses and personal lives.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Episode Notes

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
• 50th anniversary series
• Episode 385: ONS 50th Anniversary: Evolution of Cancer Survivorship
• Episode 263: Oncology Nursing Storytelling: Renewal
• Episode 253: The Ethics of Caring for People You Know Personally
• Episode 187: The Critical Need for Well-Being and Resiliency and How to Practice
• Episode 91: The Seasons of Survivorship
• ONS Voice articles:
• Being a Patient Taught Me How to Be a Better Oncology Nurse by Margaret Hopkins
• Sharing Our Stories Supports, Celebrates, and Advances the Nursing Profession
• Our Unified Voices Can Improve Cancer Survivorship Care
• Why I Truly Understand How Our Patients Hold Onto Hope
• ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (third edition)
• ONS course: Essentials in Survivorship Care for the Advanced Practice Provider
• ONS Nurse Well-Being Learning Library
• ONS Huddle Cards:
• Coping
• Moral Resilience
• Survivorship Care
• Connie Henke Yarbro Oncology Nursing History Center

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 [email protected].

Highlights From This Episode

Parsons: "I thought I knew cancer. I thought I knew the treatment. I thought I knew the side effects. There's so much I didn't know. There's so much behind the scenes before a patient comes and sits in my chair. The stuff that they go through I now can understand. It surprised me how much I didn't know." TS 11:39

Hopkins: "I had been thinking I'm going to be that hero, that I can go to work. I work at night, get 8 am radiation appointments, and go home and go to sleep and wake up and go to work again because everyone said, 'Oh, it's not that bad. Radiation will be okay. You can work.' … But the real challenge for me was I didn't know how to be a patient and a nurse at the same time. And my first radiation treatment, I go in there, and I change into the gown, and then I started cleaning up because I was getting treatment done at the hospital where I worked, and were taught if you see a mess, you clean it. So I was acting like a nurse. And I almost wanted to go help the other patients, but I couldn't because I had to focus on healing." TS 15:36

Dickerson: "What made the difference for me were the nurses who didn't just treat my illness. They treated me as a whole person—my emotions, my feelings. They made me smile. They would hold my hand or just take a moment to really ask, 'Hey, how are you?' And those small, little gestures made me feel worthy, made me feel like a human. I always tell nurses it's not just about the chemo; it's about the connection. Sometimes your presence is the most healing thing that you can offer to your patient." TS 30:52

"Antibody–drug conjugates (ADCs) have three basic parts: the antibody part, the cytotoxic chemo, and the linker that connects the two. First, the antibody part binds to the target on the surface of the cell. Antibodies can be designed to bind to proteins with a very high level of specificity. That's what gives it the targeted portion. Then the whole thing gets taken up by the cell and broken down, which releases the chemotherapy part. Some sources will call this the 'payload' or the 'warhead.' That's the part that's attached to the 'heat-seeking' part, and that's what causes the cell death," Kenneth Tham, PharmD, BCOP, clinical pharmacist in general oncology at the University of Washington Medicine and Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about antibody–drug conjugates.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 28, 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 nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the mechanism of action of antibody–drug conjugates.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Pharmacology 101 series
  • Episode 303: Cancer Symptom Management Basics: Ocular Toxicities
  • Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction
• ONS Voice articles:
  • An Oncology Nurse's Guide to Cancer-Related Ocular Toxicities
  • Antibody–Drug Conjugates Join the Best of Two Worlds Into One New Treatment
  • Nursing Management of Adverse Events From Enfortumab Vedotin Therapy for Urothelial Cancer
  • Oncology Nurses' Role in Translating Biomarker Testing Results
  • The Pharmacist's Role in Combination Cancer Treatments
• ONS Voice drug reference sheets:
  • Belantamab mafodotin-blmf
  • Datopotamab deruxtecan-dlnk
  • Enfortumab vedotin
  • Fam-trastuzumab deruxtecan-nxki
• ONS book: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
• ONS course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
• Clinical Journal of Oncology Nursing articles:
  • Antibody–Drug Conjugates and Ocular Toxicity: Nursing, Patient, and Organizational Implications for Care
  • Nurse-Led Grading of Antineoplastic Infusion-Related Reactions: A Call to Action
• Other ONS resources:
  • Antineoplastic Administration Huddle Card
  • Biomarker Database
  • Chemotherapy Huddle Card
  • Monoclonal Antibodies Huddle Card
• Association of Cancer Care Centers (ACCC) antibody–drug conjugates page
• Drugs@FDA
• Hematology/Oncology Pharmacy Association (HOPA)
• National Cancer Institute cancer drugs page
• Network for Collaborative Oncology Development and Advancement (NCODA) clinical resource library
• ACCC/HOPA/NCODA/ONS Patient Education Sheets website

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 [email protected].

Highlights From This Episode

"The mechanism of action of the chemo itself depends on what agent or what 'warhead' is attached. Generally, [ADCs] have some kind of cytotoxic mechanism related to many of the chemotherapies that we use in practice, without attachment to the antibody. Some of them can be microtubule inhibitors, vinca alkaloids like vincristine. Some of them can be topoisomerase I (TOP1) inhibitors like irinotecan. Some can be alkylating agents that cause DNA breaks. So, again, looking back at the arsenal we have of cytotoxic chemo, these can all be incorporated into the ADCs." TS 5:54

"I want to talk about a case where the biomarker is being tested, but the biomarker isn't the target that you're looking for. One good case of this is a newer agent that was approved called datopotamab deruxtecan. The datopotamab portion is specific to a target called 'trophoblast cell surface antigen 2' (TROP2), which is expressed on the surface of many epithelial cancers. This agent was first approved in hormone receptor-positive, HER2-negative breast cancer, and received accelerated approval in patients with non-small cell lung cancer (NSCLC) with an EGFR mutation. ... The antibody looks for a target, TROP2. But in both of these cases—in the breast cancer and the NSCLC—you're testing for expression of different mutations or lack thereof. You're not looking for expression of TROP2. There's more research that needs to be done about the relationship between TROP2 expression and the presence or absence of these other biomarkers, but until we know more, we're actually testing for biomarkers that aren't the target of the ADC." TS 10:22

"There are common adverse advents to antibodies and chemo in general. Because we have both of these components, we want to watch out for the adverse effects of both of them. Antibodies, as with most proteins, can trigger an immune response or an infusion reaction. So, many ADCs can also cause hypersensitivity or infusion reactions. The rates of that are really variable and depend on the actual antibodies themselves. Then you have the cytotoxic component, the chemotherapy component, which has its own characteristic side effects. So, if we think of general chemo side effects—fatigue, nausea, bone marrow suppression, alopecia—these can [occur] with a lot of ADCs as well." TS 15:34

"The rate of ocular toxicity in [mirvetuximab soravtansine] is quite high. The manufacturer reports that this can occur in up to 60% of patients. With rates so high, the manufacturer recommends a preventive strategy. For this particular agent, [they] recommend patients have required eyecare. ... This ocular toxicity is something we do see in other ADCs that don't have the same target and don't necessarily have the same payload component. For example, tisotumab vedotin and again, datopotamab deruxtecan, can both cause ocular toxicities and both would have required ocular supportive care." TS 20:08

"Overall, I feel like the future is incredibly bright for these agents. There have only been around a dozen therapies approved by the U.S. Food and Drug Administration (FDA) despite this idea—the first agent came out in 2000. So, 25 years later, there are only around a dozen FDA-approved treatments. But there are so many more that are coming through the pipeline. And as we're discovering more biomarkers and developing more specialized antibodies, it's only natural that more ADCs will follow." TS 26:50

"Any time the patient hears the word 'cancer,' they shut down a little bit, right? They may not hear everything that the oncologist or urologist, or whoever is talking to them about their treatment options, is saying. The oncology nurse is a great person to sit down with the patient and go over the information with them at a level they can understand a little bit more. To go over all the treatment options presented by the physician, and again, make sure that we understand their goals of care," ONS member Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, manager of clinical education and clinical nurse specialist at Karmanos Cancer Institute in Detroit, MI, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about prostate cancer treatment considerations for nurses.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 21, 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 nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the treatment of prostate cancer.

Episode Notes

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Episode 387: Prostate Cancer Screening, Early Detection, and Disparities
  • Episode 373: Biomarker Testing in Prostate Cancer
  • Episode 324: Pharmacology 101: LHRH Antagonists and Agonists
  • Episode 321: Pharmacology 101: CYP17 Inhibitors
  • Episode 208: How to Have Fertility Preservation Conversations With Your Patients
  • Episode 194: Sex Is a Component of Patient-Centered Care
• ONS Voice articles:
  • Communication Models Help Nurses Confidently Address Sexual Concerns in Patients With Cancer
  • Exercise Before ADT Treatment Reduces Rate of Side Effects
  • Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer
  • Nurses Are Key to Patients Navigating Genitourinary Cancers
  • Sexual Considerations for Patients With Cancer
  • The Case of the Genomics-Guided Care for Prostate Cancer
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition)
  • Manual for Radiation Oncology Nursing Practice and Education (Fifth Edition)
• Clinical Journal of Oncology Nursing articles:
  • Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers
  • Physical Activity: A Feasibility Study on Exercise in Men Newly Diagnosed With Prostate Cancer
  • The Role of the Advanced Practice Provider in Bone Health Management for the Prostate Cancer Population
• Oncology Nursing Forum articles:
  • An Exploratory Study of Cognitive Function and Central Adiposity in Men Receiving Androgen Deprivation Therapy for Prostate Cancer
  • ONS Guidelines™ for Cancer Treatment–Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer
• Other ONS resources:
  • Biomarker Database (refine by prostate cancer)
  • Biomarker Testing in Prostate Cancer: The Role of the Oncology Nurse
  • Brachytherapy Huddle Card
  • External Beam Radiation Huddle Card
  • Hormone Therapy Huddle Card
  • Luteinizing Hormone-Releasing Hormone Antagonist Huddle Card
  • Sexuality Huddle Card
• American Cancer Society prostate cancer page
• National Comprehensive Cancer Network homepage

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 [email protected].

Highlights From This Episode

"I think it's important to note that urologists are usually the ones that are doing the diagnosis of prostate cancer and really start that staging of prostate cancer. And the medical oncologists usually are not consulted until the patient is at a greater stage of prostate cancer. I find that it's important to state because a lot of our patients start with urologists, and by the time they've come to us, they're a lot further staged. But once a prostate cancer has been suspected, the patient needs to be staged for the extent of disease prior to that physician making any treatment recommendations. The staging includes doing a core biopsy of the prostate gland. During this core biopsy, they take multiple different cores at different areas throughout the prostate to really look to see what the cancer looks like." TS 1:46

"[For] the very low- and low-risk group, the most common [treatment] is active surveillance. ... Patients can be offered other options such as radiation therapy or surgery if they're not happy with active surveillance. ... The intermediate-risk group has favorable and unfavorable [status]. So, if they're a favorable, their Gleason score is usually a bit lower, things are not as advanced. These patients are offered active surveillance and then either radical prostatectomy with possible removal of lymph nodes or radiation—external beam or brachytherapy. If a patient has unfavorable intermediate risk, they are offered radical prostatectomy with removal of lymph nodes, external radiation therapy plus hormone therapy, or external radiation with brachytherapy. All three of these are offered to patients, although most frequently we see that our patients are taken in for radical prostatectomy. For the high- or very high-risk [group], patients are offered radiation therapy with hormone therapy, typically for one to three years. And then radical prostatectomy with removal of lymph nodes could also be offered for those patients." TS 7:55

"Radiation can play a role in any risk group depending on the patient's preference. ... The types of radiation that we use are external beam, brachytherapy, which is an internal therapy, and radiopharmaceuticals, [which are] more for advanced cancer, but we are seeing them used in prostate [cancer] as well. External beam radiation focuses on the tumor and any metastasis we may have with the tumor. It can be used in any risk [group] and for recurrence if radiation has not been done previously. If a patient has already been radiated to the pelvic area or to the prostate, radiation is usually not given again because we don't want to damage the patient any further. Brachytherapy is when we put radioactive pellets directly into the prostate. For early-stage prostate cancer, this can be given alone. And for patients who have a higher risk of the cancer growing outside the prostate, it can be given in combination with external beam radiation. It's important to note with brachytherapy, it cannot be used on patients who've had a transurethral resection of the prostate or any urinary problems. And if the patient has a large prostate, they may have to be on some hormone therapy prior to brachytherapy, just to shrink that prostate down a little bit to get the best effect. ... Radiopharmaceuticals treat the prostate-specific membrane antigen." TS 11:05

"The side effects of surgery are usually what deter the patient from wanting surgery. The first one is urinary incontinence. A lot of times, a patient has a lot of urinary incontinence after they have surgery. The other one is erectile dysfunction. A lot of patients may not want to have erectile dysfunction. Or, if having an erection is important to the patient, they may not want to have surgery to damage that. In this day and age, physicians have gotten a lot better at doing nerve-sparing surgeries. And so they really do try to do that so that the patient does not have any issues with erectile dysfunction after surgery. But [depending on] the extent of the cancer where it's growing around those nerves or there are other things going on, they may not be able to save those nerves." TS 15:26

"Luteinizing hormone-releasing hormone, or LHRH antagonists or analogs, lower the amount of testosterone made by the testicles. We're trying to stop those hormones from growing to prevent the cancer. ... When we lower the testosterone very quickly, there can be a lot more side effects. But if we lower it a little bit less, we can maybe help prevent some of them. The side effects are important. When I was writing this up, I was thinking, 'Okay, this is basically what women go through when they go through menopause.' We're decreasing the estrogen. We're now decreasing the testosterone. So, the patients can have reduced or absent sexual desire, they can have gynecomastia, hot flashes, osteopenia, anemia, decreased mental sharpness, loss of muscle mass, weight gain, and fatigue." TS 17:50

"What we all need to remember is that no patient is the same. They may not have the same goals for treatment as the physicians or the nurses want for the patient. We talked about surgery as the most common treatment modality that's presented to patients, but it's not necessarily the option that they want. It's really important for healthcare professionals to understand their biases before talking to the patients and the family. It's also important to remember that not all patients are in heterosexual relationships, so we need to explain recovery after treatment to meet the needs of our patients and their sexual relationships, which is sometimes hard for us. But remembering that—especially gay men—they may not have the same recovery period as a heterosexual male when it comes to sexual relationships. So, making sure that we have those frank conversations with our patients and really check our biases prior to going in and talking with them." TS 27:16

"It's critical to identify those mutations found that are driving the cancer's growth and guide the personalized treatment based on those results. And important to remember, too, early testing is crucial for patients with non-small cell lung cancer (NSCLC). In studies, it has been found to be associated with improved survival outcomes and reduced mortality," ONS member Vicki Doctor, MS, BSN, BSW, RN, OCN®, precision medicine director at the City of Hope Atlanta, GA, Chicago, IL, and Phoenix, AZ, locations, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the oncology nurse's role in NSCLC biomarker testing.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

This podcast is sponsored by Lilly Oncology and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Episode Notes

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
  • Episode 363: Lung Cancer Treatment Considerations for Nurses
  • Episode 359: Lung Cancer Screening, Early Detection, and Disparities
  • Episode 238: Cancer Genomics for Every Oncology Nurse
  • Episode 157: Biomarker Testing Improves Outcomes for Patients With Non-Small Cell Lung Cancer
• ONS Voice articles:
  • Non-Small Cell Lung Cancer Prevention, Screening, Diagnosis, Treatment, Side Effects, and Survivorship
  • Only a Third of Patients With Advanced Cancer Get Biomarker Testing, Limiting Use of Potentially Effective Precision Therapies
  • Precision Medicine in Lung Cancer: How Comprehensive Testing Optimizes Patient Outcomes
  • Targeted Therapies Are Transforming the Treatment of Non-Small Cell Lung Cancer
• ONS book: Guide to Cancer Immunotherapy (second edition)
• ONS course: Genomic Foundations for Precision Oncology
• Clinical Journal of Oncology Nursing article: Using Nurse Navigators to Improve Timeliness of Biomarker Testing for Non-Small Cell Lung Cancer
• Oncology Nursing Forum article: Precision Medicine Testing and Disparities in Health Care for Individuals With Non-Small Cell Lung Cancer: A Narrative Review
• Other ONS resources:
  • Best Practices for Biomarker Testing in Non-Small Cell Lung Cancer: A Case Study
  • Genomics and Precision Oncology Learning Library
  • Genomics Case Study: Precision Medicine in the Setting of Metastatic Non-Small Cell Lung Cancer
  • Biomarker Database (refine by non-small cell lung cancer)
  • Genomic Biomarkers Huddle Card
  • Targeted Therapy Huddle Card
• National Comprehensive Cancer Network homepage

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 [email protected].

Highlights From This Episode

"These biomarkers are used to provide information about cancer's characteristics or behavior. In oncology precision medicine specifically, molecular tests can help with diagnosing a cancer that is maybe an unknown primary. It can help with monitoring response to therapy, detect recurrence of disease before other tests can find that, predict prognosis or how aggressive the cancer may be, and guide treatment decisions for targeted therapies." TS 3:14

"Some of the key biomarkers recommended by the National Comprehensive Cancer Network (NCCN) to be tested in patients who have NSCLC are EGFR, ALK, KRAS, BRAF, MET exon 14 skipping mutation, HER2 which is a protein expression from an ErbB protein, PD-L1 which is a protein expression that's used to guide immunotherapy choices, and then finally there are three fusions: ROS1, RET, and NTRK. [These] are pretty rare but really important to be tested for in patients who have NSCLC." TS 3:46

"Another important challenge for nurses related to this topic is that these results may not reveal a targeted mutation for the patient and that could be very disappointing. So, being able to provide that emotional support to a patient if they have that result … you can actually reinforce with them that if [they] go onto another treatment that the physician decides to put [them] on, the tumor can change. New pathogenic variants can develop based on the treatment that they're getting, and another test can be done. And maybe at that time—a new biomarker that could be targeted—we'd be seeing on the new test." TS 7:32

"Another circumstance we didn't talk about yet is that maybe the result came back saying that the quality was not sufficient. And sometimes that happens, but that doesn't mean that we're at the end of the road, necessarily. So, you could explain to the patient that that may mean that possibly, a new biopsy would be ordered by the physician. Or if a new biopsy or another tissue sample is not available, then maybe the physician would pivot to sending a blood specimen for the molecular testing. So that would definitely be a way [nurses] could support their patients." TS 11:52

"In the case of patients with NSCLC, early testing is so important. So, advocating for that prompt biomarker testing to be done, making sure that it's comprehensive, that it's actually looking for all of those—I think it was 12 biomarkers—that I mentioned earlier. That this testing is done as soon as possible after diagnosis or progression. Something that I talk about all the time—personalized care, precision medicine—really matters. So, tailoring treatments for patients based on the biology of the tumor that's driving the cancer's growth is really crucial if you're going to be working as an oncology nurse. Another crucial thing, because it's changing so quickly, is to stay informed." TS 16:23

"I think we really need to push more of our oncology nurses to get into elected and appointed positions. So often we're looking at health positions to get involved in, and those are wonderful. We need nurses as secretaries of health, but there are others. We as nurses understand higher education. We understand environment. We understand energy. So I think we look broadly at, what are positions we can get in? Let's have more nurses run for state legislative offices, for our House of Representatives, for the U.S. Senate," ONS member Barbara Damron, PhD, LHD, RN, FAAN, told Ryne Wilson, DNP, RN, OCN®, CNE, ONS member and member of the ONS 50th anniversary committee, during a conversation about the future of oncology nursing advocacy and health policy. Wilson spoke with Damron and ONS member Janice Phillips, PhD, RN, CENP, FADLN, FAAN, about how ONS has advanced advocacy and policy efforts over the past 50 years and its approaches for the future.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Episode Notes

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
• ONS 50th anniversary series
• Episode 229: How Advocacy Can Shape Your Nursing Career
• ONS Voice articles:
• Oncology Nurses Take to Capitol Hill to Advocate for Cancer Care Priorities
• Our Unified Voices Can Improve Cancer Survivorship Care
• With Voices Amplified by ONS, Oncology Nurses Speak Out for Patients and the Profession on Capitol Hill
• NOBC Partnerships Advance Nurses' Placements on Local and National Boards
• Nursing Leadership Has Space for You and Your Goals
• ONS courses:
• Advocacy 101: Making a Difference
• Board Leadership: Nurses in Governance
• Oncology Nursing Forum articles:
• Nurses on Boards: My Experience on the Moonshot
• Strengthening Oncology Nursing by Using Research to Inform Politics and Policy
• ONS Center for Advocacy and Health Policy
• Current ONS position statements
• Connie Henke Yarbro Oncology Nursing History Center
• Campaign for Tobacco-Free Kids
• Cancer Moonshot
• National Cancer Policy Forum
• National Council of State Boards of Nursing APRN Roundtable
• National Patient Advocate Foundation
• Nurses on Boards Coalition
• One Voice Against Cancer
• Patient Quality of Life Coalition
• Robert Wood Johnson Foundation Health Policy Fellows

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 [email protected].

Highlights From This Episode

Phillips: "I think that there are so many pressing issues, but I'm going to start with any kind of threats or legislation that's poised to take away safety-net resources. It's really going to set us back because we all know that, particularly for minorities and certain other underserved populations, they have experienced poor cancer outcomes for a variety of reasons, variety of socioeconomic reasons, lack of access to quality screening resources—you name it. When you take away those safety net resources and take away resources for people who are already underserved, uninsured, or underinsured, it also jeopardizes their ability to get proper screening, get proper follow-up, have access to state of the art cancer services. I think the lack of affordability of health care is a problem that continues to challenge us, whether you on Medicaid or whether you have limited insurance." TS 10:16

Damron: "Because ONS is so grounded in science and research—we're not just a clinical organization; we're grounded in scholarship, science, research, and publication—we're able to take this vast network of strong clinicians [and combine it] with amazing scientists. … We've had some amazing scientists come out of ONS; some of the leading nurse scientists of all time were also oncology nurses. So by combining this, we're able to make a difference at the state and federal level. So the advocacy work that I've been involved in, state and federal levels, really involved working with the ONS staff involved with advocacy and those scientists and clinicians who brought that expertise." TS 18:19

Phillips: "I think expanding the work around multiculturalism in oncology will always be important. Are there any new partnerships or avenues that ONS can reach out to or explore? Maybe there are other specialty organizations or groups—and not always necessarily nursing— because as we think about the determinants of health, we think about things like health and all policies. Maybe there are other disciplines or other specialties that we need to embrace as we launch our agendas." TS 23:28

Damron: "As nurses, just our basic nursing training, we get these skills—we see a problem, we identify the problem, we assess what we're going to do about it, we do it, and then we evaluate what we did. Does that work or not? That's how you make policy. So we were all trained in this. Then what you bring on top of that are oncology nursing experience, whether it's clinical, whether it's research, whether it's teaching, practice, etc. Those continue to refine those skills that are basic to us as nurses. We have this built-in skill set, and we need to own it and understand it." TS 30:25