“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 

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 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• 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 [email protected].

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

“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 

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 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• 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 [email protected].

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

“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 

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 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• 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 [email protected].

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

“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 

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 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• 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 [email protected].

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 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 

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 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• 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 [email protected].

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

“It was really the ability to be able to connect with many individuals from my profession. Reflecting on what initially drew me to ONS Congress, I can’t help but reminisce about my first time attending in 2002. I was going down memory lane the other day and found some pictures from my first time attending. As I reflected, I could not help but feel immensely grateful for the support and education I received as a novice nurse during that time from attending Congress,” Jessica MacIntyre, DNP, MBA, APRN, AOCNP®, 2024–2026 ONS president, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about ONS Congress. Taylor spoke with several 2024 ONS Congress attendees, asking the question “What brought you to ONS Congress?” Listen to their stories and learn how the conference has affected their careers in this special episode.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Episode Notes 

• Information on submitting an abstract to ONS Congress
• Oncology Nursing Foundation ONS Congress Scholarships
• Oncology Nursing Podcast episodes:
  • Episode 258: ONS Through the Ages: Stories From the Early Days With Cindi Cantril and George Hill
  • Episode 160: Build Innovative Staff Education Tools and Resources
  • Episode 191: Explore Orientation Opportunities for New-to-Practice Nurses
• ONS Voice articles:
  • Our Unified Voices Can Improve Cancer Survivorship Care
  • Personalized Patient Education: Ensure Effective, Inclusive, and Equitable Patient Education With These Five Strategies
• ONS Congress presentations from episode guests
  • The Nurse as an Effective Educator: Facilitating Patient-Centered Learning (Beau Amaya)
  • Powerful Outcomes From Nurse and Patient Policy Advocacy (Gilanie De Castro)
  • Back to Basics: Utilizing Huddles to Emphasize Standard Care and Maintenance of Central Venous Catheters in an Effort to Reduce CLABSI (Erin Hillmon)
  • Enhancing Triage Precision: Nurse Navigation's Impact on a Lymphedema Program (Jessica MacIntyre)
  • Implementing a Graduate Nurse Residency Program (Leah Scaramuzzo)

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“What I want to accomplish is really to contribute significantly to an organization that has contributed so greatly to me. And until you go to Congress, you don’t fully realize the ripple effect that ONS has on the field of oncology nursing. They really are a cornerstone to our profession. So when I volunteer with ONS, I feel like I’m serving the oncology nursing community as a whole, and I’m so grateful to get to do that on a national level.” (Stacey Clements, BSN, RN) TS 3:35

“What is bringing me to Congress is to talk about patient education, health literacy, ways that we can improve the patient experience and help them understanding. And I think this is such an important topic because it’s what we do at the core of nursing. We really teach patients and their caregivers how to take care of themselves. And sometimes we forget that it’s not just a checklist to get the education done. It’s really learning what the patient needs, what they need to think about—some consideration about what may be affecting the way that they’re retaining information. Then hopefully I can give some tools and have some discussion with many different nurses across the U.S.” (Beau Amaya, MS, RN, OCN®) TS 5:04

“Why I am so excited to attend Congress is that it really gives us an opportunity to work together with our colleagues, learn what each other is doing, and kind of leverage our collective wisdom. So this way we work smarter instead of harder.” (Leah Scaramuzzo, MSN, RN, MEDSURG-BC, AOCN®) TS 7:58

“I was a scholarship recipient, which I was super excited to receive this year for the Congress 2024 in D.C. … Out of COVID, we all were virtual, so I wanted to able to see people in person and attend a national event. Also, I’m looking forward to reigniting my passion for oncology nursing because you kind of get burned out after a while in this field.” (Brenda Marsolek, BSN, RN, OCN®) TS 9:14

“I’m also really excited to share my role as a nurse resident. I hear a lot that new nurses shouldn’t be hired in oncology or it’s difficult to hire them. And I did it. I successfully did it with the help of [Leah and Brenda]. And so, I think other people can do that as well and that we can have new grad nurses have really healthy careers in oncology in the future.” (Brandy Thornberry, ASN, RN, OCN®) TS 10:38

“I chose to be a presenter this year because I always enjoyed listening to the presentations that everyone else brings to Congress. I always learned so much. I wanted the opportunity to be able to share one of the projects I did last year that had great results attached to it, so that hopefully others can listen to my presentation and maybe take something away from it back to their own centers.” (Erin Hillmon, MSN, RN, BMTCN®) TS 11:28

“Nurses can find ways to engage in shaping health policy. Many nurses don’t recognize the connection between health policy and the bedside. Policies beyond one’s institutions or organizations have a direct impact on how we nurses practice. And my goal is to empower nurses to understand that because of our professional experience, education, and interactions with those populations who we care for, we are really poised to influence and shape health policy.” (Gilanie De Castro, MSN, RN, OCN®, NE-BC, CNML) TS 14:38

“The big thing I want to let everybody know about Congress is that there’s so much to learn, and there’s so much experience that every attendee brings. No matter what level of education you have, what setting you work in, what kind of patients you take care of, everybody has something that they can bring to the table. It doesn’t matter where you learn this information either. There’s lots of sessions, posters, and networking roundtables. What I’ve learned in these few years is really just embracing what Congress can bring to everybody. So for anybody that’s on the fence, I’d urge you to take that leap and register. Attending Congress is a decision you won’t regret.” (Holly Tenaglia, DNP, APRN, AGCNS-BC, OCN®) TS 19:47

“One of the things that I know Dr. [Tom] Connor worked on very heavily in his career is the long-term impact on the health of nurses and other exposed healthcare workers. We definitely need more longitudinal studies, which are difficult to do. And it’s not something that you see every day where I talk to chemo nurses and said, ‘Hey, I’ve been in this 20 years. It hasn't bothered me at all.’ Well, until it does. Therefore, it’s so important when we’re training incoming nurses—how very important it is to start with these practices early in the career and throughout the career,” Charlotte A. Smith, RPh, MS, senior regulatory advisor at Waste Management PharmEcology Services in Milwaukee, WI, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about hazardous drug and waste disposal.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to hazardous drugs and hazardous waste.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 209: Updates in Chemo PPE and Safe Handling
  • Episode 142: The How-To of Home Infusions
• ONS Voice articles:
  • Two Oncology Nurses Implement Process to Allow Patients to Disconnect Pumps From the Comfort of Their Own Homes
  • The Oncology Nurse’s Role in Oral Anticancer Therapies
  • Strategies to Promote Safe Medication Administration Practices
• ONS Safe Handling of Hazardous Drugs Learning Library
• ONS position statement: Infusion of Antineoplastic Therapies in the Home
• ONS book: Safe Handling of Hazardous Drugs (fourth edition)
• ONS course: Safe Handling Basics
• Clinical Journal of Oncology Nursing articles:
  • Environmental Risk Factors: The Role of Oncology Nurses in Assessing and Reducing the Risk for Exposure
  • Oral Chemotherapy: A Home Safety Educational Framework for Healthcare Providers, Patients, and Caregivers
  • Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste
  • Reconciliation and Disposal of Oral Medication: Creating a Safe Process for Clinical Research Personnel
• Pharmacy Practice News article: Applying NIOSH Hazardous Drug Assessment of Risk Principles To Home Healthcare (by Charlotte Smith and Tom Connor)
• Books mentioned in this episode:
  • Silent Spring by Rachel Carson
  • Our Stolen Future by Theo Colborn, Diane Dumanoski, and John Peterson Myers
  • Generations at Risk by Ted Schettler, Gina Solomon, Maria Valenti, and Annette Huddle
• Drug Enforcement Agency: National Prescription Drug Takeback Day
• Environmental Protection Agency: Final Rule: Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine
• MD Anderson Cancer Center: Chemotherapy at Home: 9 Things to Know (patient resource)
• Memorial Sloan Kettering Cancer Center: Safe Handling of Chemotherapy and Biotherapy at Home (patient resource)
• National Institute for Occupational Safety and Health:
  • Hazardous Drugs in Healthcare Settings
  • Managing Hazardous Drug Exposures: Information for Healthcare Settings
  • NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“A hazardous waste is a chemical, some of which are drugs, that EPA has determined is hazardous to the environment. Hazardous waste may be listed waste, which are given actual numbers, or they may be characteristic waste, which meets certain levels of concern, such as ignitability or toxicity. Only a small percentage of drug waste meets the EPA’s definition of hazardous waste, including a number of chemotherapy drugs.” TS 2:09

“The poster child for hazardous waste is warfarin, which, as you may be aware, is not only appropriate for managing clotting time but is also available commercially as rat poison. This is an example of how chemicals can serve more than one purpose and why dosage and regulation are so important.” TS 4:04

“Some of your listeners may have been around long enough to remember the book Silent Spring, by Rachel Carson, in which she eloquently exposed the risks to many species by the widespread use of DDT, an insecticide, at that time. More recently, the book Our Stolen Future by Theo Colborn, a pharmacist, Diane Dumanoski, and John Peterson Myers, raised the specter of the effects of endocrine disruption on wildlife and humans. The effects of drugs like diethylstilbestrol, or DES, once given during pregnancy, on the fetus, impacted the risk of cancer and other untoward effects in the offspring. The book remains a dramatic reminder of the risk of exposure to hazardous chemicals, including drugs.” TS 9:37

“Providing a homecare checklist for both the nurse and the patient and family is a simple way to keep track of all areas that need to be covered. For example, who in the household may be at most risk from exposure? This list includes infants, elderly family members, caregivers, pregnant family members, even pets. Is there a secure area to store the drug that cannot be reached by children?” TS 14:21

“I think what happens—we become so into our routine that what we do on a daily basis, we just kind of go through and do it without always thinking about it. And we can forget that not everyone has the same context of understanding these risks that the medications have to both the environment and the individual exposed to them. And I know it’s challenging to put on all the gowns and the gloves and whatnot. And, you know, it gets in the way of doing their job. It's important to educate each individual potentially exposed to these drugs, as if they do not have the understanding that we do. So embedding those consistent safety practices into daily routine is so imperative to ensure safe handling of hazardous drugs and then the proper disposal of hazardous waste pharmaceuticals.” TS 18:55

“When we’re talking about the role of nurses in addressing these challenges, they play a critical role because of when they actually get to see patients. And so, if we can help with early identification and assessment, really finding out, using financial screening tools to identify any patients that might be at risk, early on, of financial toxicity, that can really allow for timely interventions,” Sarah Paul, LCSW, OSW-C, senior director of social work at CancerCare in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about financial toxicity in adolescent and young adult (AYA) cancer survivors.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to financial toxicity in the adolescent and young adult population.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 300: AYAs With Cancer: End-of-Life Care Planning
  • Episode 294: AYAs With Cancer: Clinical Trial Enrollment Barriers and Facilitators
  • Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
  • Episode 276: Support Young Families During a Parent’s Cancer Journey
  • Episode 62: Financial Toxicity Legislation
• ONS Voice articles:
  • AYA Cancer Survivorship: Younger Survivors Face Different Challenges and Prefer More Casual Support Programs
  • Nursing Considerations for Adolescent and Young Adult Cancer Survivorship Care
  • How to Support Adolescents and Young Adults With Cancer at the End of Life
  • LGB AYA Patients With Cancer Have High Burden of Chronic Conditions in Survivorship
  • AYA Champions Clinic Fills Gaps in Care and Addresses Unmet Needs
• ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition)
• Clinical Journal of Oncology Nursing articles:
  • Two Case Reports on Financial Toxicity and Healthcare Transitions in Adolescent and Young Adult Cancer Survivors
  • Crucial Conversations: Addressing Informational Needs of Adolescents and Young Adults Diagnosed With Cancer
  • A Nurse-Pharmacist Collaborative Approach to Reducing Financial Toxicity in Cancer Care
• Oncology Nursing Forum article: A Brief Screening Tool for Assessment of Financial Toxicity
• ONS Financial Toxicity Huddle Card
• ONS Nurse Navigation Learning Library
• Adolescent and Young Adult Cancer Awareness Week
• American Society of Clinical Oncology
• CancerCare
• Got Transition
• National Comprehensive Cancer Network
• Patient Advocate Foundation
• Triage Cancer

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“For nurses that are caring for AYA patients, it’s really important to not only be aware of financial toxicity but know how to assess for financial toxicity because of the pivotal stage that these patients are at in their life. They often don’t have the financial stability or insurance coverage that adults who are maybe middle age or even in the older adult population might have.” TS 2:11

“The idea of [AYAs] not really understanding insurance coverage—I think it’s really important that as a team, we simplify some of this complex information, breaking it down into more manageable steps and providing that guidance on the documents and all the information that’s needed to apply [for financial assistance].” TS 8:59

“We see significant impacts in the AYA community, especially those that are in school or at the early stages of their career, because putting a job or school on hold to focus on treatment can have long-term effects. So, we see a couple of things. In education, we see academic delays; interrupting education can delay graduation or achievement of certain educational milestones, which would affect their ability to pursue higher education or even specialized training for their career. We also see, which is very difficult, loss of scholarships or financial aid. Some AYAs are starting school. It’s based on a scholarship or a grant or financial aid, and they can’t meet those full-time enrollment requirements or be able to maintain the GPA that they need to stay in the program. We see people losing their scholarships, and this is not their fault.” TS 10:11

“Down the road, you have this stress leading to chronic stress. We know that constant worry about finances can create a chronic stress environment. That is going to impact mental health across the board, which can lead to increased irritability, feelings of sadness, or even conflict among family members. So when we talk about managing these dynamics, we really want to focus on the importance of open communication because a lot of times we see families avoid discussing financial issues to shield each other from that additional stress.” TS 18:06

“One of the challenges that we face with this population is that we might assume that if they’re not talking about it, if an AYA is not bringing up finances, that it’s not an issue. And so sometimes even our own assumptions or assumptions of healthcare professionals that they don’t even need to ask, ‘How are finances going? Are you working currently? Do you feel financially stable? Are you insured?’ Often, maybe there’s not room for those questions. Maybe the appointments are too rushed. … Healthcare professionals could maybe take a pause to evaluate their own hidden or implicit bias, reflecting on their own experience, really trying to become aware of the assumptions they might have about this population.” TS 32:46

“At the beginning, like when you first meet someone before they’ve even started anything, kind of get a baseline of ‘What’s your ability to complete your daily activities? How is your coordination? How’s your speech now? How is your writing ability?’ up front before we start anything that could be toxic. And then prior to every treatment, I tend to look at their gait, watch them walk in or walk out of the office, to see if they’re changing at all,” Colleen Erb, MSN, CRNP, ACNP-BC, AOCNP®, hematology and oncology nurse practitioner at Jefferson Health Asplundh Cancer Pavilion in Willow Grove, PA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about central nervous system toxicity.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome:  Learners will report an increase in knowledge related to CNS toxicities.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 303: Cancer Symptom Management Basics: Ocular Toxicities
  • Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy
  • Episode 278: Cancer Symptom Management Basics: Hepatic Complications
  • Episode 269: Cancer Symptom Management Basics: Gastrointestinal Complications
  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications
  • Episode 250: Cancer Symptom Management Basics: Dermatologic Complications
  • Episode 244: Cancer Symptom Management Basics: Cardiovascular Complications
• ONS Voice articles:
  • Cognitive Impairment Is Much More Than “Chemo Brain”
  • When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve
  • An Oncology Nurse’s Guide to Bispecific Antibodies
  • CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says
• ONS courses:
  • Essentials in Advanced Practice Symptom Management
  • Treatment and Symptom Management—Oncology RN
  • Nursing Considerations for CAR T-Cell Therapy for Patients With Hematologic Malignancies: Patient Education and Symptom Management
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)
  • Core Curriculum for Oncology Nursing (seventh edition)
• Clinical Journal of Oncology Nursing articles:
  • Associated Toxicities: Assessment and Management Related to CAR T-Cell Therapy
  • Dronabinol Therapy: Central Nervous System Adverse Events in Adults With Primary Brain Tumors
  • Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients
• ONS Huddle Card: Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS)
• American Society of Clinical Oncology (ASCO)
  • Nervous System Side Effects
  • Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“Biotherapy, immunotherapy, and cellular therapy can cause changes in cognitive function and personality, even without other signs of obvious neurotoxicity. Things like cytokines, whether it’s infused or as a result of side effects, can bypass the blood-brain barrier and can also alter that vascular permeability to allow other substances to kind of cross the barrier and can also alter your hypothalamic activity.” TS 2:26

“There’s definitely an effect on patients who are older. You know, there’s less pliability, less ability of their nervous system to sort of rebound from an insult in some cases. And I think there’s more exposure. There’s more risk of coexisting conditions, things like diabetes or thyroid issues. There’s also higher risk of impaired liver and renal function or dehydration or polypharmacy-type things. So I think there’s just a lot of sort of inherent risks as people get older and have more coexisting conditions.” TS 5:33

“[Their caregiver says] they used to read all the time—and if you ask the patients, they’re like, “Oh, well, I can’t focus on the words because they all seem too blurry.” … But when you, if you ask them specifically, “Is your vision blurry?” they’ll say no. Then when you really get down to it, that caregiver piece I think is really crucial in this kind of toxicity, because it’s the little things that if you catch them when they’re little things, then won't lead to big things.” TS 11:00

“A couple of things I think are really important when you look at this class of drug: It developed by a concerted effort in cancer drug development to look at new agents that would be effective based on the mechanism. And then once they found a drug in this class that was beneficial, they further modified it to try to get better efficacy and less toxicity,” Rowena “Moe” Schwartz, PharmD, BCOP, FHOPA, professor of pharmacy practice at James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the nitrosoureas drug class.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to nitrosourea administration.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 286: Pharmacology 101: Alkylating Agents
  • Episode 288: Pharmacology 101: Antimetabolites
  • Episode 296: Pharmacology 101: Anthracyclines and Other Antitumor Antibiotics
  • Episode 299: Pharmacology 101: Plant Alkaloids
• ONS Voice article: The Oncology Nurse’s Role in Oral Anticancer Therapies
• ONS courses:
  • ONS/ONCC Chemotherapy Immunotherapy Administration Certificate™
  • ONS Fundamentals of Chemotherapy and Immunotherapy Administration™
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
  • Safe Handling of Hazardous Drugs (fourth edition)
• Clinical Journal of Oncology Nursing article: Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients
• Oncology Nursing Forum article: ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications
• ONS Oral Anticancer Medication Learning Library
• ONS Oral Adherence Video
• National Institute for Occupational Safety and Health: Hazardous Drugs in Healthcare Settings

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

“With the nitrosoureas, there’s something really interesting because there’s another mechanism that has been identified. And that is that when you put these nitrosoureas in the body, they break down into intermediates, and one of them is an isocyanate. … These isocyanates, what they do is they inhibit DNA repair, therefore have an impact on cells that are damaged. You can think of it as the second mechanism, and people that work in the neuro-oncology space think of this when they think of drugs like lomustine in brain cancer, how that drug decreases the DNA repair protein O6-methylguanine-DNA methyltransferase.” TS 4:11

“These drugs are very lipophilic, meaning they cross the blood-brain barrier. That’s why we use them in brain tumors, so that’s one of the key things. That’s also one of the toxicities we see when drugs cross blood-brain barrier; we see neurotoxicity. So that’s one to at least always consider but also the benefit of it crossing over and being able to treat cancers within the CNS.” TS 8:19

“As a group, these drugs are alkylating agents, so definitely the safe handling is essential. And with DNA-damaging agents, that means anybody who is going to come in contact with these drugs. So, carmustine is given intravenously. Lomustine or CCNU, those are capsules. So handling is different depending on the agents.” TS 12:45

“The thing with the lomustine or the CCNU capsules, the thing that’s really important here is that the dosing is really different than how we normally give oral medications. And so, it’s really important that patients are aware of exactly how much they take and not that they don’t repeat the dose every day. So I think just like with other oral regimens that are not daily, we really have to make sure patients are aware of the specifics of how they take the drug.” TS 14:25