The ONS Podcast

"What I appreciate about our patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia is the consideration that they receive a cancer diagnosis, and the best thing for them to do is actually nothing. There is a large population of patients that we don't recommend any type of treatment. We recommend that they establish care with an oncologist and that they have a relationship with those care teams," ONS member Caitilin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about an overview of CLL for oncology nurses.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 3, 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 increased knowledge of the diagnosis and management of chronic lymphocytic leukemia.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer
Episode 256: Cancer Symptom Management Basics: Hematologic Complications

ONS Voice articles: Compensation Funds Curb Financial Burden for Certain Exposure-Related Cancers
Infection Prevention for Oncology Nurses
Nurse-Led Bone Marrow Biopsy Clinics Truncate Time for Testing, Treatment
Patient Stress Linked to More Advanced Leukemia
Patients With CLL Report Worse QoL and Other Factors

Clinical Journal of Oncology Nursing articles:  Care Coordination: Overcoming Barriers to Improve Outcomes for Patients With Hematologic Malignancies in Rural Settings
Pseudohyperkalemia in Chronic Lymphocytic Leukemia: An Often Overlooked Clinical Entity
Richter Transformation Arising From Chronic Lymphocytic Leukemia

ONS book: Site-Specific Cancer Series: Leukemia (first edition)
Hematology, Cellular Therapy and Stem Cell Transplantation Learning Library
ONS Biomarker Database
ONS clinical practice resource: Genomics Taxonomy
Blood Cancer United: Chronic Lymphocytic Leukemia: In Detail
CLL Society: Patient Education Toolkit
Lymphoma Research Foundation: Lymphoma and CLL Publications
National Comprehensive Cancer Network
To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Some of the common risk factors are environmental exposures, occupational exposures, and chemical exposures. For example, in certain farming communities where there are pesticides, that can definitely contribute to the risk of developing CLL. There's some consideration for high levels of radon exposure or exposure to Agent Orange. So our veterans, both from the Vietnam War but also more recently in Iraq. There's definitely a consideration that those types of exposures increase the risk of developing CLL." TS 3:01
"Generally, the average age of diagnosis for CLL is in the seventh decade of life. But over 90% of people are diagnosed at age 50 and above. So, this tends to be a diagnosis in the six or seventh decade of life. It's extremely rare in children, although it has been observed, and it's twice as likely to develop in men than it is compared to women. And then individuals who are White are more frequently affected by CLL than other racial or ethnic groups, followed by people of color. And that includes Black, Hispanic, and Native American individuals, but it's rarer in Asian populations." TS 9:33 
"There's a lot of adjustment and coping with a new diagnosis. When we think about the diagnostic approach, we get a lot of information that's incredibly valuable and helps us really to pivot and guide patients as to where they need to go and how we can best support them. We've had well-established studies that look to say, 'If we were to treat patients earlier or have different thresholds for consideration for treatment, do patients do better?' ... I think it's really great that we can actually guide patients in a much more precise way, that you don't need any type of therapy at this point, and it may change and evolve in the future." TS 20:29
"I have some patients that are doers and they want to do something, so this active surveillance or watch and wait really paralyzes their coping. And so they want to do something. Oftentimes, that's really when I pull in some integrative strategies and say exercise is always going to be beneficial. The more active you are, the more physically fit you are. If you really want to do something, make sure that you stay hydrated, that you eat well, and you're engaged in a physical activity that you enjoy and can be consistent with." TS 32:37
"I think another piece that we don't often discuss is around the immunoglobulins and the immune system, but CLL has a pretty significant impact on immune dysfunction. And so patients with CLL, even if they are not on any type of active treatment, their immune system doesn't necessarily function fully. And so they're more likely to develop some upper respiratory infections or more easily develop the flu or coronavirus. ... Often times, we think a lot about supporting patients to get vaccines and to have early evaluation if those symptoms develop because you're more likely to develop upper respiratory infections. I think there's a component around immune dysfunction that I think is really valuable for people to understand that it's not contingent upon the treatment. It's contingent upon the disease and mechanistically, how the B cells are dysfunctional and don't provide that immunity that otherwise would be in a healthy B cell." TS 42:54

"There are a huge array of medical dynamics that people endure, and when they leave a lasting impact, a word that we don't use widely enough is the word 'trauma.' There's an entire category of phenomena in the medical arena that are, in fact, traumatic. One way we know that these experiences are traumatic is that we know that huge portions of people who experience things like cancer do indeed develop problems like [post-traumatic stress disorder]," James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about understanding medical trauma in oncology.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 26, 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 increased knowledge of medical trauma and its effects on patients with cancer, caregivers, and healthcare professionals.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Episode 315: Processing Grief as an Oncology Nurse
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 257: Redefining the Bell: The Ethics of Hope for Oncology Nurses and Patients
Episode 103: What Oncology Nurses Need to Know to Support Caregivers
ONS Voice articles:
'Between Two Kingdoms' Gives Us a Glimpse Into How Patients and Families Experience Malignancy
AYA Cancer Survivors Experience Five Times Higher Depression Rates Than Individuals Diagnosed at Older Ages
From Stigma to Support: Changing the Cancer Conversation
Help Caregivers Control the Chronic Stress of Cancer Care and Manage PTSD
Moral Injury and Trauma in Nursing
Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress
When the Story Ends, Cancer Does Not Win: Reframing Death in Terminal Cancer Care
Word Choice Matters When Caring for Patients With Cancer
ONS course: ONS Psychosocial Dimensions of Cancer Care™ 
Clinical Journal of Oncology Nursing articles:
Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach
Trauma-Informed Care Addressing the Mental and Emotional Needs of Patients With Cancer
Oncology Nursing Forum articles:
Post-Traumatic Distress and Symptom Experience in Patients With Head and Neck Cancer–Related Tracheostomy and Family Caregivers
The Effect of Neuroticism, Fear of Progression, and Self-Efficacy on Post-Traumatic Growth in Patients With Lung Cancer Undergoing Chemotherapy
Reclaiming Your Life From Medical Trauma by James C. Jackson
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Many people have a notion about what medical trauma is, but perhaps they lack a definition. I use a definition that is deliberately broad because I think it is better to be inclusive than exclusive. A medical trauma to me is a medical experience or a medical encounter that basically leaves a mark. It leaves an emotional mark, and that mark is significant enough to disrupt your daily life." TS 2:06
"When somebody develops a life-threatening illness—let's say cancer—it's not their problem only. It's very much a family problem. It affects any manner of people. There is literature that says that family members of people with life-threatening conditions often have rates of PTSD that are every bit as high as the patients do. There's also literature that says that if we can identify this issue as a family problem—a family challenge, not just an individual challenge—then very often that patient is going to do better." TS 8:23
"We just need to make space for people to feel however they feel. And we need to emphasize, I think, that in some ways, even though there's no cancer on the scan, cancer casts a long shadow in the lives of people, which is why when patients after cancer see their primary care provider, when they come back for a checkup with oncology, we need to continue this conversation of 'How is your mental health? Are you okay? How's your anxiety? How are you managing?' … We need to be really curious and kind, and we need to query people about how they're doing, even if officially they don't have cancer." TS 16:20
"Trauma-informed care has become a bit of a buzzword in our culture. But when it is engaged correctly, I think it's really important. And I think in a nutshell, what it means is that as providers, we need to recognize that some situations and circumstances are likely to be traumatic, and we need to pivot and engage people differently now that we know that. Specific features of trauma-informed care might be we're really going to value your emotional safety. We're going to emphasize that. We are going to emphasize boundaries. We are going to ask your permission instead of telling you how to do things. We are going to be really attentive to the language we use to engage you because we're aware of there might be things about your situation that are really triggering." TS 28:15
"I think one [misconception] certainly is that it is only afflicting and affecting people who are frail or weak—not very strong. That's emphatically not true. But that's a popular misconception—that if I'm strong enough, if I'm resilient enough, this experience will not be traumatic to me. It's just not true. Medical trauma doesn't just happen in emotionally weak people. Medical trauma can impact people of all sorts." TS 33:42
"The other misconception, I think, is that there is no hope for people in the throes of medical trauma. I'm not advocating 'hopium,' It's a term that was coined, I think, during the pandemic. I don't think that living with medical trauma is all rainbows and unicorns and shiny things. But the truth is, if you get the treatment that you need, you can find a way to thrive with medical trauma even as you're impacted by medical trauma. This, this 'both-and-ness' is really true. You can both be adversely affected and you can even find some beauty in your struggle. Both can be true." TS 34:13
"I wish people understood that there is a name for this phenomenon. We're naming it here today medical trauma. Not everyone who has cancer has medical trauma—not even close—but there are many people who do. And I think many of those people, they don't quite have a name for it. And when I introduce this name for it—trauma—many of them say, 'Oh, my gosh, that makes so much sense. I didn't quite understand why I was struggling so much with this. I didn't quite understand why it casts such a long shadow in my life. I didn't really understand why I was having panic attacks every time I had to get another scan at the oncology office to see if my breast cancer had returned. Now I understand. Now I understand it's because it was trauma.'" TS 35:09

"We typically think of the disease progressing for our higher-risk patients because many of them already start with increased blasts or a lot of dysplasia. And they have these chromosomal variants that make them prone to evolving into acute myeloid leukemia (AML). With them, we can anticipate that they are going to progress to AML. And that's what we're trying to prevent. It's kind of like a biologic evolution and not a switch," ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term myelodysplastic syndrome (MDS) considerations for oncology nurses.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 19, 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 management of long-term side effects related to myelodysplastic syndrome and its treatment.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 415: Myelodysplastic Syndrome Treatment Considerations for Oncology Nurses
Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses
Episode 256: Cancer Symptom Management Basics: Hematologic Complications
Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis

Clinical Journal of Oncology Nursing articles:  Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia
Family Caregiver Preparedness: Developing an Educational Intervention for Symptom Management
Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery

Oncology Nursing Forum article: An Integrative Review of Sex Differences in Quality of Life and Symptoms Among Survivors of Hematologic Malignancies
ONS book: BMTCN® Certification Review Manual (second edition)
ONS course: Psychosocial Dimensions of Cancer Care™ 
ONS Learning Libraries:  Survivorship Learning Library
Hematology, Cellular Therapy, and Stem Cell Transplantation

Survivorship Care Plan Huddle Card
American Association of Colleges of Nursing End-of-Life Nursing Education Consortium (ELNEC)
American Cancer Society: Living As a Myelodysplastic Syndrome Survivor
American Society of Hematology
Aplastic Anemia and MDS International Foundation: MDS Toolkit
Blood Cancer United: Myelodysplastic Syndromes
Family Caregiver Alliance
HealthTree Foundation
Inspire: MDS Support and Discussion Community
Myelodysplastic Syndromes Foundation
To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"When our higher-risk patients have disease-related progression, their [malignancy] can transform to AML. And we know this occurs in about one-third of our patients and is one of the most serious late effects. Even in lower-risk disease, we have this worsening marrow failure with or without increasing blast, where [patients] may have just started out with anemia, then they also develop neutropenia and thrombocytopenia. And as those counts worsen, we usually know that their disease is progressing." TS 2:47
"The golden rule is looking at the blood count but also looking at the patient and how they're doing over time. The backbone of MDS monitoring is the complete blood cell count with the differential. What you're looking for is trends over time. How many units of blood are they receiving, what threshold are you going to transfuse them at, and how many units of blood are they getting at a time? ... And then paying attention to the absolute neutrophil count for infection risk. [Another] really important piece of when you look at the differential with patients is seeing if they have any abnormal cell counts. Do they have circulating blasts? Are those monocytes going up? If you start to see blasts circulating or increasing monocytes, then their disease could be changing, even if they have low-risk disease." TS 15:58
"For lower-risk disease, we're paying more attention to their quality of life, how the patient's tolerating therapy, trying to help them stay safe over the long haul, and starting them on iron chelation if it matches that patient and they can have access to those drugs. ... For higher-risk disease, if the patient's goal is to be cured and not to progress to AML, you want to get them to transplant if that's [also] one of their goals. If they do evolve into AML, try and see what treatment matches best for them." TS 22:28
"You want to start early for patients who have febrile neutropenia—that's really important when a patient is an hour or two away from a center where they can get started on antibiotics. So, you have to think outside the box. What can we do to keep them safe? ... I know this group in Alaska that's in our advisory meetings and they try to facilitate transportation to Seattle. That's the closest academic center to them. Collaborating with telemedicine appointments, starting earlier, developing that strong relationship with patients, and contacting them between visits [can help patients living in rural areas]." TS 25:22
"I think the biggest [psychosocial challenge] I see is a lot of unmet anxiety and depression counseling. A lot of times, [patients are] losing their place in their family because they're the ones that need all the help now. Also, the uncertainty that goes along with the diagnosis. There is communication skills counseling, and End-of-Life Nursing Education Consortium (ELNEC) has a lot of training for communication skills and how to really talk to patients. Not that we take the place of a psychologist, but just being able to talk to somebody can go a long way. And if we can get training for that, we can help more patients." TS 31:15

"Until immunomodulators, patients [with myeloma] did not have a great overall survival rate. But when we introduced lenalidomide, we started seeing our patients have life expectancies between five and seven years—which was unheard of prior to these immunomodulators going forward. I think it's promising and allows patients to have quality of life versus therapy of life," ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about immunomodulators.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 12, 2027. Daniel Verina is on the speakers' bureau for Johnson & Johnson, GlaxoSmithKline, and Pfizer. This financial relationship has been mitigated. 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 about the use of immunomodulators to treat cancer.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Pharmacology 101 series
Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses
Episode 386: Interprofessional Navigation and the Oral Anticancer Medication Care Compass
Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy

ONS Voice articles: Maintain Oral Adherence With ONS Guidelines™
Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations
Sexual Considerations for Patients With Cancer

Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles
Oncology Nursing Forum articles: Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study
Facilitators of Multiple Myeloma Treatment: A Qualitative Study

ONS book: Multiple Myeloma: A Textbook for Nurses (third edition)
ONS Symptom Intervention resource: Peripheral Neuropathy
Risk Evaluation and Mitigation Strategies (REMS) Lenalidomide
Pomalidomide
Thalidomide

International Myeloma Foundation: Using Immune Therapy to Fight Multiple Myeloma
International Myeloma Society
Multiple Myeloma Research Foundation: Treatments for Multiple Myeloma
To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"We definitely want the diagnosis of multiple myeloma before initiating these drugs. We're going to look at serum protein electrophoresis. We want to make sure that we know the patient has serum free light chains and myeloma proteins to really confirm their disease. Plus, a bone marrow biopsy." TS 7:21
"Each immunomodulator has slightly different side effects. Thalidomide's biggest side effects are constipation, weakness, fatigue, somnolence, peripheral neuropathy, mood swings, hand tremors, and depression. With each generation, less of the side effects actually occurred. Most of lenalidomide's side effects, not discounting the deep vein thrombosis, are pancytopenia—the neutropenia, the anemia, and the thrombocytopenia. [The side effects] are very similar in pomalidomide." TS 15:40
"The REMS program is critical for oral immunomodulator therapies—thalidomide, pomalidomide, and lenalidomide. It was developed due to the risk of developing embryofetal toxicities. ... It is mandatory testing and counseling, so all females of reproductive potential must have two negative pregnancy tests prior to starting the therapy and then monthly pregnancy tests while on the therapy alone. Again, they must use two forms of effective contraceptives or abstain from heterosexual sex four weeks prior, during, and after. And the same thing for men. I focus on that because males may say, 'I have a vasectomy.' These therapies tend to bind to the semen. So, males must still use a latex or synthetic condom during any sexual contact with a female of reproductive potential, even if they did have a vasectomy." TS 18:31
"The capsule itself cannot be chewed, crushed, or opened. I bring that up because as healthcare professionals, we have educated our patients. If it's difficult to swallow capsules or tablets, we've always said to them, 'Oh, don't worry, just crush it into applesauce or open it up and sprinkle it on your mashed potatoes.' But because of this embryofetal toxicity, I advise my patients not to open the capsule. If they can't swallow it for any reason, they have a sore throat or they're just unable to, then [we tell them] to hold the therapy and then call us." TS 22:49
"We spoke about three generations already, but there's actually a fourth generation [of immunomodulators]. They're called cereblon E3 ligase modulators(CELMoDs). They're still in clinical trials but really showing promise in the therapy of myeloma. They're showing very good affinity to cereblons, just like the immunomodulators do. I think, in all cancer therapies, as newer generations come out or newer therapies move forward, some of the older generations might move aside, but they get integrated later on. So I don't think [immunomodulators] will disappear totally, but they will probably be modified." TS 36:39

"Radiation therapy is often extremely well tolerated in colorectal cancer. Technology has really changed things. But location of the tumor can affect side effects, such as radiation dermatitis. If a patient has a low-lying tumor, if it's less than six centimeters from the anal verge, the patient is likely to have some skin reaction. It's good to be proactive if that's the case," ONS member Lorraine Drapek, DNP, FNP-BC, AOCNP®, nurse practitioner in the Department of Radiation Oncology at Massachusetts General Hospital in Boston, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radiation side effects in colorectal cancer. 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 June 5, 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 side effects of radiation to treat colorectal cancer.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Episode 374: Colorectal Cancer Treatment Considerations for Nurses
Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices
Episode 194: Sex Is a Component of Patient-Centered Care
ONS Voice articles:
Frank Conversations Enhance Sexual and Reproductive Health Support During Cancer
High-Fiber Diet Reduces Diarrhea in Colorectal Cancer Survivors
Hyperbaric Oxygen Therapy Shows Promise for Certain Radiation Side Effects
Increasing Incidence of Colorectal Cancer in Younger Adults Is a Call to Action for Oncology Nurses
Oncology Drug Reference Sheet: 5-Fluorouracil
Oncology Drug Reference Sheet: Oxaliplatin
Oncology Nurses Are Key in Sexual Health Conversations With Minority Women
Sexual Considerations for Patients With Cancer
The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management
ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)
ONS courses:
ONS/ONCC® Radiation Therapy Certificate™
ONS ROCN™ Certification Review™
Clinical Journal of Oncology Nursing articles:
Sexual Dysfunction: Common Side Effect
Updated Interventions for Radiation-Induced Diarrhea: Putting Evidence Into Practice With the Oncology Nursing Society
Physical Activity: A Systematic Review to Inform Nurse Recommendations During Treatment for Colorectal Cancer
ONS Learning Libraries:
Colorectal Cancer
Radiation
Advanced Practitioner Society for Hematology and Oncology
American Society for Radiation Oncology
American Society of Clinical Oncology Clinical Practice Guidelines
Colontown
Colorectal Cancer Alliance
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"In recent years, there has been more nonsurgical management of rectal cancer, especially in what we call the low-lying population. This is the population of patients who would likely end up with a permanent colostomy because their cancer is so low in terms of being close to or involving the anal verge. There is now a regimen where these patients can get their chemotherapy followed by their chemoradiation and then be monitored on close surveillance without surgery." TS 2:23
"Another assessment would be to assess what effects have they had from their chemotherapy that they're bringing with them. FOLFOX-based treatment is commonly used, and the platinum therapy oxaliplatin often causes peripheral neuropathy. What is the patient having? What are those symptoms like? Are they having peripheral neuropathy? If they are that is likely not going to get better or improve during their whole course of radiation. In fact, sometimes when oxaliplatin therapy stops, the peripheral neuropathy can get worse as patients are going through other treatments." TS 5:42
"If the patient has a low-lying tumor, if it's less than six centimeters from the anal verge, the patient is likely to have some skin reaction. It's good to be proactive if that's the case. And then proactively minimizing radiation dermatitis effects, such as keeping the area clean, good washing of the area, and prophylactically starting them on or having someone start them on steroid creams a couple of times a day to minimize that radiation dermatitis effect in the long run." TS 7:25
"I have a sexual health clinic for women with these effects. It's very important as nurses that if you can develop the comfort to ask patients about their sexual activity—it's hard, but it really needs to be done. And I will tell you that the healthcare providers are not doing it. They don't have time, and like us as nurses, we don't get this in school, and neither do they. The other providers don't get it in school either, but it's important. Patients are getting more and more worried about their sexual health. They're coming to us at a younger age, and this is really, really important to address." TS 15:35
"I would say that working with your advanced practice providers and education for advanced practice providers has definitely been focusing on [sexual health] more. Your PAs and your NPs—I think they're going to have the ears and the wherewithal to be able to be your allies and colleagues in this. By and large, it's my APP colleagues and nursing that I talk to the most about this. … Again, it's not an easy thing to bring forward, having dilators in place. But I will tell you in the department that I work in, it was me and couple of nurses who pushed this issue with the physicians for two years and finally got it put in place. It can be done. There's a lot more centers out there doing that." TS 21:51