The ONS Podcast

"Patients often fear that when the treatment stops, the caring will stop as well. It is so important to remind the patients we're serving that we're not stopping the care. We're just changing our focus and prioritizing things differently. We're still treating pain, we're managing symptoms, and we're helping them achieve the goals that matter most to them. The care doesn't go away. In many ways, it becomes even more personalized and supportive," ONS member Julia Proshwitz, BSN, RN, OCN®, NPD–BC, clinical educator of inpatient and outpatient oncology services, infusion, and vascular access at Corewell Health in Saint Joseph, MI, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about reframing death in terminal 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 November 6, 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 caring for people with terminal cancer.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
Episode 257: Redefining the Bell: The Ethics of Hope for Oncology Nurses and Patients
Episode 251: Palliative Care Programs for Patients With Cancer
Episode 135: ELNEC Has Trained More Than One Million Nurses in End-of-Life Care

ONS Voice articles: By Fulfilling 49 Patient Wishes, One Unit Improves Both EOL Care and Healthcare Workers' Well-Being
Communication Is Essential to End-of-Life Choices
End-of-Life Care Helps Patients Pursue Purpose in the Presence of Pain
When the Story Ends, Cancer Does Not Win: Reframing Death in Terminal Cancer Care
Writing Condolence Cards Supports Nurses as Well as Deceased Patients' Families

Clinical Journal of Oncology Nursing articles: Clinical Oncology Nurse Best Practices: Palliative Care and End-of-Life Conversations
Elevating End-of-Life Care: Implementing General Inpatient Hospice Services on a Medical Oncology Unit
Enhancing Nurses' Comfort and Capability With End-of-Life Care for Patients With Cancer
Promoting End-of-Life Care and Healthcare Worker Well-Being: Implementing the 3 Wishes Project in an Oncology Intensive Care Unit

Oncology Nursing Forum article: Exploring Information Needs of Patients With Cancer and Family Caregivers: A Descriptive and Network Analysis of End-of-Life Inquiries
ONS Huddle Card: Palliative and Hospice Care 
Being Mortal by Atul Gawande
Center to Advance Palliative Care: Palliative Care in Cancer Care
End-of-Life Nursing Education Consortium: Resources
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
"Cancer isn't always something that people can overcome and it's not always with determination alone. There are many patients who can do everything right. They've showed up with incredible courage, they've never missed a treatment, and their cancer still progresses. When we only talk about cancer as a battle, we risk creating this idea that people win or lose based on effort, and that's just not how cancer works. Personally, I prefer following the patient's lead. If they see themselves as a fighter, I'll meet them there. And if they see it differently, that's okay too. ... If we look at cancer care as a tally mark of wins and losses, we lose the person and the experience. And it really should be about them." TS 2:06
"A lot of times, patients will ask nurses those difficult questions—the ones they don't want to ask anyone else. And sometimes it's because they trust us. Sometimes it's because the person sitting beside them after everyone else leaves the room has just given them that space to feel like they are having a private moment. And sometimes it's just because they feel vulnerable and really want to dig into that piece of discovery for their journey. As nurses, we're able to help translate some of those complex medical terms, but we're also there to listen. And sometimes listening is the most important thing we can do. There is truly so much power that can be discovered in silence and just being present with someone." TS 5:27
"I've learned that some of the most important questions have nothing to do with clinical jargon or medicine at all. Asking, 'What's most important to you right now?' 'What are you hoping for today or in the near future?' or 'What does a good day look like for you?'... Those questions can tell us so much more. It's like opening a book to their present story. This is a huge chapter in their life, and we really want to understand those components. ... That vulnerable nature of being able to just completely be a person with them and not just a clinician, is a huge part of how we can arrive for the patients we care for." TS 11:53
"I've found that at the end of life, most patients aren't talking about test results, scans, lab values, and the treatment they received. They're talking about those relationships and memories, finding forgiveness and joy, the legacy they're leaving behind, and really understanding the meaning of their life, their journey, how people have impacted them, and how they've impacted others. Cancer may always be part of their story, but it never has to be their whole story." TS 18:02
"Our goal is not simply to help people live longer. Our goal is to help people live well in oncology. ... I have learned over and over again that a person's life is not defined by their diagnosis, and it's certainly not defined by whether their cancer was cured. … As healthcare professionals, we may not always be able to change the outcome, but we can always influence the experience. We can help patients feel heard, respected, comforted, and valued. At the end of the day, I believe end-of-life care is really about honoring the person in front of us. When we do that well, we're not just caring for a patient. We're helping to preserve dignity, meaning, and humanity during one of life's most profound transitions. A successful cancer journey isn't always measured by survival. Sometimes it's measured by how well we help someone to live, love, and find meaning all the way to the end."  TS 25:18

"With the gene therapy itself, we collect the patient's own hematopoietic stem cells and modify them outside the body. The other approach is using a lentiviral therapy, which uses an inactivated virus to add a healthy gene, so the cells produce functional hemoglobin. While gene therapy looks a lot like an autologous stem cell transplant, the key difference is that the cells are genetically modified before they're returned to the patient," Tia T. Wheatley, DNP, RN, AGACNP-BC, TCTCN™, nurse practitioner in hematology and oncology at UCLA Health in Los Angeles, CA, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about gene therapies for sickle cell disease. Johnston also spoke to ONS member Michelle Cha, MS, BSN, RN, clinical research nurse at the Centers for Bleeding Disorders at Georgetown University Medical Center in Washington, DC, about gene therapy for hemophilia.
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 October 30, 2027. Michelle Cha reported financial relationships with HemaBiologics, Sanofi, Acumetis Global, and Bayer, as well as research funding from multiple organizations. These financial relationships have 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 related to gene therapy for noncancer indications.
Episode Notes
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Episode 433: Cancer Treatments for Noncancer Indications: Chemotherapy/Immunotherapy
Episode 416: Cancer Treatments for Noncancer Indications: Radiation
Episode 288: Pharmacology 101: Antimetabolites
Episode 286: Pharmacology 101: Alkylating Agents
Episode 208: How to Have Fertility Preservation Conversations With Your Patients
Episode 173: Oncology Nurses' Role in Stem Cell Transplants for Pediatric Sickle Cell Disease
ONS Voice articles:
Adherence to Recommended Oral Hygiene Can Help Prevent Oral Mucositis in Patients With Cancer
FDA Approves First Adenoviral Vector-Based Gene Therapy for High-Risk, BCG Unresponsive, Non–Muscle-Invasive Bladder Cancer
Fertility Preservation Protects Possibilities for Patients With Cancer
New NIH Program Aims to Increase Gene Therapies for Rare Diseases
Photobiomodulation Shines a New Light on Oral Mucositis Care
ONS book: Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition)
ONS course: ONS Hematopoietic Stem Cell Transplantation™
Clinical Journal of Oncology Nursing articles:
Gene Therapy for Sickle Cell Disease: No Donor, No Problem
Role of the Nurse Coordinator in Hemophilia Gene Therapy
ONS Huddle Cards:
Alkylating Agents
Antimetabolites
Fertility Preservation
Financial Toxicity
Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library
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
Wheatley: "When we talk about the evaluation process prior to the therapy, it's very similar in ways to an autologous stem cell transplant evaluation. We still assess things like heart function, liver function, lung and kidney function, along with considering the patient's sickle cell history, their infectious disease status, and their overall health going into it. I think two areas that are especially important during this time are discussions of fertility preservation and financial clearance. These patients will receive myeloablative chemotherapy, so reproductive risk needs to be evaluated and discussed early in the process. And because these treatments are extremely resource intensive, insurance coverage and financial resources need to be addressed before treatment begins." TS 3:43
Wheatley: "The actual infusion itself is very similar to what we're used to in transplant nursing when giving cryopreserved stem cells. In this case, though, we want to be very mindful that patient product verification is done. This is an absolutely critical step for patient safety because we've manufactured a product specifically for that patient. The infusion process itself—nurses and stem cell techs go through a very extensive process to ensure that the patient's identity matches their product before it's even thawed and infused. So that way, patients don't receive the wrong manufactured product." TS 10:26
Wheatley: "I think hair loss deserves particular attention because it can have significant personal and cultural meaning for some patients. I, myself, am a biracial woman with Black heritage, and I'm particularly sensitive to what this topic can mean for some patients of color. But I also think it's important that we as clinicians don't make assumptions. Having that conversation up front and asking patients what hair loss means to them, what concerns they may have, and discussing that possibility of alopecia early can help patients anticipate this change and can help reduce distress when it occurs." TS 18:48
Cha: "Hemophilia gene therapy uses an adeno-associated virus, or AAV, as a vector to deliver a non-hemophilia gene to the liver. The vector will target hepatic tissue in the liver, and the goal is that it will allow the body to start producing its own clotting factor, because in hemophilia someone will have a deficiency in circulating clotting factor. For hemophilia A that would be factor VIII, and for hemophilia B that would be factor IX. The goal is to increase endogenous clotting factor production, and that would reduce or potentially eliminate the need for routine clotting factor infusions, which some people may need to do based on the severity of their hemophilia." TS 21:54
Cha: "Access is a very important part of gene therapy because it is a very high-cost therapy. I believe the literature estimates that it cost approximately $2.9 million per patient. So insurance coverage kind of becomes extremely significant on whether or not someone can access this treatment. … I also think it's really important to acknowledge that there is a degree of privilege involved with accessing a high-cost therapy. So having appropriate insurance coverage and financial resources can influence someone and whether they're able to obtain treatment." TS 25:11
Cha: "I think the nurse coordinator plays a role across the entire treatment paradigm, regardless of the outcome and regardless of what the patient ends up deciding, whether they decide that gene therapy is for them or not. They, in the short term, will help coordinate a lot of treatment, follow-up insurance and access, identifying resources, and making sure that patients have the support and even transportation to infusion and follow-up appointments. Nurses can definitely help navigate that, as well as working with the social worker, who is also a part of the hemophilia treatment center." TS 34:15

"The question isn't simply, 'does this patient need their chemo or other cancer treatment or do they need rehabilitation?' It's often about how we can safely provide both of these things that they need. Don't assume that rehab means that cancer treatment needs to stop. The oncology and the rehabilitation teams can work with each other, especially if that starts early, and determine what we can safely coordinate," Grace Campbell, PhD, MSW, CRRN, FARN, adjunct assistant professor at the University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center in Pennsylvania, and immediate past president for the Association of Rehabilitation Nurses, told Katie Hubbard, MSN, RN, OCN®, NPD-BC, oncology clinical specialist at ONS, during a conversation about inpatient cancer rehabilitation.
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 October 23, 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 inpatient rehabilitation and its role in the care of people with cancer.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 318: Early Mobility for Hospitalized Patients
Episode 58: The Power of Cancer Rehabilitation

ONS Voice article: Cancer Rehabilitation Serves a Critical Role in Patient Care
Clinical Journal of Oncology Nursing articles: Examining Contributors to Intent to Continue Exercising in Patients With Cancer in Rehabilitation
Physical and Psychological Effects of a 12-Session Cancer Rehabilitation Exercise Program
The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise

American Cancer Society: Cancer Rehabilitation
Association of Rehabilitation Nurses resources:  Cancer Rehabilitation and the Role of the Rehabilitation Nurse: A White Paper by the Association of Rehabilitation Nurses
Learning Center
Position Statement: Rehabilitation of People With Cancer (endorsed by ONS)

Contemporary Issues in Cancer Rehabilitation article: A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes
ECOG: Performance Status Scale
Inpatient Rehab Versus Skilled Nursing Comparison
National Academies of Sciences, Engineering, and Medicine book: Diagnosing and Treating Adult Cancers and Associated Impairments
Rehabilitation Nursing Journal article: The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting
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 we talk about inpatient rehab, we're really talking about a level of rehabilitation designed for patients who have significant functional impairments, often in multiple areas of function, along with having medical, nursing, and rehabilitation needs that require an inpatient interdisciplinary environment for that sort of intensive, around-the-clock care. It's important to emphasize here that rehabilitation in general, and inpatient rehab in particular, is so much more than just getting stronger." TS 1:46
"Oncology nurses are in a great position here because as we know, nurses often see functional decline before anyone else does. These can be simple things, like she used to walk to the bathroom and now she needs a bedside commode; or he used to be able to transfer independently, and now it takes two people to get him out of bed. The patient is medically ready for discharge, but their spouse or partner can't physically get them into the house because of lower extremity muscle weakness and a full flight of steps to enter the home. Those are some really key rehab signals. Some other things to watch for include new difficulty with bathing or dressing, frequent falls or near falls, wheelchair dependance when they were not previously a wheelchair user, difficulty managing stairs, and new cognitive or safety concerns. These can be very subtle, but nurses can pick up on these as well as talk with the family or the patient's significant others." TS 12:41
"It's really important that we define success from the patient's perspective. What does the patient want to do? That is really the measure of success. Some patients just want to be able to walk to the bathroom by themselves. Some patients want to be able to get in and out of a car and even drive, if that's appropriate for them. Some patients may need to go back to work. How can we, in inpatient rehab, set them up to be able to go back to work?" TS 22:06
"Rather than saying to somebody, 'We're sending you to rehab because you're too sick to go home,' we can say something like, 'You've had a huge change in what you're able to do and we want to help you regain as much independence as possible while we continue your cancer care.' And while we haven't really talked about patients with advanced cancer who may be receiving palliative care, it's important to note that even these patients may benefit from a brief inpatient rehab admission ... particularly to provide in-depth evaluation for home equipment, and to provide family training on caring for this patient, permitting them to then go home if that's what they choose. You don't have to necessarily be able to get better to benefit from inpatient cancer rehab." TS 34:05
"Rehab should be considered as a part of cancer care, not something that simply happens when cancer treatment is over. It really should be an active part of the cancer care continuum. And the final thing that I would like to leave the audience with is a simple five question framework: What could the person do before cancer? What can they do now? What has changed and why? What do they need to be able to do? And what do they want to be able to do? If we ask those questions about every patient, we are much more likely to identify patients who could benefit from rehab and from any type of rehab—inpatient, outpatient, et cetera. I think this message for oncology nurses is particularly important. You don't have to be a rehabilitation expert, but you can be the person who recognizes that something has changed. You can ask the important questions. You can document what you see, and you could get the rehab team involved early." TS 46:49

"Biomarker testing isn't just about generating more information. It's about answering very practical questions for our patients. Can we identify disease earlier? Can we understand whether treatment is working? Are we able to identify why a cancer has become resistant? Ultimately, I think that's where precision oncology becomes very meaningful. It's not about the molecular report sitting in the chart. It's about taking that information and using it to make the best possible decision for our individual patients," ONS member Erica Bello Rodriguez, MSN, AGNP, NP-C, AOCNP®, oncology nurse practitioner and supervisor of advanced practice providers at Northwell Health Cancer Institute in Westchester, NY, told Katie Hubbard, MSN, RN, OCN®, NPD-BC, oncology clinical specialist at ONS, during a conversation about precision oncology.
This podcast episode was produced by ONS and is sponsored by AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.
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 contact hours.
ONS Podcast™ episodes: Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices
Episode 238: Cancer Genomics for Every Oncology Nurse
Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy
Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies

ONS Voice articles: An Oncology Nurse's Guide to Tumor-Agnostic Therapies
Gene Alterations in Circulating Tumor DNA Can Help Guide Treatment Decisions in Patients With Advanced Breast Cancer
Genetic Counselors Help Patients and Oncology Nurses Predict Current and Future Cancer Diagnoses
Germline and Somatic Variants: What Is the Difference?
Learn How to Read a Germline Genomic Testing Report
Learn How to Read a Somatic Biomarker Testing Report
Oncology Nurses' Role in Translating Biomarker Testing Results
Pharmacogenomics Testing Helps to Ensure That Effective Therapy Is Safe Therapy
The Oncology Nurse's Role in Identifying Patients for Cancer Genetics Counseling
What Is a Liquid Biopsy?

ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses
Clinical Journal of Oncology Nursing articles: Pharmacogenomic Germline Testing: Applications in Oncology Nursing
Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence
Shifting to a Biomarker Paradigm Across Cancer Care
Using a Genomics Taxonomy: Facilitating Patient Care Safety and Quality in the Era of Precision Oncology

ONS Huddle Cards: Genomic Biomarkers
Genomic Testing Methods
Pharmacogenomics
Referring for Germline Biomarker Testing

ONS Biomarker Guides
ONS Genomics and Precision Oncology Learning Library
ONS Genomics Taxonomy
American Cancer Society: Precision or Personalized Medicine
American Society of Clinical Oncology Publications: JCO Precision Oncology
National Cancer Institute: Cancer Genomics Research
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 most important developments since 2020 have really been broader than any single variant or drug. We've seen precision oncology evolve from simply identifying a genomic alteration to developing a much more comprehensive understanding of what is driving an individual's cancer and how we can act on that information. One major development has been the expansion and accessibility of comprehensive biomarker testing and next-generation sequencing. We're able to identify more of the molecular characteristics of a tumor, and those findings can increasingly help inform treatment decisions and clinical trial opportunities for our patients. We've also seen the continued evolution of tumor agnostic therapy, which represents a really important shift in how we think about cancer treatment." TS 3:52
"Nurses have become increasingly important as a translator and advocate. Genomic reports are incredibly complex, and patients don't necessarily understand terms such as 'pathogenic variant,' 'actionable biomarker,' or 'tumor agnostic therapy.' Nurses are often the people who have meaningful relationships with the patients, and they have to take that complex science, simplify it, and highlight it for them. ... The science is becoming more precise but the need for a nurse to make that science understandable and patient-centered is becoming even greater." TS 7:12
"I'm really excited about circulating tumor DNA, or ctDNA. For example, I think about a patient with stage III colon cancer who has completed treatment with curative intent. Her scans may look completely clear and clinically, she looks great, but we're beginning to use ctDNA to look for molecular residual disease. Essentially, we're trying to determine whether there may be microscopic disease present that we just can't see on imaging yet. For that patient, a positive ctDNA result could tell us that there may still be disease at a molecular level, even though the computed tomography (CT) scan looks normal to us. It also has the potential to help us monitor disease over time, understand treatment response, and identify emerging resistance. I think that's really exciting because historically, we thought about biomarkers more as a snapshot. With ctDNA, we're beginning to think about biomarkers as something we can follow longitudinally. I think it's important to acknowledge that we're still learning exactly when ctDNA results should change treatment, but the potential is enormous." TS 9:09
"We have incredible biomarker-driven treatments, but not every patient has equal access to comprehensive testing, genetic counseling, clinical trials, or the therapies a biomarker may identify. Access can vary based on geography, insurance coverage, the healthcare system, and many other external factors. So one of the challenges is making sure that precision oncology doesn't become something that's only available to patients who have the resources to navigate the system. We really need to work on helping those that don't have as much access." TS 18:14
"If I had to summarize where I think we're headed, I would say we're moving from precision oncology being a snapshot of a patient's cancer to something much more longitudinal. ... We're going to be better at understanding what's driving the cancer, how it's changing, how it's responding, and hopefully intervening earlier and more precisely. Ultimately, I think the goal is to not just give more information, but to provide better decisions and better outcomes for our patients." TS 24:36

"The most important thing related to hypersensitivity reactions is that there is often a potential for rapid progression, and that's what makes these reactions an oncologic emergency. The patients may have symptoms that are mild, and that quickly can progress to respiratory compromise, hypertension, cardiovascular issues, or anaphylaxis. Early recognition is so important, so we don't want to wait for our patient to become hypotensive or significantly hypoxic before we identify that they're having a serious reaction," ONS member Christina Matousek, DNP, RN, OCN®, patient education specialist at Smilow Cancer Hospital in New Haven, CT, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about hypersensitivity reactions.
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 October 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 managing hypersensitivity reactions in people receiving antineoplastic therapies.
Episode Notes 
Complete this evaluation for free NCPD.
ONS Podcast™ episodes:
Oncologic Emergencies 101 series
Episode 395: Pharmacology 101: Monoclonal Antibodies
Episode 299: Pharmacology 101: Plant Alkaloids
Episode 286: Pharmacology 101: Alkylating Agents
Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction
ONS Voice articles:
Master Hypersensitivity Reactions With These Strategies for Prevention and Management
Nurses Have Immediate Access to Necessary Medications and Supplies With Hypersensitivity Reaction Kits
Oncology Drug Reference Sheet: Carboplatin
Oncology Drug Reference Sheet: Docetaxel
Oncology Drug Reference Sheet: Paclitaxel
ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging
Course: ONS Oncologic Emergencies™
Clinical Journal of Oncology Nursing articles:
Early Recognition and Response of Chemotherapy-Induced Hypersensitivity Reactions: A Nursing Discussion
Prophylactic Protocol for Carboplatin Hypersensitivity in High-Risk Patients With Gynecologic Cancer
How Do Oncology Nurses Feel During a Hypersensitivity Reaction?
ONS Oncologic Emergencies Learning Library
ONS Huddle Card: Anaphylaxis
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
"Traditionally, hypersensitivity reactions are divided into four different types. Type 1 are reactions that are immediate, which are often IgE mediated and are the reactions we tend to worry most about during an infusion because they can lead to anaphylaxis. Our types 2, 3, and 4 involve different immune mechanisms and may have a more delayed presentation. But clinically, when an oncology nurse has a patient receiving an infusion and the patient suddenly says something doesn't feel right, our first priority isn't necessarily identifying the exact immunologic mechanism. It's recognizing the reaction, stopping or pausing the agent according to one's institutional protocol, assessing our patient, and then determining how severe the reaction is." TS 2:08
"The first step always, always, always is to stop or pause the infusion according to the medication and institutional protocol, and then you're immediately assessing the patient. The patient may say to you, 'I have an itchy throat.' And while they're stating that, I'm going over and shutting off the pump immediately. Treatment after that really depends on the severity of symptoms. So when the nurse is doing their assessment, they're going to be assessing, of course, airway, breathing, circulation, so our ABCs. They're going to be obtaining vital signs. They're going to get an O2 saturation. Stay with the patient, of course. Call for assistance. And then notify the appropriate provider and activate any institutional hypersensitivity protocol." TS 6:44
"For patients who still need a medication that caused a reaction, there are desensitization protocols that may sometimes allow the medication to be administered safely. These protocols use carefully controlled, progressively increasing doses, but it does require specialized monitoring and collaboration with oncology, pharmacy, and allergy specialists to ensure that the patient receives the medication safely. The most important thing is that a rechallenge should never be an automatic decision, and it really should be based on the patient's individual risk–benefit assessment and an established protocol within the institution itself." TS 11:50
"I think that this is an area where simulation and competency-based education are incredibly valuable. I know at my institution, we train all of our nurses on giving chemotherapy after they take the ONS chemotherapy immunotherapy course. We actually have our own chemotherapy skills day, and we do a simulation on hypersensitivity reactions. I think it's one thing to read a hypersensitivity protocol. I can give anyone an algorithm and tell them to read it and memorize it. But I think it's another thing to have a patient suddenly become short of breath or hypotensive when you're administering chemotherapy. The nurses really need opportunities in a safe space to practice recognizing symptoms, grading the severity of the reaction, activating the appropriate response, and locating and administering emergency medications." TS 17:27
"I think we don't talk about the psychological trauma that can happen of having a reaction to these types of drugs. For instance, someone has cancer; they're coming in for a medication that you know that they need. And suddenly they feel that they can't breathe, and they're watching the entire healthcare team rush into their room. Even when the reaction is managed successfully, the patient remembers that. So when they come in for their next infusion, they're not just receiving chemotherapy. They may be thinking, 'Is this going to happen again?' And so that's why I think oncology nursing really matters. We can explain what happened, what we're changing, what we're going to do to prevent this from happening in the future, and what we're going to do if symptoms occur again." TS 22:33