The ONS Podcast

"Think about what organs lie in the radiation field, and anything that lies in that radiation field is likely going to have some potential temporary—hopefully temporary—side effects. If you think about the pelvis, the things that live in there are the bladder, urethra, some bowel, rectum, reproductive organs, skin, some lymph nodes. And so, all of those things could potentially have associated side effects," ONS member Kayla Kafka-Peterson, BSN, RN, ROCN™, nurse navigator and leader in the brachytherapy and peri-anesthesia programs at UCLA Health, in Los Angeles, CA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about radiation side effects in cancers of the pelvis.
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 17, 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 radiation to the pelvis.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Radiation Site-Specific Side Effects series
Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices
Episode 298: Radiation Oncology: Nursing's Essential Roles
ONS Voice articles:
Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education
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:
Nurse Navigation and Care During Brachytherapy for Cervical Cancer: 2025 ONS Bridge™ Session
ONS ROCN™ Certification Review™
ONS/ONCC® Radiation Therapy Certificate™
Clinical Journal of Oncology Nursing articles:
Updated Interventions for Radiation-Induced Diarrhea: Putting Evidence Into Practice With the Oncology Nursing Society
Genitourinary Distress: Common Side Effect
Sexual Dysfunction: Common Side Effect
Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers
Oncology Nursing Forum article: Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer
ONS Guidelines™ and Symptom Management Resources:
Radiodermatitis
Radiation-Induced Diarrhea
Brachytherapy Huddle Card
American Brachytherapy Society
American Society for Radiation Oncology (ASTRO)
European Society for Radiotherapy and Oncology (ESTRO)
GEC-ESTRO Committee
International Gynecologic Cancer Society
Nursing Certificate Program
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Brachytherapy is delivered two main ways. The most common is LDR and HDR. LDR stands for low-dose-rate radiation, which is the older type of brachytherapy, but it is still very much practiced today. And it is where we put radioactive seeds directly into the tumor or tumor resection bed, depending on what you're treating. And those pieces of radioactive material, such as iodine-125 or palladium-103, those will give off radiation over time and treat the area that they are in, and they will place more or less seeds into the tumor, depending on that patient's needs and their anatomy." TS 3:26
"The most common [side effect] for external beam is bladder irritation—cystitis. It can be some burning, some frequency, some urgency, and it can often mimic a UTI [urinary tract infection]. We also have to make sure our patients do not have a UTI. Most of the time they don't, but we don't want to miss that. Once a UTI has been ruled out, the mucosa in the bladder and the urethra, it has a very high cell turnover rate. And things with a high cellular turnover rate like mucosal linings, they respond to radiation very quickly. They also heal very quickly, but they start to break down quite quickly during radiation." TS 16:15
"For the bladder, some things that we can teach the patients … to keep their urinary system as comfortable as possible during treatment. We really encourage hydration because the more hydrated they are, the more diluted their urine will be and the less acidic it will be. As those tissues start to respond to the radiation, they will become, for lack of a better word, a little bit raw. And if you think of something acidic going on something that is raw, it's going to burn, and these patients do get burning. And so by promoting hydration, their urine becomes less acidic; it doesn't burn as much when they do urinate. And I find a lot of patients who are experiencing the urinary side effects, they don't want to drink because they're afraid to urinate. And it actually makes the burning worse because their urine gets ultra-concentrated." TS 22:29
"Anybody who has a vagina, who receives treatment to the pelvis—it doesn't matter if it's for vaginal cancer or if it's for bowel or rectal—if they have received radiation to the pelvis, they are at risk for vaginal stenosis and adhesions. And this, of course, can be more pronounced in patients who have a higher dose in the vagina or a larger surface volume of the vagina treated. But over time, that tissue, even long after radiation is done, will undergo late changes where they will have continued scar formation, and it starts to lose its elasticity and its functionality. And at times it can stick to itself, causing these adhesions." TS 28:15
"I think a common misconception is that you cannot safely work around radiation. That is something that I have heard a lot. In certain regions of the world, the nurses actually report that they have been having trouble getting good applicants because nobody wants to work in radiation because they think that you'll get radiated, that it's not safe. We've really tried to make radiation safety a big part of our teaching to show that actually, you can safely work around radiation with today's technology." TS 41:43

"When we think of drug interactions, specifically, the National Cancer Institute actually defines this as a change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods or when taken with certain medical conditions. Drug interactions may cause the drug to either be more or less effective or cause effects on the body that are not expected," Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about interaction pathways.
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), including 30 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by July 10, 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 related to drug interactions in oncology care.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Pharmacology 101 series
ONS Voice articles:
Are Your Patients Taking Herbs That May Interact With Their Cancer Drugs?
Pharmacogenomics Testing Helps to Ensure That Effective Therapy Is Safe Therapy
Use of Herbal Products Carries Risk for Drug Interactions, but Patient–Clinician Knowledge, Communication Remain Low
What the Research Says About Drug Interactions and Medical Cannabis
ONS books:
Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
ONS Huddle Cards:
DPYD Gene and DPD Enzyme
Pharmacogenomics
ONS Oral Anticancer Medication Toolkit
American Journal of Nursing articles:
Understanding Pharmacokinetics: Part1: Drug Absorption
Understanding Pharmacokinetics: Part 2: Drug Distribution
Understanding Pharmacokinetics: Part 3: Drug Metabolism
Understanding Pharmacokinetics: Part 4: Drug Elimination
Journal of Nuclear Medicine Technology articles:
Pharmacology, Part 1: Introduction to Pharmacology and Pharmacodynamics
Pharmacology, Part 2: Introduction to Pharmacokinetics
ClinPGx
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
"One of the most notable food interactions that interacts with many different medications is actually grapefruit or grapefruit juice. This is known to be a very strong CYP3A4 inhibitor. … A lot of medications are metabolized through the CYP3A4 pathway. By inhibiting the effect of these enzymes, that can actually increase and significantly increase the concentrations of these therapies. It's not an interaction that's just limited to grapefruit. I would say grapefruit being in the food interaction is kind of one of the most well-known, but it can also be seen with other foods as well, like pomegranate juice or a very specific type of orange called Seville oranges. And this is really just due to the presence of a substance called furanocoumarins." TS 6:12
"There have been a pretty large number of genes identified that are responsible for coding some of those common enzyme families that I had been discussing, some of those CYP450 enzymes, but other enzymes as well that are important for drug metabolism. Based on the type of gene, there could be some different categories where patients are normal metabolizers, intermediate metabolizers, or poor metabolizers. There are some other categories as well based on the type of gene we're looking at. And that can ultimately impact the way you are able to metabolize drugs." TS 15:56
"Another common [geneotypic variation] that we always think about in oncology is G6PD, where if someone has G6PD deficiency, these patients can be at greater risk of hemolytic anemias when receiving certain types of therapies. Dapsone and rasburicase are just a couple that have been associated with this risk." TS 17:50
"One of the big concerns is always polypharmacy. Our patients truly can be on a lot of medications. In the field that I work in, transplant, patients automatically from their transplant are on many, many different medications that can potentially predispose them to side effects. … But I think when it comes to the many drug interactions that may flag in these situations, we really have to look at the patient as a whole. Like, how long have these patients been on these therapies? Are they having side effects? Have they been on the combination for a very long time now? So I think that not just looking at the drug reference and seeing that there are like 10 different interactions flagged, but really assessing your patient as a whole can be very important—just because real-world practice, of course, is not black and white. It's often very gray, so it's just important to use clinical judgment in those scenarios." TS 26:10

"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