The ONS Podcast

"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

"There are a lot of specifics that nurses need to keep in mind as they are administering this herpes simplex modified virus to patients because accidental exposure is of concern both to the patient, to their family members, as well as to healthcare workers. I always recommend nurses wear personal protective equipment, such as a gown, safety glasses, gloves, and/or a face shield," Heidi Finnes, PharmD, RPh, BCOP, director of clinical ambulatory practice at Mayo Clinic and assistant professor of pharmacy at Mayo Clinic Alix School of Medicine in Rochester, MN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about oncolytic viral therapy. 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 May 29, 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 about the use of oncolytic viruses to treat cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 338: High-Volume Subcutaneous Injections: The Oncology Nurse's Role Episode 330: Stay Up to Date on Safe Handling of Hazardous Drugs Episode 273: Updates in Chemotherapy and Immunotherapy ONS Voice articles: Cutaneous Malignancies Have High Response to Oncolytic Virus Plus Immunotherapy Oncolytic Virus Kills Tumor Cells While Supporting T Cells What Nurses Need to Know About Talimogene Laherparepvec for Advanced Melanoma Clinical Journal of Oncology Nursing articles: Intralesional Therapy: Consensus Statements for Best Practices in Administration From the Melanoma Nursing Initiative Safe and Effective Standards of Care: Supporting the Administration of T-VEC for Patients With Advanced Melanoma in the Outpatient Oncology Setting Oncology Nursing Forum article: Administration and Handling of Talimogene Laherparepvec: An Intralesional Oncolytic Immunotherapy for Melanoma ONS book: Guide to Cancer Immunotherapy (second edition) ONS clinical practice resource: Safe Handling of Oncolytic Viruses ONS Huddle Card: Immunotherapy Association of Community Cancer Centers (ACCC) Drugs@FDA Hematology/Oncology Pharmacy Association (HOPA) Network for Collaborative Oncology Development and Advancement (NCODA) Patient Education Sheets 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 "[Oncolytic viruses] can have direct lysis to the tumor cells themselves, or they can cause immunogenic activation. They release tumor-associated antigens and then proinflammatory signals, so think of T cells, natural killer cells, those sorts of things, that can convert to immunologically cold tumors. Those are tumors that are immune silenced into hot tumors which are now immune activated. By doing that, they recruit those T cells and other cells to the area to attack both the primary tumors. But that's also thought to be how they work on distant or noninjected sites as well. This immunomodulatory capacity has led to the reclassification of oncolytic viruses as a form of cancer immunotherapy. So, think of it kind of similarly to how we think of immune checkpoint inhibitors in recruiting immune cells and leaving our immune system in the on position. This is also kind of a form of immunotherapy." TS 4:35 "One of the toxicities I know that is of significant concern to patients, family members, and healthcare workers is the incidence of herpes infections. Systemic herpetic infections are extremely rare and usually more common in patients who may be immunocompromised. In patients who also have other immune-related diseases—such as vitiligo, vasculitis, pneumonitis, sometimes worsening psoriasis—because you're mounting an immune response with these types of things, sometimes you can see a worsening of those types of immune symptoms. But for the most part, these types of side effects are very well tolerated in most patients." TS 9:07 "Talimogene is generally transmitted via bodily fluids or touch. It's not airborne. Herpes simplex virus isn't an airborne type of virus. Another thing to consider is where are you going to inject this? Are you going to do this in your infusion therapy unit? Are you going to do it in a dedicated room? Who's going to escort the patient to the room? How is the virus going to arrive at the room? How will you clean the room and all of the laboratory equipment or any of the exam tables that may be in there? I think having all of that discussed and assigned mitigates the consternation that can sometimes occur—the fear that occurs with administering a virus that is thought to be fairly communicable." TS 15:44 "Helping patients understand how this works [is important] because hearing that you're receiving a virus, particularly a herpes simplex virus, can be scary to a patient. I think understanding that it's modified or essentially we're taking the parts out of it so that we can directly inject a portion that recruits immune cells to that area, because the goal is for the oncolytic virus to attack cancer cells and then destroy them by triggering an immune response in the body." TS 20:51 "Sometimes patients are very concerned about urine in the toilet, bodily fluids, kissing loved ones, holding hands, hugging, you know, am I going to infect my loved one because I'm getting this type of an oncolytic virus therapy? I like to reassure patients that they can continue to hold hands and hug their loved ones as normal. Viral DNA is usually only present on the injection site. And as I mentioned previously, we want to cover that injection site with an occlusive dressing, at least with talimogene, for up to seven days. And particularly, if those injection sites are at all oozing or weeping, active virus is usually only on that injection site itself." TS 24:14

"We want to make sure that we discuss the details of the treatment and what treatments there are, whether it's an oral drug, whether it's a subcutaneous injection or an IV injection, [the patient's] potential for responding, whether this treatment is curative or supportive, and what the number of visits are. All of those different pieces of information that go into the decision-making process are really important," 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 myelodysplastic syndrome (MDS) treatment considerations. 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 May 15, 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 about the treatment considerations for MDS. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses Episode 256: Cancer Symptom Management Basics: Hematologic Complications ONS Voice articles: FDA Approves Luspatercept-Aamt for Anemia in Adults With MDS Infection Prevention for Oncology Nurses Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents Whole-Genome Sequencing May Guide Treatment Choices for AML and MDS Clinical Journal of Oncology Nursing articles: Reducing Effects of Hospital-Associated Deconditioning in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation Resilience in Older Adults Diagnosed With Cancer and Receiving Chemotherapy Targeted Drug Therapies: Beyond Blood Counts and Chemistries Oncology Nursing Forum article: Frailty in Patients With Hematologic Malignancies and Those Undergoing Transplantation: A Scoping Review ONS books: BMTCN™ Certification Review Manual (second edition) Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition) ONS course: Hematopoietic Stem Cell Transplantation™ ONS Learning Library: Hematology, Cellular Therapy, and Stem Cell Transplantation ONS Symptom Intervention resources: Prevention of Infection: General Prevention of Infection: Transplant Aplastic Anemia and MDS International Foundation: MDS Drugs and Treatments Blood Cancer United: MDS Treatment HealthTree Foundation 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 "The goals that I try to consolidate to make sure they're consistent with the patient's goals are to improve their counts, especially the anemia or cytopenias. If they're getting blood transfusions, we want to reduce the number of transfusions that they receive because we know that's linked to reduced overall survival, and it really impacts quality of life. ... And then for high-risk patients, it's a more serious discussion because we know that they are the ones who can progress to acute myeloid leukemia (AML). And we're trying to delay progression to AML. That means we're trying to improve their survival and we're also trying to manage their cytopenias and decrease their infection risk." TS 2:28 "If we look at approvals for low-risk disease and high-risk disease, those were really made based on the Revised International Prognostic Scoring System (IPSS-R) and sometimes the International Prognostic Scoring System (IPSS). Under those classification systems, when we think of lower-risk MDS, we think of patients who are primarily anemic but don't have increased blasts in their bone marrow. ... For higher-risk MDS, we want to have that discussion with those patients because their life expectancy is much shorter than patients with lower-risk MDS. We want to see if hematopoietic stem cell transplant would be something that they would be interested in if they don't have a lot of comorbidities and are relatively healthy." TS 11:41 "There are a lot of things to consider—[patients'] blood counts, comorbidities, whether they're frail, and what their goals are. There are some patients where there's no way they would want to go through transplant. And some patients want to be cured, so it just depends on your patient." TS 14:22 "I think of hematopoietic allogeneic transplants as a treatment for more of the patients with higher-risk MDS. ... With the Molecular International Prognostic Scoring System (IPSS-M), a patient can have pretty good blood counts and not have increased blasts in the bone marrow. You could send them for a transplant referral upfront without having to give them additional treatment. ... There is a recent publication that said if a patient doesn't have more than 10% blast, you could refer to transplant as a first option. ... Also, if you had a lower-risk patient who is relatively young and doesn't have any other treatment options, this would also be a patient that you could refer to transplant to see if we could care for them, and then they wouldn't have to be getting transfused all the time." TS 21:12 "I think that we often think low-risk, no treatment needed, but it depends on the person. They often need ongoing supportive care to manage their symptoms even if they're not getting treatment. And just because we're not treating them, active observation, bringing them in to see how they're doing, if they've had infections, if their blood counts are changing, that is paying attention to them and doing something. Just because they're low-risk doesn't mean they don't need anything and we can just schedule for a one-year follow-up." TS 26:30

"We thought, from a nursing standpoint, 'What is our goal for doing this?' What we wanted was first, education of the patient. Can we successfully educate the patient to prepare them? Can we alleviate as much anxiety as possible so that they feel comfortable coming in and having this done? The second goal is to preserve kidney function throughout the treatment. To date, we've been successful with that. And the third goal is to complete treatment without infection," ONS member Chris Amoroso, BSN, RN, OCN®, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about intrarenal administration for upper urothelial tract disease. 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 May 1, 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: Nurses caring for people with cancer require knowledge of the different routes for drug administration, including intrarenal administration via a percutaneous nephrostomy. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 141: Care Coordination for Urothelial Cancer Episode 133: Treatment Advancements for Advanced or Metastatic Urothelial Cancer ONS Voice articles: A Primer on Urothelial Cancer Chemo Combo May Be a Bladder Cancer Treatment Alternative During BCG Shortage Nurses Are Key to Patients Navigating Genitourinary Cancers Clinical Journal of Oncology Nursing articles: Avelumab First-Line Maintenance Therapy: Managing Patients With Advanced Urothelial Carcinoma Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma ONS Learning Libraries: Cancer of the Genitourinary Tract Safe Handling of Hazardous Drugs 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 an office setting, it's not something we can really visualize. Patients will present with hematuria or flank pain, obstructions in the ureter, some hydronephrosis, they may be having a lot of urinary tract infections. And a routine cystoscopy in the office is not going to visualize the ureters. We can do biopsies like a ureteroscopy, a computerized tomography urogram, or a urine cytology. And those are usually the main ways of diagnosing upper tract disease—again, because it's rare." TS 2:33 "We ask patients to get into a comfortable position where they can sit or lay for an hour without too much movement. The movement of their body position can interfere with the flow of the medication going in. ... When we're ready to start, we're cleaning the ends of the nephrostomy tube and the IV tubing with a chlorhexidine solution. We're instilling this using micro drip tubing. The tubing has to be microchipped so we can accurately control the flow. The IV bag with medication is hung about 10 inches above kidney level. And the reason we do that is because we do not want to increase the intrarenal pressure. ... We want a slow infusion via gravity over about an hour. We're watching throughout the procedure to make sure that there's no leakage, no discomfort, really just watching the patient and having that communication with the patient. Are they feeling anything different? Do we notice a difference in the flow rate? Is it slowing down? And if so, why is it? Did the patient change position? If we have any [instance] where the patient says, 'I can feel something there,' or we see leakage, we stop that infusion immediately, emphasizing that it has to be gravity, never on a pump." TS 7:30 "We go over all the bacillus Calmette-Guérin (BCG) precautions because this is the drug that we're giving. As if we were doing traditional intravesical therapy such as placing a catheter up into the bladder, we're still giving patients BCG. So, we need them to follow the special precautions. We ask every patient, regardless of the drug we're giving them, to sit down to urinate, pour two cups of bleach in the toilet, let it sit for about 15 minutes, then close the lid and flush twice. Even though we're giving this for upper tract disease, it's still being excreted into the urine. So, precautions need to be followed. Sitting down to urinate to avoid splashing of the drug, putting the two cups of bleach in every time they urinate for a duration of six hours, closing the lid, and then flushing that toilet twice. The same precautions, whether it's traditional intravesical or intrarenal." TS 14:20 "The induction phase is the first six installations. So, the first time we give this drug, we're doing it once a week for six weeks. And during those six weeks, we're communicating with the patient. We'll do a follow-up phone call and ask, 'How are you feeling? Any issues?' And we do get to know our patients really well. ... If they call, we're going to send them for a urine culture and make sure there's nothing there. ... After those six weeks, we make sure the patient understands that this is not one course and done. We want to continue to do this to give them the best chance at preventing recurrence. After we've done those six, we'll wait about four to six weeks, and then we'll do a cystoscopy and ureteroscopy in the operating room to make sure we have the response we're looking for. Again, letting the patients know because sometimes they don't understand that this is going to continue—it's not six treatments and done." TS 23:08 "You can't think of this as the same as bladder cancer. This is in the upper tract. We can't approach it as if it was non-muscular invasive bladder cancer. The diagnosis is different. It's harder to diagnose. Again, we're not visualizing the ureters in a routine office cystoscopy. ... You can't resect it out. When I was talking to our surgeon, he said, 'You can't resect the urothelial disease in the ureters like you would in a bladder tumor.' You can't go and just pick it apart. It's a little bit more complex than that. You can't go in and resect out lesions in the ureter itself." TS 36:20

"Not every patient with myelodysplastic syndrome (MDS) is going to progress and die. Only 10%–20% of them will evolve into acute myeloid leukemia. And not all of them need blood transfusions. Some present with low platelet count. It's not just people who are anemic that have MDS—it's different depending on what type of MDS they have. These are averages. We're giving you statistics based on averages, and you're an individual, so we want to treat you as an individual," 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 myelodysplastic syndrome. 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 April 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: Nurses caring for people with myelodysplastic syndrome require knowledge of its pathophysiology, the presenting symptoms, and its diagnosis. 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 302: Patient Navigation Eliminates Disparities in Cancer Care Episode 256: Cancer Symptom Management Basics: Hematologic Complications ONS Voice articles: Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents Whole-Genome Sequencing May Guide Treatment Choices for AML and MDS Clinical Journal of Oncology Nursing articles: Deciphering TP53 Mosaic Variants on Germline Biomarker Testing: Implications for Oncology Nurses Myeloid Malignancies: Recognizing the Risk of Germline Predisposition and Supporting Patients and Families Oncology Nursing Forum article: Impact of a Hematologic Malignancy Diagnosis and Treatment on Patients and Their Family Caregivers ONS book: BMTCN™ Certification Review Manual (second edition) ONS Clinical Practice resource: Genomics Taxonomy Genomics and Precision Oncology Learning Library American Cancer Society: Myelodysplastic Syndrome Prognostic Scores Aplastic Anemia and MDS International Foundation Blood Cancer United: MDS Diagnosis HealthTree Foundation Myelodysplastic Syndromes Foundation: What Is MDS? 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 the bone marrow maturation process, you have a pluripotent stem cell. You have myeloid and lymphoid, and then on the myeloid side, you make your white blood cells, your red blood cells, and your platelets. And during that maturation process, there's this problem that arises. It's called a clonal variation. Or something goes wrong as the cells go through that process year after year. It's called ineffective hematopoiesis. ... That process of becoming mature, functioning cells, arising from that hematopoietic stem cell is broken, and this leads to low blood counts. Usually, it's anemia, so the hemoglobin is low. You can see that the mean corpuscular volume (MCV) is really high, and those are clues that a patient might have MDS—anemia with a high MCV." TS 3:05 "The International Prognostic Scoring System (IPSS) was the first way that we staged MDS into lower-risk and higher-risk disease. Now we have the IPSS-R, which is the revised system. And that was intended to be a way of classifying patients into lower-risk or higher-risk disease, where we talked about the goals being different. And it's really looking at the depth of the cytopenias, so how low are those neutrophils? How low is the hemoglobin and the platelet level? What percentage of blast does the patient have in their bone marrow? [This] gauges whether they have lower-risk or higher-risk disease. And now that we have the Molecular International Prognostic Scoring System (IPSS-M), we also take into account the variants that a patient has and that can really change whether you think they have lower-risk or higher-risk disease." TS 8:46 "During a person's lifetime, if they were a heavy smoker, we always think of lung cancer, but it can actually predispose a person to MDS. If they worked heavily in chemicals. I can remember more than one patient who worked for pesticide companies. Repeated exposure to these things that can affect our blood cells cumulatively, they can make a person more prone to MDS. Also, patients who have family members who have had bone marrow problems." TS 13:39 "The way I explain it to patients who say, 'What does dysplasia mean?' I say, 'Well, if you had a picture of a face. If the cell has too many eyes, or one eye above the other or below the other, or too many ears, or they're just disfigured. They don't look right and they don't mature normally.' And so, the descriptions I frequently see are nuclear budding and micromegakaryocytes. Once you read a lot of the reports, you start to pick out, 'Okay, these are the terms that go along with dysplastic red blood cells or dysplastic megakaryocytes,' which are your precursors to platelets." TS 21:28 "The cytogenetics and the variants—that's a hard concept to explain to patients. And staying current on how we understand the disease and how it evolves. Now we have pre-MDS states called clonal cytopenia of undetermined significance. That was new to me. And then clonal hematopoiesis of indeterminate significance. And some of those clones have other healthcare problems that go along with them." TS 30:52

"Interventional oncology has really evolved into an important component of modern cancer care and is often described now as the fourth pillar alongside medical, surgical, and radiation oncology. The specialty now encompasses a broad spectrum of image-guided procedures that support from cancer diagnosis, treatment, to effectively managing symptoms that are caused by the disease. In other words, what we're seeing is that across the continuum of care, IO is playing a vital role," ONS member Evelyn P. Wempe, DNP, MBA, APRN, ACNP-BC, AOCNP®, CRN, NEA-BC, executive director for advanced practice providers for the oncology service line at the University of Miami Sylvester Comprehensive Cancer Center in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about interventional oncology. 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 April 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 an increase in knowledge related to interventional oncology as a treatment modality for cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 347: Care Considerations for Radiopharmaceuticals and Theranostics in Patients With Cancer Episode 285: Transarterial Chemoembolization: The Oncology Nurse's Role ONS Voice articles: Advancements in Interventional Oncology Ease Pain and Limit Opioid Use Build Your Confidence in Understanding Vascular IO Procedures From Heat to Cold to Electrical Pulses, Here's How Percutaneous IO Can Preserve Life and Function Interventional Oncology Is an Evolving Subspecialty for Oncology Nurses Clinical Journal of Oncology Nursing articles: Interventional Oncology (December 2025 supplement) Expanding the Scope: The Emergence of Interventional Oncology Nursing The Evolution of Interventional Oncology and the Specialized Role of Oncology Nursing Interventional Oncology Learning Library Interventional Oncology Huddle Card Society of Interventional Oncology Association for Radiologic and Imaging Nursing Society of Interventional Radiology: Cancer resources RadiologyInfo.org (Radiological Society of North America) 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 the 1990s, tumor-focused procedures such as embolization and ablation began to emerge, marking a shift toward oncologic applications. The 2000s saw rapid technologic advancements that expanded the scope and volume of oncology-directed interventions, including vascular access device placement, liver-directed transcatheter therapies for tumor control, and more sophisticated ablation modalities. Today, interventional oncology, or IO, extends beyond procedural work, encompassing comprehensive clinical care through dedicated IO clinics that support patient consultations, treatment planning, and postprocedure follow-up." TS 1:50 "In the immediate postprocedure phase, the IO nurse plays a critical role in patient safety in education, and oftentimes it may not be the same nurse that's caring for the patient in the procedural environment versus the postprocedural environment. But the role is really about continuous need to assess the patient's comfort level, to ensure that there is hemodynamic stability of the patient while closely monitoring for complications such as bleeding at the access site—of course, depending on the procedure—if there's any hematoma formation or changes in vital signs, or if there's any pain that needs to be addressed. Most importantly is maintaining patient safety in that immediate phase after the procedure." TS 8:07 "Before an IO procedure, both teams really must review the patient's clinical status. There has to be a clear understanding of: Is this patient ready to undergo a procedure? Is there any necessary imaging that needs to be done, as well as laboratory review and any systemic treatments, that may affect procedural planning? And oftentimes, in my experience, really, the oncology nurses are the ones really speaking with each other based on what the decision has been from both teams working together and communicating this to the patient." TS 13:49 "I think the oncology nurse needs to assess the patient's baseline understanding of interventional oncology. I often began my visits with a simple, open-ended question, 'Tell me why you're here today.' This allowed me to gauge their knowledge of the specialty and the purpose of the visit with the IO team. And in many cases, patients were unfamiliar with interventional oncology, which meant education needed to start with an explanation of what IO is and how it fits into their cancer care journey. Once that foundation was established, I was then able to introduce information about the specific procedure and its role in their overall treatment plan. And we can work together to establish goals of care and health. Having this approach ensured patients were informed, engaged, and better prepared for the procedure ahead." TS 16:06 "As nurses explore career options, interventional oncology is definitely one to consider. It really unites technology and innovation, and I think that's where we're heading with health care, with so much advancement in research and science. There's definitely a place for oncology nurses in this space, and it would be great to see that continue to flourish." TS 24:23

"You want to try to act quickly and be able to know what the pathways are for appropriate escalating when a patient is having symptoms that are reflective of cytokine release syndrome (CRS) or neurotoxicity. These toxicities are very manageable and treatable when recognized early. To summarize, choosing the right patient, knowing the toxicity profile for each product, and acting early is really what helps to prevent severe outcomes with chimeric antigen receptor (CAR) T-cell therapy," Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center 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 CAR T-cell immunotherapy. 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 March 20, 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 CAR T-Cell immunotherapy in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 267: Side-Effect Management for CAR T-Cell Therapy for Hematologic Malignancies Episode 261: CAR T-Cell Therapy for Hematologic Malignancies Requires Education and Navigation Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome ONS Voice articles: A Body of Evidence Helps Nurses Manage CAR T-Cell Therapy Toxicities CAR T-Cell Therapy Programs Oncology Clinical Social Workers Add Layers of Support for Patients and Families During CAR T-Cell Therapy Studies Show Best Practices to Manage CAR T-Cell Therapies' irAEs and Improve Outcomes ONS Voice oncology drug reference sheet: Lisocabtagene Maraleucel Clinical Journal of Oncology Nursing articles: CAR T-Cell Therapy for Relapsed/Refractory Aggressive Large B-Cell Lymphoma CAR T-Cell Therapy: Updates in Nursing Management Nursing Considerations in Navigating Patients Receiving CAR T-Cell Therapy ONS book: Guide to Cancer Immunotherapy (second edition) ONS Huddle Cards: Chimeric Antigen Receptor T-Cell Therapy Cytokine Release Syndrome Immune Effector Cell–Associated Neurotoxicity Syndrome Immunotherapy Immuno-Oncology Learning Library American Society of Gene and Cell Therapy: Learning Center American Society for Transplantation and Cellular Therapy: Learning Center National Comprehensive Cancer Network home page To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "CAR T-cell therapy combines an adoptive cell transfer with genetic engineering. And what that really means is that we are harvesting a patient's own T cells and then we engineer them with a synthetic receptor that helps them recognize that cancer. And all of this work has evolved through many decades of stepwise advances in how we design and activate the T cells. That led us to several landmark trials and ultimately the first CAR T-cell therapy approved by the U.S. Food and Drug Administration in 2017, which was tisagenlecleucel for pediatric and young adult patients that had acute lymphoblastic leukemia." TS 3:34 "If a patient has higher disease burden or an inflammatory biology, that does tend to correlate with higher toxicity risk. And then that might influence the way we monitor the patients who are getting the CAR T therapy. And then finally, baseline neurologic examinations, because neurotoxicity can occur with these agents. It's very important that we as a whole healthcare team really understand what the patient looks like at baseline to be able to determine if they're having any altered changes or confusion. If I had to summarize it, we want to confirm the target and make sure that we have the right CAR T product for the patient. We want to confirm that the patient, physiologically and mentally, is ready for the CAR T therapy." TS 10:53 "I think the two [toxicities] that every nurse will hear about almost immediately when talking about CAR T therapy are CRS or ICANS, which stands for immune effector cell–associated neurotoxicity syndrome. ... ICANS can either follow or even occur alongside CRS. And this can present as something as simple as just being slightly confused or altered, leading into progressively more severe elements such as word-finding difficulties, tremors, or changes in handwriting. Or even more severe cases that lead to seizures or decreased levels of consciousness. So, in this setting, neurologic assessments and knowing and understanding what your patient's baseline neurologic status is is so important. Those are really the two largest side effects that cross the board when it comes to CAR T therapies." TS 16:02 "In terms of the more practical aspects of administration, this is not a typical medication infusion. CAR T cells are living cells. So the way they are handled and administered is very specific. The majority of CAR T products are given as a single IV infusion. The cells come to us frozen either from a cellular lab or they will come from the pharmacy department. So those cells are typically thawed, and timing is of the essence. You really need to coordinate the timing of [thawing] to when they get infused to your patient. They tend to have a short shelf life once they're not frozen anymore." TS 26:34 "Now that therapy has, in many places, transitioned to be administered in the outpatient setting, education becomes absolutely critical. The patient is coming for their daily visit to clinic and then they're going home. And it's really up to the caregiver, who is usually not a nurse, who has to recognize early signs of toxicity. They need to be educated about what a fever is, what number constitutes a fever, what does confusion look like, what does hypotension look like? ... Do they have access to a thermometer? If you are asking them to look at blood pressure, do they have access to a blood pressure monitor? And sometimes those can be subtle things that might be overlooked. So, the emphasis in outpatient quality education is teaching those caregivers what to watch for, how to act quickly, and who to call immediately. You need to make sure that they have that information readily available if something happens." TS 30:55

"The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term multiple myeloma considerations for oncology nurses. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by March 6, 2027. Ann McNeill is on the speakers' bureau for Pfizer. This financial relationship has been mitigated. All other 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 multiple myeloma and treatment. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses Episode 398: An Overview of Multiple Myeloma for Oncology Nurses Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer Episode 201: Which Survivorship Care Model Is Right for Your Patient? ONS Voice articles: Effective Care Transitions Are Essential for New Multiple Myeloma Treatments Infection Prevention for Oncology Nurses Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations Nurse-Led Survivorship Programs Sexual Considerations for Patients With Cancer Oncology Nursing Forum articles: A Qualitative Study of the Experiences of Living With Multiple Myeloma Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study ONS book: Multiple Myeloma: A Textbook for Nurses (third edition) ONS Huddle Cards: Pain Management Sexuality Survivorship Care Plan ONS Learning Libraries: Hematology, Cellular Therapy, and Stem Cell Transplantation Survivorship ONS Symptom Intervention resources: Chronic Pain Fatigue Peripheral Neuropathy American Cancer Society: Living as a Multiple Myeloma Survivor Blood Cancer United: Resources for Healthcare Professionals International Myeloma Foundation: Resources and Support for the Myeloma Community Multiple Myeloma Research Foundation: Empower Patients and the Community 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 do consider myeloma an incurable hematologic malignancy, even though we have had improvements in survival. But just like for any malignancy, our goal is to maximize survival. We want to eliminate as many myeloma cells as we possibly can. And subsequently, we want to improve the quality of life for these patients in the long term. So those are basically our treatment goals. That's what we think of when we're treating patients all throughout their treatment journey." TS 1:39 "It is very typical for patients along their journey to have received several lines of therapy. I think it's important to realize that the cells acquire new mutations, making them more resistant to these further subsequent lines of therapy. We see quicker, more aggressive relapses in those patients with multiple prior lines of therapy. We can see an increase in the CRAB symptoms, which are the calcium elevations, the renal dysfunction, profound anemia, and even bone disease. We can see a rapid rise in the monoclonal protein in the labs or even a very rapid rise in the involved light chain in that serum free light chain assay, so it's important to monitor these labs." TS 9:14 "All oncology nurses are focusing on these survivorship plans now. And I think that's a great thing when you think about a diagnosis of cancer and a survivorship plan, because it means these patients are living a longer time. We still look at long-term health maintenance guidelines depending on the patient's sex and their age. ... I think preventing infection is always going to be something absolutely on the forefront in our survivorship plan with myeloma. I mean, myeloma is an immune system malignancy. The treatments that we have given patients can sometimes, especially in later life therapies, further compromise the immune system. So, we're always looking to prevent serious infection." TS 12:46 "Patients get treatment, especially induction therapy. They may or may not get transplant. They may have been on a very minor maintenance schedule, depending on their age. And they feel really well. And then they decide not to return for their follow-up because they feel so good. I think nurses are critical in the communication aspect of the patient-provider aspect. So, nurses are really the key means of communication. The providers are absolutely important—the physicians, the nurse practitioners and every other member of the team—but I think the nurses have a really special rapport with patients. They're usually the ones providing the education on the treatment regimens. They're managing the toxicity profiles. They're doing all the coordination of care between visits. They are really going to be the ones telling the patient, 'Hey, you're going to feel good and that's a wonderful thing, but you still need to come once a month or once every six weeks or once every two months for your labs.'" TS 15:17 "It has been amazing. The science, the research, the treatments, the approvals from the U.S. Food and Drug Administration. Survivorship has improved dramatically. Let's take the first few years of the new century, right? The five-year survival rate was about 38%. If you then jump to 2015–2019, which is still seven plus years ago, it has doubled. So, we're talking about anywhere from 60%–80% over a five-year survival. So that's an amazing improvement in their five-year survival rate for myeloma." TS 23:28 "Survivorship in myeloma begins at diagnosis, not just after treatment. And I think that because it is managed as a chronic, often relapsing disease, it does require lifelong evolving care. Patients should realize that they will know us for the rest of their lives. We will know everything about you. I always tell them, 'I will know everything about your hobbies, your children, your grandchildren, what you love to do on the weekends.' It's very important that that point is made right at diagnosis, not just after so many lines of treatment. It's very important that we are going to follow these patients throughout their journey." TS 28:18

"Because the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That's one of our biggest questions that we ask, usually every consult that we're seeing with solid tumor. 'Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?' And then also patients who have undergone organ transplants. Now, interestingly, this does include stem cell transplants," Kelsey Finch, PharmD, BCOP, oncology pharmacist practitioner at Columbus Regional Health in Indiana, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about checkpoint inhibitors. 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 February 20, 2027. Kelsey Finch has disclosed a speakers bureau relationship with AstraZeneca. 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 related to checkpoint inhibitors in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 273: Updates in Chemotherapy and Immunotherapy Episode 174: Administer Pembrolizumab Immunotherapy With Confidence Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment ONS Voice articles: Here's Why Oncology Nurses Are Pivotal in Managing Immune-Related Adverse Events Make Subcutaneous Administration More Comfortable for Your Patients Nursing Considerations for ICI-Related Myocarditis Oncology Nurses Navigate the Changing Landscape of Immuno-Oncology Postdischarge ICI Patient Education Eliminates Hospital Readmissions Shorter Administration Times Still Require High-Acuity Care ONS Voice oncology drug reference sheets: Dostarlimab-Gxly Nivolumab and Hyaluronidase-Nvhy Nivolumab and Relatlimab-Rmbw Pembrolizumab and Berahyaluronidase Alfa-Pmph Retifanlimab-Dlwr Toripalimab-Tpzi ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Cancer Immunotherapy (second edition) ONS course: ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing articles: Immune Checkpoint Inhibitor–Related Myocarditis: Recognition, Surveillance, and Management Immune Checkpoint Inhibitor Therapy: Key Principles When Educating Patients Triple M Syndrome: Implications for Hematology-Oncology Advanced Practice Providers ONS Huddle Cards: Checkpoint Inhibitors Immunotherapy ONS Learning Libraries: Genomics and Precision Oncology Learning Library Immuno-Oncology Learning Library Drugs@FDA package inserts National Comprehensive Cancer Network homepage OncoLink: All About Immunotherapy 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 "Before immune checkpoint blockade, the two-year overall survival rate in metastatic melanoma was hovering around 10%. After these agents came to market, depending on the trial and the agents used, that number actually increased to about 50%–65%. So, five times the amount of patients were actually living at the two-year mark. Not surprisingly, studies then exploded across several tumor types, leading to approvals in all sorts of cancers, mostly in the solid tumor. But there are a couple hematologic as well. Lung cancer, kidney cancer, head and neck, Hodgkin lymphoma, hepatocellular, the list goes on. So, it's really just transforming the stage IV setting across all tumors, specifically from uniformly fatal prognosis to one where durable responses and long-term survival is also possible." TS 3:03 "There are four different mechanisms officially being used in therapies that are approved by the U.S. Food and Drug Administration (FDA). Those are cytotoxic T-lymphocyte–associated protein 4, programmed cell death protein 1, and programmed cell death ligand 1, which I'm counting as two different mechanisms, even though they somewhat work together. And lymphocyte-activation gene 3 is the fourth one that's in there. So, all these mechanisms impact the T cell in our immune system. The T cell is traditionally responsible for protecting our body from harmful things like bacteria, viruses, and cancer. When the tumor binds to cytotoxic T-lymphocyte–associated protein 4 receptors, that happens on the T cell itself. And that inhibits the activation of the T cells, essentially allowing that tumor to then live. So when developing medications that block this receptor, they noted an added benefit that it actually increased the T-cell proliferation as well as keeping that T cell active. So not only are we not blocking the T cells, we're making them more productive." TS 5:38 "If you have a chance of any sort of tissue rejection, specifically with allogeneic stem cell transplants or where we see that focusing on it, there's a little bit of controversy, mixed bag on opinions as far as autologous stem cell transplants. But it's best to at least exercise a little bit of caution. If they have a chance of organ rejection, is that worth the risk of the therapy that we're looking to give? And then, patients with HIV, any sort of immunologic concerns at baseline that we could potentially worsen." TS 14:37 "As a rule of thumb, with immune checkpoint blockade, regardless of what mechanism you're looking at, if something in your body can get inflamed, that can wind up as an adverse event. So, whenever I talk to my patients, the key word is anything ending in '-itis.' ... The most common adverse events that we end up seeing are dermatitis and hypothyroidism. Immune checkpoint blockade can cause both hyper- and hypothyroidism. Very often, we actually start in the hyper- and then end up, for lack of better words, burning out the thyroid, ultimately leading to a sustained hypothyroidism." TS 18:34 "The half-life of immune checkpoint inhibitors is usually around 30 days, meaning that once these agents are given, the drug will be in the patient's system for up to five months. Specifically, it will probably build month to month, so often we don't even see a lot of our adverse events until month three or four. Usually, when we're that far into treatment, we're not looking for new adverse events in things like chemotherapy. But these drugs do build over time." TS 24:28 "As far as safe handling is concerned, these agents are not chemotherapy. That makes drug compounding and administration pretty straightforward. When looking at the follow-up care, the most important thing, in my opinion, is to engage in meaningful dialogue with your patients. A lot of the side effects can be nonspecific. So, really listening to the patient and evaluating changes in their lifestyle, I think it'll get you far. We usually hark in on the new, worsening, or persistent whenever we're talking to patients because they'll be looking for things as well. So, just having a dialogue of how their life has changed can certainly help." TS 26:17

"You also want to deal with patient preferences. We do want to get their disease under control. We want to make them live a long, good quality of life. But do they want to come to the clinic once a week? Is it a far distance? Is geography a problem? Do they prefer not taking oral chemotherapies at home? We have to think about what the patient's preferences are to some degree and kind of incorporate that in our decision-making plan for treatments for relapsed and refractory myeloma," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma treatment considerations. 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 February 6, 2027. Ann McNeill has disclosed a speakers bureau relationship with 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 related to the treatment of multiple myeloma. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 398: An Overview of Multiple Myeloma for Oncology Nurses Episode 395: Pharmacology 101: Monoclonal Antibodies Episode 372: Pharmacology 101: Proteasome Inhibitors ONS Voice articles: Effective Care Transitions Are Essential for New Multiple Myeloma Treatments New Multiple Myeloma Treatments Present New Challenges in Side Effect Management Reduce Racial Barriers and Care Inequities for Black and African American Patients With Multiple Myeloma ONS Voice FDA approval alerts ONS Voice oncology drug reference sheets: Belantamab mafodotin-blmf Daratumumab Motixafortide Selinexor Clinical Journal of Oncology Nursing articles: Journey of a Patient With Multiple Myeloma Undergoing Autologous Stem Cell Transplantation Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles Oncology Nursing Forum article: Facilitators of Multiple Myeloma Treatment: A Qualitative Study ONS books: Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition) Multiple Myeloma: A Textbook for Nurses (third edition) ONS course: ONS Hematopoietic Stem Cell Transplantation™ ONS Huddle Cards: Financial Toxicity Hematopoietic Stem Cell Transplantation (HSCT) Monoclonal Antibodies ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library American Society of Clinical Oncology (ASCO)–Ontario Health: Treatment of Multiple Myeloma Living Guideline International Myeloma Foundation: Clinical Trials Fact Sheets Clinical Trial Support Resource Library Multiple Myeloma Research Foundation resource: 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 "Typically for our first-line therapies, we use certain classes of drugs and some of them are proteasome inhibitors like bortezomib and carfilzomib. We also have IMiDs or immunomodulatory agents like thalidomide, lenalidomide, and pomalidomide. We have monoclonal antibodies, anti-CD38 monoclonal antibodies. Of course, we can never talk about treatment for myeloma without mentioning dexamethasone. It is an integral part of our treatment regimen. Most of our frontline therapies now are not just a single agent. They're not even doublets anymore. Typically, they're triplet therapies. And now in 2026, it's leaning more toward quadruplet therapies. By that, I mean you're taking a proteasome inhibitor, an immunomodulatory drug, dexamethasone, and an anti-CD38 monoclonal antibody all together to present patients with a good chance their induction therapy will lead to a good chance of them responding to treatment." TS 4:25 "[With] myeloma labs, there should be some indication after each cycle of therapy that the treatment is working. So, you don't have to do a whole myeloma panel, but maybe getting a monoclonal protein spike, maybe getting a free light chain assay, or maybe an immunoglobulin G or immunoglobulin A level, just to see if the treatment is working. So, those labs are crucial to determine whether the therapies are working. And again, the lab improvements usually correlate with the clinical presentation of the patient." TS 11:01 "There are active clinical trials ongoing with drugs like cell mods. Cell mods are the new oral anticancer agents for myeloma that have shown great promise with efficacy and safety profiles. And then there are other combinations that are showing a lot of promise. So, drugs that are already approved by the U.S. Food and Drug Administration (FDA). And I'm talking about pairing anti-CD38 monoclonal antibodies with bispecific T-cell engagers. If you do that, there has been some evidence that these combinations are very efficacious and responses are durable. And there are ongoing clinical trials and studies being done right now to see if these can be FDA-approved to pinpoint where they are as far as in comparison to other treatments." TS 20:10 "I always tell patients to try to participate in safe, and I want to stress safe, physical activity. So, I tell patients, the more you sit on the couch or you sit in the chair for most of the day, that unfortunately will make your pain worse. So, trying to get up and about and doing some physical activity, such as getting a physical therapy evaluation and a treatment program, no matter how passive or mild or gentle it is, can really help these patients with bone pain." TS 26:10 "I think it's important to realize that myeloma has had amazing advances in science, research and treatments. I think that all of these things coming together, all the science and clinical trials and everything like that, has led to a significant increase in overall survival of our patients, which ultimately is a great thing. We want patients to live longer and they're living longer with a very good quality of life. So, I think it's important to realize that myeloma is very well studied, very well researched, and it's still ongoing with many, many clinical trials." TS 36:04

"The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we're trying to set up, is a way to make what is currently an invisible risk, visible," ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public health director of the division of occupational and environmental medicine at the University of Maryland School of Medicine in Baltimore, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry. 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 January 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 in the incidence of hazardous drug exposure and the tracking and reporting of healthcare worker exposures. Episode Notes Complete this evaluation for free NCPD. University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry information sheet ONS Podcast™ episodes: Episode 330: Stay Up to Date on Safe Handling of Hazardous Drugs Episode 308: Hazardous Drugs and Hazardous Waste: Personal, Patient, and Environmental Safety Episode 209: Updates in Chemo PPE and Safe Handling ONS Voice articles: Hazardous Drug Surface Contamination Prevails, Despite More Diligent PPE National Hazardous Drug Exposure Registry Safeguards Oncology Professionals NIOSH Releases Its 2024 List of Hazardous Drugs Safe Handling—We've Come a Long Way, Baby! Strategies to Promote Safe Medication Administration Practices Surfaces in Patient Bathrooms Often Contaminated With HDs, Despite Use of Plastic-Backed Pads ONS books: Safe Handling of Hazardous Drugs (fourth edition) Safe Handling of Hazardous Drugs Quick Guide™ ONS course: Safe Handling Basics Clinical Journal of Oncology Nursing articles: Hazardous Drug Exposure: Case Report Analysis From a Prospective, Multisite Study of Oncology Nurses' Exposure in Ambulatory Settings Personal Protective Equipment Use and Surface Contamination With Antineoplastic Drugs: The Impact of the COVID-19 Pandemic Sequential Wipe Testing for Hazardous Drugs: A Quality Improvement Project The Use of Plastic-Backed Pads to Reduce Hazardous Drug Contamination Oncology Nursing Forum articles: Ensuring Healthcare Worker Safety When Handling Hazardous Drugs Factors Influencing Nurses' Use of Hazardous Drug Safe Handling Precautions Other ONS resources: ONS Safe Handling of Hazardous Drugs Quick Guide Introduction to Safe Handling Huddle Card Safe Handling of Hazardous Drugs Learning Library Hematology/Oncology Pharmacy Association (HOPA) course: Safe Handling of Hazardous Drugs National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs in Healthcare Settings, 2024 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 thought that in order to answer some of the unclear questions about health risk, we would set up an exposure registry, in this case, for oncology personnel who handle the drugs. This would then create a cohort that we could ask questions to. For example, we could try to characterize whether there is a cancer excess in this group. Or characterize the reproductive abnormalities in excess that people are experiencing." TS 6:21 "It's sort of counterintuitive that the healthcare industry, whose mission itself is care of the sick, is a high-hazard industry. We typically think about the risk as being from infectious diseases, and certainly we've all lived in our practice lifetime through some examples of that. Even before COVID-19, some of us were doing preparation for Ebola and that sort of thing. So, we're kind of used to that. But the hazards that you kind of grew up with, we've routinized or normalized handling group one, human carcinogens, which a number of these drugs are—it's just something we do every day. Well, it is, but we have to do it with respect and with care every day. And I think sometimes in that routineness of it, we have sort of lost sight of the vigilance that we need to maintain." TS 11:19 "It's very easy in the life cycle of a drug in an organization to do something that doesn't just impact you, but unknowingly, you've contaminated a surface for somebody who comes behind you. Who maybe doesn't have plastic protective equipment on because something that got contaminated shouldn't have been contaminated in the first place. If we could all be thinking of it as more of a team sport, especially in terms of safe handling, that our disposition and drug handling affects not just us and our health, but those of our colleagues." TS 24:47 "For the job history pieces, we ask what year you started, what year you stopped, and we ask about estimations of handling. So we'll be able to come up with either a duration or some kind of metric for the intensity and duration of your handling history, which will then permit us to sort the population who completed the survey into sort of low, medium, high. And we'll see whether the health outcomes that are being reported are influenced by that drug handling history." TS 27:45 "The idea that we aren't exposed to the same therapeutic dose we give to our patients is absolutely true. However, the dosing schedule to them versus us is very different, and we are exposed frequently, if not daily, to very small concentrations. They don't reach a cytotoxic dose necessarily, but we do know from a lot of studies that either ourselves or our colleagues are taking up drug from contaminated work environments. And you've probably seen there is an awful lot of intermediate evidence looking at genotoxic insult in pharmacists and nurses who handle the drugs. So clearly we're showing uptake and we're showing that there are biologically plausible, concerning measures that are taking place in us. So, I think that we need to come back and circle around the idea that we need to have deep respect for the toxicity of these agents." TS 35:03

"Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it's really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the 'so what': We are the first line of defense," ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer Institute in Florida, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about ototoxicity in cancer care. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 9, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to the management of ototoxicity after chemotherapy treatment. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ Cancer Symptom Management Basics series ONS Voice articles: Oncology Drug Reference Sheet: Cisplatin Oncology Drug Reference Sheet: Carboplatin Oncology Drug Reference Sheet: Oxaliplatin FDA Approves Sodium Thiosulfate for Cisplatin-Associated Ototoxicity in Pediatric Patients ONS book: Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition) American Cancer Society resources: 4 Causes of Hearing Problems for Cancer Survivors Cancer Survivors Network American Speech-Language-Hearing Association (ASHA) Hearing Loss: An Under-Recognized Side Effect of Cancer Treatment Embedded Ear Care: Audiology on the Cancer Treatment Team American Society of Clinical Oncology (ASCO) Annual Meeting abstract: Innovative Infusion Center Assessments of Chemotherapy-Induced Neurotoxicities: A Pilot Study Supporting Early and Routine Screenings as Part of Survivorship Programs Children's Oncology Group supportive care endorsed guideline: Prevention of Cisplatin-Induced Ototoxicity in Children and Adolescents With Cancer: A Clinical Practice Guideline Ear and Hearing article: Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment International Ototoxicity Management Group (IOMG) IOMG Wikiversity page Shoebox hearing assessments World Health Organization initiative: Make Listening Safe To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "At different pitches, the eardrums move faster or slower, signaling the inner ear, or the cochlea—the thing that looks like a snail in the pictures. The cochlea has fluid and hair cells inside of it that receive movements from the eardrum. The hair cells change the movement into electrical signals that actually go to the auditory nerves or the cranial nerve VIII." TS 2:15 "Ototoxicity is an umbrella term for some sort of exposure to a toxin that causes damage to the inner ear. These toxins can be in the environment, such as loud or different noises, or they can be from medications, including antibiotics or commonly cancer treatments, such as radiation chemotherapy. Some common chemotherapies can be platinum-based chemotherapies like cisplatin or carboplatin. And then what patients are experiencing if they have ototoxicity can be hearing loss." TS 3:15 "The hypothesized mechanism of action is that the chemicals like the platinum compound in cisplatin … that platinum compound travels through our bloodstream. Since chemotherapy is systemic, it'll go to the inner ear, and it gets stuck there by binding to the cellular DNA in that cochlea, or that snail-looking image. That initiates the release of the reactive oxygen species, which are really trying to help clean it out, but releases such high levels that it ends up causing damage to those inner ear hairs. These inner ear hairs cannot regenerate themselves, so then they're permanently damaged. And remember we said that those hairs send electrical signals to the brain that recognize sound. So that function is permanently gone once those hair cells are damaged." TS 7:10 "I definitely think this is a huge interdisciplinary collaborative effort. As nurses and advanced providers, we're assessing and providing education. Our medical oncologists are doing those dose modifications and submitting those audiology referrals. The radiation oncologists are very important to know about this—maybe dose localization awareness. Maybe they do some changes with the doses. And then our audiologists and [ear, nose, and throat physicians], they can do that diagnostic confirmation and any rehabilitation measurements and really monitor them throughout their journey as well. And nurse navigators play a huge part in making sure those patients get those referrals, because a lot of the time the audiologists aren't in the cancer clinic, so they may have to go to another location or may need help coordinating with all their appointments that they have." TS 22:28 "We had a really innovative way of monitoring the hearing that a couple other studies have also tested. It's a remote point-of-care hearing screen. It was on [a tablet] with calibrated headphones. And then it's a paid-for subscription to an audiology testing platform. … Myself, along with a couple of other nurses, were trained how to use this testing device with the tablet and the headphones and the software program. And it was a quick down-and-dirty portable hearing assessment for patients. So anyone who was new to cisplatin, never gotten cisplatin treatment before, was enrolled into the study, and they received a hearing test every time that they came for chemo, and we gave it to them during their hydration." TS 28:59