Podcasts about oncologic emergencies

Oncologic Emergencies: Part 2 In this two-part series, we dive into the world of oncological emergencies with guest expert, Dr. Monica Wattana. In part 1, we covered everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also discussed some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. In part 2, we tackle pain management, palliative care, and some tough ethical dilemmas. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer.  Did you learn something new that changed your practice? We'd love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associate Professor and Education Director for the Department of Emergency Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas Resources: Pocket Guide to Oncologic Emergencies, by Dr. Monica Kathleen Wattana  Gould Rothberg BE, Quest TE, Yeung SJ, et al. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin. 2022 Nov;72(6):570-593. doi: 10.3322/caac.21727. Epub 2022 Jun 2. PMID: 35653456. Multinational Association of Supportive Care in Cancer (MASCC) Guidelines SPIKES: A Strategy for Delivering Bad News, by Dr. Claire Ciarkowski **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this two-part series, we dive into the world of oncological emergencies. Our guest expert, Dr. Monica Watana, an emergency physician specializing in this area. In part 1, we cover everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also talk about some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer. Stay tuned for part two, when we'll tackle pain management, palliative care, and some tough ethical dilemmas.  Did you learn something new that changed your practice? We'd love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associate Professor and Education Director for the Department of Emergency Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas Resources: Pocket Guide to Oncologic Emergencies, by Dr. Monica Kathleen Wattana  Gould Rothberg BE, Quest TE, Yeung SJ, et al. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin. 2022 Nov;72(6):570-593. doi: 10.3322/caac.21727. Epub 2022 Jun 2. PMID: 35653456. Multinational Association of Supportive Care in Cancer (MASCC) Guidelines SPIKES: A Strategy for Delivering Bad News, by Dr. Claire Ciarkowski ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

This week's episode will be focusing on common topics both for new fellows & residents. We will go over the important details on some clinically important oncologic emergencies including brain metastases, hypercalcemia, cord compression and SVC syndrome. 

“Transfusion safety is really a registered nurse activity, and I just continue to reiterate the blessing of nursing assessment, getting those vitals before the transfusion, and then monitoring them closely and stopping the transfusion if they have a reaction, because that's really an assessment, and we can't delegate that to nonlicensed staff. And so that's really why we just celebrate that nurses have such a great role in transfusion safety,” Renee LeBlanc, BSN, RN, manager of the infusion services office at Fred Hutchinson Cancer Center in Seattle, WA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about administration of plasma and cryoprecipitate. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by May 31, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to plasma and cryoprecipitate administration. Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes: Episode 234: Oncologic Emergencies 101: Thrombotic Thrombocytopenia Purpura Episode 228: Oncologic Emergencies 101: Disseminated Intravascular Coagulation Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome ONS Voice articles: Nursing Considerations for Adverse Events From CAR T-Cell Therapy Manage Thrombosis in Patients With Cancer ONS courses: Essentials in Oncologic Emergencies for the Advanced Practice Provider Oncologic Emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Journal of Oncology Nursing article: STAT: Cytokine Release Syndrome ONS Huddle Cards Cytokine Release Syndrome Disseminated Intravascular Coagulation AABB (Association for the Advancement of Blood and Biotherapies, formerly American Association of Blood Banks) American Association of Clinical Oncology Blood Bank Guy (Joe Chaffin, MD) Joint Commission: Patient Blood Management Certification Review Process Guide 2021 To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “Plasma is indicated for massive transfusions and emergent reversal of warfarin therapy–related intracranial hemorrhage. Nurses may also see plasma ordered pre-op for multiple coagulation deficiencies or factor XI deficiency.” TS 2:58 “Surgical centers performing procedures with large-volume blood loss would be a prime location for staff to be experts in transfusing plasma and cryo. Nurses caring for patients with cytokine release syndrome may be familiar with monitoring for hypofibrinogenemia. Cryoprecipitate in this setting may be given more prophylactically than for a patient who's actively bleeding or having a procedure.” TS 6:48 “Plasma coagulation factors have a short half-life. Transfusing as close to the procedure will ensure the highest level of factor activity at the time of the procedure. Nurses can ensure best outcomes through care coordination and timing the transfusions as close to the procedure as possible. So we don't want to start transfusing plasma at midnight if the factors are going to be expiring and their procedure isn't until 9:00 in the morning.” TS 10:40 “One of the questions that I get sometimes, especially with plasma, is, ‘I don't have time to be at the bedside for 15 minutes for four units.' Remember that each unit is a different donor, and what they eat, what kind of antibodies they have, whether they were pregnant—it's all part of that experience. It's not the same plasma product given four different times or three different times. And so just really drawing nurses into the value of being at the bedside for that first 15 minutes of that final determination of acceptability and tolerance.” TS 14:20  

“Of all the eight different pulmonary toxicities you and I have talked about over these two different podcasts, they're all very different etiologies and treatments. So, we went everywhere from infection and good stewardship with antibiotics to pulmonary GVHD to diffuse alveolar hemorrhage. And I think that's what's the hardest part for us as nurses. It's not just one thing that's causing it, and there's multiple different ways to treat these things,” Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about pulmonary toxicities in cancer treatment. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by May 24, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to pulmonary complications in people with cancer. Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes: Episode 295: Cancer Symptom Management Basics: Pulmonary Embolism, Pneumonitis, and Pleural Effusion Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond Oncologic Emergencies 101 series ONS Voice articles: Pneumonitis With Immunotherapy Treatment The Case of the Post-Transplant Pulmonary Problem How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer ONS courses: Essentials in Oncologic Emergencies for the Advanced Practice Provider Oncologic Emergencies Treatment and Symptom Management—Oncology RN ONS books: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition) Clinical Journal of Oncology Nursing article: Influenza Adherence Tool Kit: Implementation and Evaluation Among Allogeneic Hematopoietic Transplantation Recipients Oncology Nursing Forum articles: Community Respiratory Virus Infection in Hematopoietic Stem Cell Transplantation Recipients and Household Member Characteristics Emergence of Stereotactic Body Radiation Therapy Multifactorial Model of Dyspnea in Patients With Cancer ONS Huddle Cards: Hematopoietic Stem Cell Transplantation Proton therapy Radiation Sepsis ONS Guidelines™ and Symptom Interventions: Dyspnea American Cancer Society patient resources: Shortness of Breath Infections in People With Cancer American Lung Association To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “[Intensity-modulated radiation therapy] is a type of radiation that can really take into account certain movements. And this is particularly important with the lungs, because we can't necessarily have patients hold their breath for a long period of time, so the chest rises and falls and the heart beats while you're trying to do radiation to the lungs. So with IMRT, they can simulate that, so that the beam is going to follow that specific movement in that patient. That's really helpful because then, hopefully, we're going to keep that radiation dose mostly on cancer tissue and not on healthy tissue. And thus, that should reduce the amount of radiation that's to the healthy tissue and hopefully reduce pneumonitis.” TS 3:44 “Proton beam radiation is something that we've described in the past as radiation that will typically have an entrance dose but not an exit dose, so minimizing toxicity by hopefully around 50%. … If you're doing proton beam therapy, that radiation is designed to only have an entrance dose from either the back or the front or the side, whichever way they're going, but then hopefully stop on a dime at that tumor so that they're only really getting the entrance dose of that radiation. … So in turn, especially if you're doing that to the lungs, that should minimize dose of radiation to healthy lung tissue.” TS 5:03 “If they're having a fever, low blood count, thick ugly mucus, this often, typically can be infection as well. And then get a chest x-ray because, a lot of times I've been saying for a lot of these things, we need a CT scan to see this. Actually, infection is probably best noted on a chest x-ray because this is something that will consolidate.” TS 18:58 “[Tumors] may be directly invading a vessel. They may directly be invading the bronchus where there's a lot of capillaries or there's a lot of blood vessels that can break and then cause them to cough up blood. You can have tumors or prior treatment that then cause a bronchial fistula that then can cause bleeding. Patients with squamous cell carcinoma of the lung are much more likely to have hemoptysis and pulmonary hemorrhage than patients with adenocarcinoma, though it definitely can happen with adenocarcinoma as well.” TS 22:00 “One of the best treatments for tumor-direct hemorrhage is radiation. This is where radiation can be very helpful for these patients. It's one of the first things that we do. We're going to go in with radiation, shrink that tumor really fast to get it away from those vessels, so patients stop bleeding.” TS 27:17

“Social work was involved because we could be radiation gung-ho, ready to go; chemo can be ready, but whoops, this patient doesn't have a ride. It can be little things like that, you know, where we kind of forget. That's why you need kind of a multidisciplinary approach. If it's not your social worker, your navigator is going to know more and be like, ‘This patient needs a ride. I'm working on gas cards.' Something like that can also halt a patient starting [treatment],” ONS member John Hollman, RN, BSN, OCN®, senior nurse manager of radiation oncology at AdventHealth Cancer Institute in Orlando, FL, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about care coordination between radiation oncology and other oncology subspecialties. 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 myoutcomes.ons.org by March 1, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning objective: Learners will report an increase in knowledge related to coordination of care to assist with the management of radiation-related side effects.   Episode Notes Complete this evaluation for free NCPD. Oncology Nursing Podcast: Episode 12: The Intersection of Radiation and Medical Oncology Nursing Episode 60: Radiation Side Effects With Head and Neck Cancers—ONS Congress Episode 128: Manage Treatment-Related Radiodermatitis With ONS Guidelines™ Episode 272: Oncologic Emergencies 101: Radiation Therapy for Emergent and Urgent Interventions Episode 298: Radiation Oncology: Nursing's Essential Roles Clinical Journal of Oncology Nursing articles: Patient Handoff Processes: Implementation and Effects of Bedside Handoffs, the Teach-Back Method, and Discharge Bundles on an Inpatient Oncology Unit Radiation Therapy Pain Management: Prevalence of Symptoms and Effectiveness of Treatment Options Partial Breast Irradiation: A Longitudinal Study of Symptoms and Quality of Life Oncology Nursing Forum article: Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy ONS Voice articles: The Intersection of Radiation and Medical Oncology Nursing (featuring an interview with John Hollman) Today's Immunotherapy Combinations New Treatments in Radiation Oncology 49th Annual ONS Congress® Radiation Track and John Hollman's radiopharmaceuticals session ONS book: Manual for Radiation Oncology Nursing Practice and Education ONS course: ONS/ONCC Radiation Therapy Certificate™ ONS Communities: Radiation ONS Huddle Cards: External beam radiation Brachytherapy Proton therapy Radiation Find your local ONS Chapter's next meeting. RT Answers American Brachytherapy Society 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 “Skin reaction is a big thing in our field for breast cancer. Managing it with lotions, creams, and stuff like that is temporary. To something more complicated, like the head and neck cancer patients with base of the tongue, where the beam is directed straight at that area of the body, which is very delicate, as we know, very, very, very tough treatment. You know, anything from esophagitis to dysphagia, dry mouth, no taste. Salivary glands are affected. So it really kind of depends, obviously, where we aim the machine.” TS 2:04 “I think it really determines on how that radiation nurse knows how radiation affects the cells that we treat. So, for instance, I always tell my patients when I'm educating them for head and neck, and I know they're going to be getting concurrent cisplatin or something like that once a week, I'm going to tell them, like, ‘The majority of your acute side effects are us. Like, the chemo is going to work as a sensitizer. You're going to have fluids that you're going to be needing, but the difficulty swallowing, you know, all that stuff is our fault.'” TS 6:12 “If your med-onc is not affiliated with your rad-onc site, that can be a horrible barrier to try to break through because you don't know anybody in that office. You identify yourself on the phone as someone from a competing company. . . . But it's just breaking through that, and it just takes that nurse's initiative and, hopefully, physician coordination as well, to work on, rad-onc between med-onc and getting that to kind of facilitate that.” TS 11:29 “Social work was involved because we could be radiation gung-ho, ready to go; chemo can be ready, but whoops, this patient doesn't have a ride. It can be little things like that, you know, where we kind of forget. That's why you need kind of a multidisciplinary approach. If it's not your social worker, your navigator is going to know more and be like, ‘This patient needs a ride. I'm working on gas cards.' Something like that can also halt a patient starting [treatment].” TS 20:52 “I love the ONS radiation communities. We do a lot of idea sharing on communities. A rad-onc nurse from New York can post something like, ‘Hey, what are you guys doing for this side effect? We're not having any luck with this.' And you get some buy-in. And as long as the nurses remember evidence-based practice is always key. You know, just because you use one lotion, it doesn't mean, it's going to be good for everybody. I like to see the evidence behind it.” TS 22:42 “With the ever-evolving radiopharms that are coming out, you know, that we're doing here, too, it's turning more into nurses are actually giving the treatment. And that's what I'm speaking on in Congress, is a nurse's evolving role in radiation and radiopharms especially. It's a huge breakthrough. It's the future pretty much.” TS 24:19

“We are there for whatever issue, whether it's skin management or helping just cheer them on and manage small things or big things, you know, to get them through these treatments. And then as a patient completes the treatment, we continue the nurse education and [managing] the late toxicities,” Michele “Michi” Gray, RN, radiation oncology care coordinator at the Cleveland Clinic in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what you should know about nursing's important role in radiation oncology.   You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   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), which may be applied to the nursing practice or oncology nursing practice  ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by February 9, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: Learners will report an increase knowledge of the radiation oncology nurse role.   Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast:  Episode 272: Oncologic Emergencies 101: Radiation Therapy for Emergent and Urgent Interventions  Episode 104: How Radiation Affects All Areas of Oncology Nursing  ONS Voice article: The Intersection of Radiation and Medical Oncology Nursing  ONS course: ONS/ONCC Radiation Therapy Certificate Course  ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)  ONS Huddle Card: Radiation  ONS Congress® Radiation Track  American Society for Radiation Oncology  To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “There's many different forms of therapeutic radiation. External beam radiation is probably the most common type of radiation therapy used in cancer treatments. Using x-rays and gamma rays are types of external beam, and that is the most common and what everybody thinks of when we talk about radiation therapy. Also, particles would be another type. Particles would be electrons and protons. Then there's brachytherapy. That's internal radiation, which is a technique that is sealed radioactive sources placed directly into or adjacent to the tumor.” TS 3:13  “First step [in the treatment coordination process] is that consult—getting the patients in the door. Quite honestly, this consult can be a long day for the patients. They may just have a consult with the radiation oncologist. [But if they're coming from a distance,] they might seeing a multidisciplinary clinic, so they are seeing all the physicians all in one day: the medical oncologist, the radiation oncologist, a surgeon.” TS 6:31  “We have a clinic team that oversees a lot of the clinical nursing side of things with rooming and then anesthesia recovery and things like that. And then we have the nursing working with the physicians and care coordination. We kind of have two different nursing roles within the Cleveland Clinic. So, education from both sides, you know, doing education, providing care for the patients and the patients' families.” TS 16:28  “This is one of the many phone calls that we get, I should say, almost daily. We get several phone calls from patients who say, ‘I've looked at my chart, I don't see my radiation treatment. Why are they no longer there? I don't see them. What's going on?' And it is because your radiation treatments ... do not interface with [the electronic health record]. You will be given a handout when you come because there is an issue with the system we use. We use a different system for the computerized radiation treatment, and then we use a different system for our computer charting. And they do not interface, they do not like each other. So, all of their radiation treatments do not show up in their [electronic health record]. They do not show up in their computer system.” TS 19:09  “Within the first two weeks, at least at the Cleveland Clinic, our plan is to give those patients a call back, see how they're doing, how they're doing with their side effects. Have they got scheduled for their follow-up? Do a check-in. Some of our patients have tox visits at six weeks with their nurse care coordinators, and that's just to check and see if they're having any lingering side effects, as well. And then we continue to get calls.” TS 26:31  “Listening to tumor board if you have the patience, so you know what patients that are going to be coming down the pike, because you've heard all the physicians discussing these cases. So, you know the plan because you've heard the surgeon, the radiation oncologist, the medical oncologist discuss the case. So, you know kind of what the plan is, then you can kind of get an idea, ‘Hey, I this one might be coming to me soon, and maybe I should be watching out for this patient or discussing this with my physician if I haven't seen it.'” TS 34:46  “In reality, it can be those days afterward, after they finish, that actually can be the worst. Letting the patients know that and that we're still only a phone call away and, you know, we're there for them. So, you know, continuing to educate also on when to call us—when to call, when to show up in clinic. We're there. We will get them an appointment. We will get them hydrated. We will do whatever they need.” TS 39:16  “Radiation therapy is not only used to treat cancers and malignant conditions. It is also used to treat quite a few benign conditions: arthritic knees, V-tach [ventricular tachycardia] in cardiac patients, Dupuytren's contractures—if you've watched the commercials that they're showing all over now—so, the Dupuytren's contractures of the hands and even plantar warts. So we use a lot of radiation therapy to treat these benign conditions, so it's not just malignant cancers.” TS 42:42 

“It's really important to look at where your target is and what the toxicities are associated with hitting that target. Make sure you include that thinking when you're talking about bispecifics,” ONS member Rowena (Moe) Schwartz, PharmD, BCOP, professor of pharmacy practice at the James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the use of bispecific monoclonal antibodies in hematologic cancers and solid tumors.   You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   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), which may be applied to the treatment ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by September 1, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge related to bispecific monoclonal antibodies in hematologic cancers and solid tumors.  Episode Notes  Complete this evaluation for free NCPD.  ONS Voice drug reference sheets and FDA announcements about bispecific anticancer therapies  ONS resources for cytokine release syndrome  Oncology Nursing Podcast Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome  Clinical Journal of Oncology Nursing article: STAT: Cytokine Release Syndrome  Clinical Practice Resource  Clinical Practice Video  Huddle Card™  Cancer article: The BiTE (Bispecific T-Cell Engager) Platform: Development and Future Potential of a Targeted Immuno-Oncology Therapy Across Tumor Types  Pharmaceutics article: Bispecific Antibodies in Cancer Immunotherapy: A Novel Response to an Old Question  U.S. Food and Drug Administration label search for package inserts  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 Today's Episode  “When we talk about bispecifics, we need to really pay attention to both the target on the cancer and the target for T-cell engaging, because that impacts both efficacy but also toxicity.” TS 4:20  “If you really look deep into the clinical trials, often the patients that are receiving these agents in clinical trials have had more than the required three or four lines of treatment. They may have had five or more lines of treatment. So it's really important to kind of look at where it sits right now, knowing, of course, that that's an evolving target.” TS 7:13  “One of the things I think can be missed, at times, is the fact that you need to consider the toxicities associated with your target on the cancer cell.” TS 10:06  “In terms of mitigating risk, there's been two major ways that have been done. One is a step-up dose schedule, and so one of the key things I would say: If you're not familiar with an agent that you're going to be administering, it's really important to review the entire step-up scheme because it's different for each agent. In some cases, patients need to be admitted to the hospital for the entire step-up strategy. Other times it's just the first dose. So it's really important to look at that.” TS 11:58  “I think we're going to get to the point where our teaching strategy is going to have to be somewhat tailored to the agent we're giving. So, how the drug is given during the step-up, what the subsequent cycling is going to be, whether it's going to be a Q21-day cycle or a weekly dosing administration or every-two-week administration after a certain point. So, I think some understanding of what to expect going forward because these are drugs that are given continually in most situations and so it's important for people to know what to expect.” TS 14:25  “I think we're going to see bispecifics that perhaps engage other aspects of the immune system besides CD3. In fact, those are in clinical trials. And I do believe that we're going to see these more and more developed for cancers beyond the hematologic malignancies. There's a lot of work being done at looking at targets that we know are helpful targets in certain cancers. And I think we'll see more drugs approved beyond the myeloma and the lymphoma and the leukemia space.” TS 20:42 

“Like all emergencies, they're unpredictable. I have seen them at the very beginning and sometimes, unfortunately, that can be the patient's first sign or symptom that they have cancer. It can be something like they've lost the ability to walk, or their breathing gets difficult. I've also seen it during the middle of their care continuum where we finish a round of radiation and they develop metastatic disease so the next time you see then for radiation can be for a cord compression. I've also seen it toward the end of their care continuum where this is strictly a quality-of-life measure,” ONS member John Hollman, BSN, RN, OCN®, senior nurse manager of radiation oncology at AdventHealth Cancer Institute in Orlando, FL, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about radiation therapy for emergent and urgent interventions. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. 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), which may be applied to the Oncology Emergencies or Treatment ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by August 11, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to radiation therapy when used in the emergent and urgent setting. Episode Notes Complete this evaluation for free NCPD.  Oncology Nursing Podcast: Episode 223: Oncologic Emergencies 101: Superior Vena Cava Syndrome Episode 210: Oncologic Emergencies 101: Spinal Cord Compression Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS Voice article: The Intersection of Radiation and Medical Oncology Nursing ONS courses: ONS/ONCC Radiation Therapy Certificate Course Oncologic Emergencies ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition) ONS Congress® Radiation Track ONS Huddle Cards: Radiation Superior Vena Cava Syndrome Spinal Cord Compression ONS Oncologic Emergencies Learning Library American Society for Radiation Oncology RT Answers 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 Today's Episode “It is a larger dose per day typically than you would give for six weeks. So, you want to give a lower dose per day if you're going to stretch it out for six to eight weeks. Shorter courses like these, for emergencies, are a higher dose per day but a short time frame of treatment.” Timestamp (TS) 14:34 “As a nurse, I kind of like to overeducate, and you can kind of tell which patients are more receptive to knowing everything, and some of them want to know the bare minimum.” TS 16:14 “The thing that's different with these patients is that sometimes those side effects will hit when they're no longer in your clinic.” TS 17:19 “I say get to know your medical oncologists and your radiation oncologist. Communication can be open; it doesn't have to be a silo if you don't need it to be.” TS 22:14 “The more educated the patient is, it lessens their nerves. I feel like the more educated they are, they know what to expect. They know every step of the process.” TS 32:02

In this episode of the podcast, we will discuss oncologic emergencies. Dr. Zanotti is joined by Dr. R Scott Stephens, a pulmonary/critical care physician and associate professor of medicine and oncology at the Johns Hopkins University School of Medicine. He is the Director of Oncology and Bone Marrow Transplant Critical Care at Johns Hopkins Hospital and the Sidney Kimmel Comprehensive Cancer Center. A recognized clinician, educator, and researcher Dr. Stephens has expertise and interest in ARDS, ECMO, and oncologic critical care. Additional Resources: Oncologic Emergencies for the Intensivist – the Old, the New, and the Deadly. Thandra K, et al. J Intensive Care Med 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886674/ Oncologic Emergencies – Traditional and Contemporary. Spring J, and Munshi L. Crit Care Clin 2020: https://pubmed.ncbi.nlm.nih.gov/33190777/ Critically Ill Patients with Cancer: A Clinical Perspective. Martos-Benitez F, et al. World J clin Onco 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643188/ Management of Febrile Neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology 2016: https://www.annalsofoncology.org/article/S0923-7534(19)31643-6/pdf Books Mentioned in this Episode: The Elements of Style. By William Strunk and EB White: https://amzn.to/3KddG7C The Structure of Scientific Revolutions: By William Kuhn: https://bit.ly/43HkS34 The Physicists: The History of a Scientific Community in Modern America. By Daniel Kevles: https://bit.ly/477Z8jO American Prometheus: The Triumph and Tragedy of j. Robert Oppenheimer. By Kai Bird and Martin Sherwin: https://bit.ly/479AEqn

  “I think the take-home message here, though, is to have very specific guidelines at your institution to manage both CRS and ICANS. The protocols should be readily available to all practitioners who may participate in the care of these patients,” ONS member Phyllis McKiernan, MSN, APN, OCN®, advanced practice provider at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS. McKiernan's and Taylor's conversation centered around the nurse's role in recognizing and managing toxicities related to CAR T-cell therapy for hematologic malignancies, specifically ICANS and CRS, which was an educational priority that ONS members identified during two ONS focus groups on the topic in March 2023. McKiernan was one of the content experts for those focus groups.  This podcast episode is produced by ONS and supported by funding from Janssen Oncology/Legend Biotech. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod   Licensed under Creative Commons by Attribution 3.0    Episode Notes  NCPD contact hours are not available for this episode.  Oncology Nursing Podcast episodes: Oncologic Emergencies 101 series Episode 261: CAR T-Cell Therapy for Hematologic Malignancies Requires Education and Navigation Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment Episode 1: Experiences With CAR T-Cell Therapy ONS Clinical Practice Resources: Chimeric Antigen Receptor T-Cell Therapy: A Timeline of Events and Adverse Events Cytokine Release Syndrome ONS Clinical Update: Focus on Clinical Experiences With CAR T-Cell Therapy ONS course: Nursing Considerations for CAR T-Cell Therapy for Patients With Hematologic Malignancies: Patient Education and Symptom Management ONS Huddle Card™️: Cytokine Release Syndrome ONS Immuno-Oncology Learning Library ONS videos: CAR T-Cell Therapy Cytokine Release Syndrome American Cancer Society American Society for Transplantation and Cellular Therapy Grading Scale for CRS and ICANS Leukemia and Lymphoma Society  Multiple Myeloma Research Foundation  National Institutes of Health's National Cancer Institute Risk Evaluation and Mitigation Strategies   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 Today's Episode  “All symptoms need to be investigated fully to determine their cause and thus the best management strategy and not just simply assume that they're related to CAR T.” Timestamp (TS) 9:21   “Accurate grading is really crucial to ensure that the toxicities are identified and managed consistently across the institution.” TS 10:52  “Once the patient shows signs and symptoms of neurotoxicity, they should have a comprehensive neurologic examine, and that should include, a neurology consult, maybe imaging, such as an MRI or CT, and perhaps even a lumbar puncture.” TS 14:12  “Letting patients and their families know what next steps are can alleviate anxiety and give the patients the confidence that the medical team is familiar with these toxicities. And let them know that these toxicities are expected and that there are protocols in place to manage these symptoms.” TS 22:56  “I think that some patients, and even healthcare professionals, who aren't familiar with CAR T believe that the toxicities are always severe and always irreversible. When, in reality, most of the toxicities are mild and managed with minimal intervention or even just supportive care.” TS 23:55   “Early detection, consistent grading, vigilant monitoring, and standardized care plans are crucial to the success of any CAR T program and can also help reduce the risk of the severe adverse effects and hopefully improve outcomes for our patients.” TS 30:26 

“Just like with anything we do in oncology, a lot of education is required. Nurses and coordinators are critical to start the education and provide effective resources that are reinforced throughout the treatment,” ONS member Beth Faiman, PhD, MSN, APN-BC, AOCN®, BMTCN®, FAAN, FAPO, advanced practice provider at Cleveland Clinic in Ohio, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about how to address knowledge gaps and barriers to practice regarding patients who are preparing for or who have received CAR T-cell therapy for hematologic malignancies. Faiman was one of the content experts for two ONS focus groups on the topic in March 2023. This podcast episode is produced by ONS and supported by funding from Janssen Oncology and Legend Biotech. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes NCPD contact hours are not available for this episode. Oncology Nursing Podcast episodes: Episode 1: Experiences With CAR T-Cell Therapy Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome ONS Voice articles: Studies Show Best Practices to Manage CAR T-Cell Therapies' irAEs and Improve Outcomes CAR T-Cell Therapy Programs: Essential Elements to Establish a Successful System A Body of Evidence Helps Nurses Manage CAR T-Cell Therapy Toxicities Clinical Journal of Oncology Nursing articles: CAR T-Cell Therapy: Updates in Nursing Management Building a Program: Implications for Infrastructure, Nursing Education, and Training for CAR T-Cell Therapy Management Across Settings: An Ambulatory and Community Perspective for Patients Undergoing CAR T-Cell Therapy in Multiple Care Settings ONS clinical practice resources: Chimeric Antigen Receptor T-Cell Therapy: A Timeline of Events and Adverse Events Cytokine Release Syndrome ONS course: Nursing Considerations for CAR T-Cell Therapy for Patients With Hematologic Malignancies: Patient Education and Symptom Management ONS videos: CAR T-Cell Therapy Cytokine Release Syndrome American Society for Transplantation and Cellular Therapy Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated With Immune Effector Cells International Myeloma Foundation Leukemia and Lymphoma Society Multiple Myeloma Research Foundation New England Journal of Medicine article: Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma Transplantation and Cellular Therapy article: Overcoming Barriers to Referral for Chimeric Antigen Receptor T Cell Therapy in Patients With Relapsed/Refractory Diffuse Large B Cell Lymphoma Learn more about CAR T-cell therapy and risk evaluation and mitigation strategies (REMS). To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Just like with anything we do in oncology, there is a lot of education that is required. The same navigators that take care of our patients through the transplant and cellular therapy process, we have similar cellular coordinators that were part of the focus group. These navigators were critical to start the education and provide effective resources that were reinforced throughout the treatment.” Timestamp (TS) 09:00 “The nurses and coordinators play a huge role during the transition of care. Not only do they help with coordinating appointments, but also the scheduling of tests and coordinating with the referring team. I heard a lot in the focus groups about the nurses communicating from inpatient to outpatient, and also coordinating from center to center.” TS 10:22 “Patients can get really nervous when they're feeling sick. I explain it to them like, “You know how you get a flu shot, and you might get a little reaction as we're training your immune system to provide immunity? Well, it's like that, but way worse.' So, you can get really sick feeling and achy from this, and so that psychosocial support is super important.” TS 18:16 “It takes a lot of burden on the patient, caregiver, and the nurse to really be astute to those symptoms and intervene. We do provide wallet cards to patients. We educate the emergency department staff. We also heard about the infection monitoring and caregiver support is absolutely critical. Fortunately, the symptom management has become quite standardized, which really affords the nurses more autonomy to intervene more efficiently.” TS 20:46 “The nurses found for education a teach-back tool to be quite useful. One of the nurses mentioned asking the patient questions such as, ‘What will you do when you have a fever? Tell me what you do,' and “What do you understand from what the doctor just told you?' And so that was just kind of a way that they could go back and forth with the educational process and really understand what the patients understood.” TS 25:46

Click here to learn more about the Oncologic Emergency Medicine fellowship.Click here to buy the “Pocket guide to Oncologic Emergencies” paperback copy, written by Monica Wattana.Check out the details of this year's Oncologic Emergency Medicine Conference.

“When someone is faced with a cancer diagnosis, you want to really try to work to make that patient an active part of their care team. Understand that there are things out of their control, but there are also things that are within their control. You can teach them how to manage fatigue associated with anemia, or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best,” ONS member Kimberly Miller, BSN, RN, BMTCN®, transplant case manager at Nebraska Medicine in Omaha, and member of the Metro Omaha ONS Chapter, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, during a conversation about nursing management of cancer-related hematologic complications. This episode is part of a series about cancer symptom management basics. The others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. 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 myoutcomes.ons.org by April 21, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to hematologic complications. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on cancer symptom management basics Additional Oncology Nursing Podcast episodes: Episode 181: Oncologic Emergencies 101: Febrile Neutropenia Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis Episode 234: Oncologic Emergencies 101: Thrombotic Thrombocytopenia Purpura ONS book: Cancer Basics (third edition) ONS course: Cancer Basics ONS Symptom Interventions for Prevention of Bleeding American Cancer Society patient education handouts: Low Red Blood Cell Counts (Anemia) Low Platelet Count (Bleeding) Low White Blood Cell Counts (Neutropenia) American Society of Clinical Oncology Answers fact sheets Centers for Disease Control and Prevention patient education on neutropenia Leukemia and Lymphoma Society patient education To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “The biggest complication is infection. You do not have the ability to present with the normal signs and symptoms of infection. You're not going to have redness and swelling and drainage. You're going to have more fever, hypertension, dysuria, shortness of breath, or cough.” Timestamp (TS) 07:22 “Some patients get really nervous if their blood counts get to a certain point. I find that we just try to explain to them, ‘We're watching your labs very frequently, we see you several times a week, these are the complications that can happen,' and talk them through the rationale for not giving a lot of maybe not necessary transfusions.” TS 15:15 “In general, the guidelines are if you expect a patient to have severe prolonged neutropenia, lasting greater than seven days, then you would want to consider giving them an antibiotic to help prevent neutropenic fever. . . . A high-risk patient would benefit from that.” TS 17:23 “Myelosuppression can delay chemotherapy, so patients who are getting treatment for their cancer may experience delays in their next cycle, they may have dose reduction, they may have to discontinue that chemotherapy if they have severe myelosuppression. That could affect their outcomes as far as their cancer treatment goes. Patients who are anemic—if you are fatigued and your legs feel heavy and you feel dizzy when you get up and you fall and your platelets are low as well, that leads to an increased risk of bleeding, and really a decrease in quality of life.” TS 23:30 “Myelosuppresion and cancer treatment in general does carry other toxicities besides the physical: emotional, mental, financial, and social.” TS 25:33 “For a patient with cancer, from diagnosis on, there's a lot that they can't control. When you're faced with that diagnosis, you want to really try to work to make that patient an active part of their care team. So, I think it's important to talk with a patient—understand that there are things out of their control, but there are things that are within their control. You can teach them how to manage fatigue associated with anemia or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best. Anything that you can let the patient have control over because their life has just changed dramatically.” TS 29:03 “Oncology nurses are wonderful at looking at the patient as a whole person. Keep in mind that there are financial toxicities as well as physical, emotional, and mental. So, it might create a bigger team of people that need to step in and help the patient find the resources that they need to be successful. Also, don't forget about the caregivers.” TS 33:47

“These policies, procedures, order sets, and algorithms for oncologic emergencies are so important. They give you knowledge in your back pocket: This is the way we're going to treat this, this is the way to quickly respond to this, and this is the way to treat this in the safest way possible,” ONS member Cassie Durand, MS, RN, CNS, AGCNS-BC, OCN®, clinical nurse specialist at Memorial Sloan-Kettering Cancer Center's Long Island, NY, regional site, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Durand discussed how to develop and apply procedures to care for patients with oncologic emergencies. This episode is part of a series of oncologic emergencies; the others are linked in the episode notes. You can also earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn .5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by December 9, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: At the conclusion of this podcast, the learner will report an increase in knowledge related to an institutional approach to preparing for oncologic emergencies. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ ONS Oncologic Emergencies Learning Library To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Nurses who are caring for these patients getting certain infusions have such a greater sense of autonomy. They can react in a moment's notice. You need to have an algorithm and order set in order to treat the patients so, so, so quickly.” Timestamp (TS) 07:28 “We know that following metrics is so important for checking adherence to our standards and, most importantly, for improving patient outcomes.” TS 08:23 “We all combine thoughts to figure out what the most relevant simulation would be for nurses in specific areas. The scenarios are very real-life mannequins—they're life-sized, they breathe, they talk, they have IV access, and they portray what we want them to. We load up the mannequin software before nurses come here. In our infusion unit, we'll have the mannequin portray a hypersensitivity reaction, and then, all of a sudden, they'll be in respiratory distress, and they may or may not code, just to keep the nurses on their toes. Because of all the preparation that goes into it on our end before the simulation is so relevant to their area, the nurses really like it because it's not random. We also hold a structured informal debrief, just like what we do in real life, after the simulation so we can ask questions, what went well, what didn't, and what we can change in the future. Simulation has become a huge aspect of our nursing education here.” TS 13:51 “We have a lot of new staff members on the floor, just like I'm sure that every institution has. So I think they really appreciate a debrief, because they can really learn so much from it. We call it a ‘hot debrief,' which means we're debriefing right after the event so that way we can get almost every member from our interprofessional group to stay and very quickly and succinctly talk about the event. That way, we're not chasing people down the next day or next shift to debrief. And we've seen some pretty good results.” TS 17:33 “We have a clinical nurse specialist (CNS) who is available 24 hours a day at our main campus site where all of our inpatient beds are. Nights, weekends—there's always one there. And they support the nurses and respond to emergencies. Our CNSs have such a great rapport with our staff members, and I find that the nursing staff always feel so comfortable now asking them questions, calling for help, wanting to show them something, or asking them to look up a policy for them. . . . As the CNS at the bedside, I think that sometimes when the nurses see us there, even just our presence there, it keeps them at ease during a critical situation because they know that we can jump in and help when needed. Our nurses do such a great job in emergencies, but I do think that having people in the CNS role there really just makes them feel so much more comfortable.” TS 23:13

“Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of thrombotic thrombocytopenia purpura (TTP),” ONS member Amanda Weatherford, MSN, RN, OCN®, clinical nurse coordinator at Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS in a conversation about nursing considerations to manage TTP. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. 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 myoutcomes.ons.org by November 18, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Upon completion of this activity, participants will report an increase in knowledge of thrombotic thrombocytopenia purpura. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ American Society of Hematology National Organization for Rare Diseases To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Immune or acquired thrombotic thrombocytopenia purpura (TTP) is the most common. It's 95% of all the cases. It is what we as nurses are most likely to encounter in our practice.” Timestamp (TS) 03:29 “TTP can show up in cancer and also as the result of chemotherapy and medications. They say it's either a system of malignancy or a consequence of treatment, and it has also shown up in patients who are post allogenic stem cell transplants.” TS 07:05 “Once you suspect that TTP is into play, you would immediately start the patient on plasma exchange or plasma pheresis, daily or twice daily, and also on high-dose steroids. You do that until you start to see improvement in platelet counts and some of the other hemolysis markers, like LDH.” TS 11:26 “Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of TTP.” TS 14:58 “In patients with cancer, TTP is either a symptom of disease or caused by the treatment. So, you could potentially just have a new patient with cancer and, along with this major, acute crisis that they've had, so dealing with a cancer diagnosis and having had TTP. Or trying to figure out if it was medication. How do we resolve that? Are we able to find a different drug and switch to a different regiment, or do we continue to give it because it's the only therapy? And do we have to continue to be on the lookout for relapse?” TS 17:47

“Consider your patient's diagnosis. What kind of cancer do they have? And ask yourself, ‘Could this patient be in disseminated intravascular coagulation (DIC)? Is there something more that we should be doing or looking at?'” Leslie Smith, RN, APRN-CNS, DNP, BMTCN®, AOCNS®, oncology clinical specialist at the National Institutes of Health in Bethesda, MD, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Smith discussed the nursing considerations for the management of DIC. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. 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 myoutcomes.ons.org by October 7, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ DIC Huddle Card ONS Prevention of Bleeding Symptom Intervention and Guideline UpToDate Information from Cleveland Clinic Information from the National Heart, Lung, and Blood Institute To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “If the D-dimer is high, that is indicative of a clotting issue occurring. So, the next step for the nurse would be to look for the lab or ask for an order—you can order a DIC panel in some institutions—but look at coagulation labs. And really care and support these patients. DIC is not a disease in itself; it is a symptom of a disease, it is a syndrome. And it's indicative of another problem occurring.” Timestamp (TS) 07:09 “In the chronic form, patients who live in a chronic inflammatory state—maybe from arthritis or whatever the process is—their coagulopathy will not be as severe as an acute form. They may have an elevated prothrombin time (PT) or partial thromboplastin time (PTT). Their platelets may be a little bit low and their fibrinogen may be just a little bit low, but it's not life-threatening. And in an acute stage of DIC, it is life-threatening.” TS 08:43 “If we are taking care of patients who have received CAR T cells, for example, nurses know to monitor for cytokine release syndrome, we're watching for fever, we're watching the C-reactive protein levels or the ferritin levels, and we're treating appropriately via tocilizumabs . . . preventing DIC that way. Patients who are at risk for developing sepsis. . . . watching for signs of impeding infection . . . . Those types of things can prevent DIC from occurring.”  TS 12:26 “I think it can be a little bit confusing for the nurse because they're vague symptoms. So, if you have a patient that is maybe thrombocytopenic, you could attribute, ‘Well, they have all this petechiae from their thrombocytopenia.' It's difficult. That's why you need to really draw a lab. . . . It is not just one lab or one sign or symptom that will diagnosis DIC. There's no one thing that tells you that the patient has DIC. You need to look at all the lab work to make that determination.” TS 14:15 “Nurses are going to support the patient with transfusions. . . . And this will help in an attempt to normalize the lab or at least get the factors and the platelets back up. And then treating the disease. . . . And then in addition, if the patient is infected or septic, administering the antibiotics.” TS 16:26 “DIC is often thought—especially by patients or family—that once you start that chemotherapy or the antibiotics, that the DIC will go away. That is not true. It can take days to weeks for the DIC to resolve itself. It's not something that is going to happen overnight. The patient will need to continue to be supported.” TS 18:13 “Consider what is the diagnosis of your patient. If they have cancer, what kind of cancer do they have? And ask the question to yourself, ‘Could this patient be in DIC? Is there something more that we should be doing or looking at?'” TS 19:22

From Cord Compression to Tumor Lysis Syndrome Do you freak out over oncologic emergencies like cord compression or tumor lysis syndrome? Join Dr. Aditi Singh (University of Pennsylvania, Abramson Cancer Center, @AditiSinghMD) for this comprehensive conversation on six commonly encountered oncologic emergencies we see in the hospital! Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | askcurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Cord Compression SVC Syndrome Malignant Obstruction Tumor Lysis Syndrome Blast Crisis Outro Credits Producer, Writer, Hosts: Meredith Trubitt, MD MPH; Monee Amin, MD Infographic and Cover Art: Caroline Coleman Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Associate Editor: Leah Witt, MD Showrunner: Matthew Watto MD, FACP Technical Production: PodPaste Guest: Aditi Singh, MD Sponsor: BetterHelp Visit BetterHelp.com/curb today to get 10% off your first month.   Sponsor: Indeed  Visit Indeed.com/internalmedicine to start hiring now.   Sponsor: Hello Fresh   Go to HelloFresh.com/curb65 and use code curb65 for 65% off plus free shipping.   

“I think that we as nurses need to advocate when a patient is uncomfortable. And it's not your classic ‘pain in my hip' kind of thing. This is a more subtle, ‘I can't breathe, I have a sense of impending doom, I'm panicked, I want someone beside me.' It may sometimes appear to be a psychosocial coping issue when it really is a physiologic one,” ONS member Brenda Shelton, DNP, RN, AOCN®, clinical nurse specialist at Johns Hopkins Medicine in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Shelton discussed the warning signs of superior vena cava syndrome and nursing considerations for its management. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. 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 myoutcomes.ons.org by September 2, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Complete this evaluation for free NCPD. Other Oncology Nursing Podcast episodes on oncologic emergencies Clinical Journal of Oncology Nursing articles: STAT: Superior Vena Cava Syndrome Superior Vena Cava Syndrome: An Education Sheet for Patients ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ Information from the National Cancer Institute Information from Cancer.net National Comprehensive Cancer Network Guidelines American Cancer Society To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Superior vena cava syndrome was first recognized with tuberculosis, and now it's almost exclusively going to occur in patients with cancer because it's physiologically the outcome of too much mass in between the sternum and the spine.” Timestamp (TS) 01:57 “You might see some very subtle right arm heaviness, edema; you might see a prominent right antecubital, or prominent veins on the hand of the right arm, or a prominent right jugular vein. But these are all things that can be subtle, and the patient may present with aching of the arm, numbness or tingling of that arm, just really things that don't necessarily raise your awareness because it's not the classic signs or symptoms you see in your textbooks.” TS 05:35 “When we think of superior vena cava syndrome, we associate it with upper body edema, particularly worse in the morning when somebody rises after having laid flat for all night. . . . But the thing that patients report the most is dyspnea. It is not necessarily entirely due to respiratory problems. In this case, it's due to compression of the vena cava and an alteration of the blood returned to the heart that leads to an altered cardiac output.” TS 06:45 “The three biggest life-threatening complications I think about are airway incompetence, cardiovascular collapse, and clotting. As you compress the vena cava, you are going to diminish the blood return into the heart, and this is going to compromise your ability to oxygenate that blood and put it back out the other side.” TS 08:46 “We always start with a total body assessment, and it's hard because this patient is going to present with potentially neurologic symptoms, cardiac and respiratory symptoms, as well as just generalized discomfort and constitutional symptoms. You know, we're so focused sometimes on febrile neutropenia and the very classic complications, that this one is a little more subtle. And so the nurse needs to be very comfortable with their cardiovascular assessment in general and be looking at vessels and be looking at jugular venous distention and pulsations.” TS 15:32 “I think that we as nurses need to advocate when a patient is uncomfortable. And it's not your classic ‘pain in my hip' kind of thing. This is a more subtle, ‘I can't breathe, I have a sense of impending doom, I'm panicked, I want someone beside me.' It may sometimes appear to be a psychosocial coping issue when it really is a physiologic one.” TS 17:16 “We often think of this as something that is a sign of terrible, bad, irreversible disease, when in fact, it could be the presenting symptoms.” TS 19:32

“It's actually the nurse who most often first identifies the subtle signs of sepsis in patients. Trust your clinical judgement,” ONS member Laura Zitella, MS, RN, ACNP-BC, AOCN®, nurse practitioner at the University of California, San Francisco, told listeners during a conversation with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Zitella explained the nursing and management considerations for febrile neutropenia and what to do if it transitions into sepsis. This episode is part of a series about oncologic emergencies; the previous episodes are also linked below. You can also earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. 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 myoutcomes.ons.org by August 12, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies Clinical Journal of Oncology Nursing articles: Sepsis: Symptoms, Assessment, Diagnosis, and the Hour-1 Bundle in Patients With Cancer NEWS Scoring System: Use in Hematologic Malignancies and Cellular Therapeutics Patient Populations Febrile Neutropenia: Decreasing Time to Antibiotic Administration in a Community Hospital Emergency Department ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ International Guidelines for Management of Sepsis and Septic Shock National Comprehensive Cancer Network guidelines on prevention and treatment of cancer-related infections Sepsis Alliance Surviving Sepsis Campaign To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “We know that fever and neutropenia in combination needs to be treated immediately. This is a high-risk oncologic emergency. Our patients who have febrile neutropenia are at very high risk of having a severe infection or sepsis.” Timestamp (TS) 03:44 “Patients with cancer are at an increased risk for infection because of the inherent immunosuppression of the cancer itself and also the treatment.” TS 08:28 “There are some very, very basic things that patients can do [to decrease risk for infection]. The most important is good handwashing. I explain to patients that your skin is the best barrier against getting an infection. If there's no break in the skin, then infection cannot get in. So, if your hands get contaminated and you wash them before you touch your eyes or your mouth or your nose, then that is a good way to prevent infection.” TS 11:42 “Even if a patient does everything perfect, most of the time when you're neutropenic, the infections that develop come from endogenous organisms. So, our body is colonized with probably 10 times as many microbes as human cells, and when the immune system is suppressed, it allows these organisms sometimes to cause infection. So, it's very important for patients to know that if they have signs of infection that they should let us know so that we can start immediate treatment to treat the infection.” TS 14:01 “If patients are higher risk or they have any organ dysfunctions, or other symptoms—like they're unwell, nausea, vomiting, diarrhea, any symptoms like that—they should be admitted to the hospital, and we would initiate IV antibiotics.” TS 17:37 “It's actually the nurse who's most often the person that first identifies sepsis in patients, so I think it's really important to trust your clinical judgement. When you look at a patient, it's really easy to tell when something is wrong. When they're starting to breathe too heavy or they're a little bit off and they're starting to get some altered mental status, or suddenly their heart rate is elevated for no reason even though they're just lying in bed. So, nurses are really positioned and are most often the ones who first pick up on these subtle signs.” TS 27:17

“Sometimes in our daily routine of taking care of patients, it's more about looking at the treatment side effects. But look at those wide array of symptoms that can present with an oncologic emergency. They will kind of sneak up on you, and as an oncology nurse, we all need to be educated about them,” ONS member Diane Cope, PhD, APRN, BC, AOCNP®, director of nursing and oncology nurse practitioner at Florida Cancer Specialists and Research Institute in Fort Myers told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. During this episode, Cope explained the clinical manifestations associated with syndrome of inappropriate antidiuretic hormone (SIADH) and its medical and nursing interventions. The episode is part of a series about oncologic emergencies; the previous episodes are linked below. You can also earn free NCPD contact hours by completing the evaluation linked below. 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 myoutcomes.ons.org by July 1, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS Huddle Card™: Hormone Therapy ONS books: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition) Clinical Journal of Oncology Nursing articles: STAT: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Syndrome of Inappropriate Antidiuretic Hormone Secretion in Malignancy: Review and Implications for Nursing Management Hyponatremia and SIADH: A Case Study for Nursing Consideration To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

When it comes to oncologic emergencies, early identification and intervention achieves the best outcomes, but some emergencies are harder to recognize. “Oncology nurses are often the first to pick up on important symptoms of serious complications,” Laura Zitella, MS, RN, ACNP-BC, AOCN®, nurse practitioner at the University of California, San Francisco, said. Zitella joined Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to talk about recognizing less common complications seen in patients with cancer, such as adrenal crisis, pulmonary embolism, and malignant small bowel obstructions. She also presented on the topic at the 47th Annual ONS Congress® in Anaheim, CA, on April 27, 2022. The advertising messages in this episode are paid for by Breast Cancer Index. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes Check out these resources from today's episode: NCPD contact hours are not available for this episode. Learn more about Laura's session at ONS Congress, and watch it on demand from May 23–June 30, 2022, to earn 2.00 NCPD contact hours. Clinical Journal of Oncology Nursing articles: Chronic Obstructive Pulmonary Disease: Clinical Implications for Patients With Lung Cancer Adrenal Insufficiency: Immune Checkpoint Inhibitors and Immune-Related Adverse Event Management ONS Voice article: The Case of the Post-Transplant Pulmonary Problem ONS Immunotherapy Wallet Cards ONS Guidelines™ for Opioid-Induced and Non–Opioid-Related Cancer Constipation Society for Immunotherapy of Cancer Clinical Practice Guideline on Immune Checkpoint Inhibitor–Related Adverse Events Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update NCCN Guidelines for Patients: Immune Checkpoint Inhibitors To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

“We call it an oncologic emergency for a reason. Even though it's usually not life threatening, the longer we wait, the more debilitating and devastating the side effects will be,” ONS member Jennifer Webster, MN, RN, AOCNS®, MPH, clinical nurse specialist at Northside Hospital in Atlanta, GA, and member of the Metro Atlanta ONS Chapter, said during her conversation with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. The nurses talked about the importance of early identification and intervention for malignant spinal cord compression and other nursing considerations for the oncologic emergency. This episode is a part of a series about oncologic emergencies; the previous episodes are linked below. You can also earn free NCPD contact hours by completing the evaluation linked below. 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 myoutcomes.ons.org by June 3, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS Huddle Card™: Spinal Cord Compression ONS books: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)  Clinical Journal of Oncology Nursing articles: STAT: Spinal Cord Compression Back Pain: Is It Spinal Cord Compression? Nurse, My Back Hurts: Understanding Malignant Spinal Cord Compression Oncology Nursing Forum article: Oncology Emergency Modules: Spinal Cord Compression American Cancer Society information on bone metastasis and spinal cord compression Leukemia and Lymphoma Society information on multiple myeloma and spinal cord compression Bone Health & Osteoporosis Foundation To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Dr. Janhavi Athale is a Critical Care physician and Hematologist/Oncologist at Mayo Clinic in Phoenix, Arizona. She presents a lecture on important "Hematologic and Oncologic Emergencies" as part of the DC5 lecture series.

ONS member Roberta Kaplow, RN, PhD, CCRN, AOCNS®, clinical nurse specialist at Emory University Hospital in Atlanta, GA, and member of the Metro Atlanta ONS Chapter, talks with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, about the latest nursing management and prevention strategies for malignant pleural effusion. This episode is a part of a series about oncologic emergencies; the previous episodes are linked in the episode notes. You can also earn free NCPD contact hours by completing the evaluation linked in the episode notes.    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 myoutcomes.ons.org by May 13, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Episode Notes  Check out these resources from today's episode:  Complete this evaluation for free NCPD.  Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Journal of Oncology Nursing articles about malignant pleural effusion American Thoracic Society's malignant pleural effusion patient education sheet Pleural catheter patient education video (from manufacturer) Pleural catheter provider information (from manufacturer)  The podcast conversations represent the guest's ideas and opinions and not necessarily those of ONS. Mention of specific products and opinions related to those products does not indicate endorsement by ONS.   To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Elevated intracranial pressure is a life-threatening cancer complication, but oncology nurses can take steps to prevent and recognize it in their patients. ONS member Mary Elizabeth Davis, DNP, RN, AOCNS®, clinical nurse specialist at Memorial Sloan Kettering Cancer Center in New York, NY, and member of the New York City ONS Chapter, talks with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, about the latest nursing strategies for increased intracranial pressure, a situation that can occur with a brain tumor, abscess, infection, or other conditions that increases or obstructs cerebrospinal fluid or blood flow in the brain. This episode is part of a series about oncologic emergencies; the previous episodes are linked in the episode notes. You can also earn free NCPD contact hours by completing the evaluation linked in the episode notes.  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 myoutcomes.ons.org by April 15, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcastepisodes on oncologic emergencies Oncology Nursing Forum article: Early Identification of Intracranial Hemorrhage Using a Predictive Nomogram ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses(third edition) ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies ONS course: Treatment and Symptom Management—Oncology RN ONS Huddle Cards™ American Association of Neuroscience Nurses American Brain Tumor Association To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Cardiac tamponade typically presents gradually over time, and it can happen multiple times throughout a patient's cancer care journey. Oncology nurses must stay cognizant of the warning signs and management approaches. ONS member Roberta Kaplow, RN, PhD, CCRN, AOCNS®, clinical nurse specialist at Emory University Hospital in Atlanta, GA, and member of the Metro Atlanta ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss the latest nursing management and prevention strategies for cardiac tamponade. This episode is part of a series about oncologic emergencies; the previous ones are linked in the episode notes. 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 myoutcomes.ons.org by March 18, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies Clinical Journal of Oncology Nursing article: Cardiac Toxicity Related to Cancer Treatment Oncology Nursing Forum article: Cardiovascular Emergencies: Pericardial Effusion and Cardiac Tamponade ONS book: Cardiac Complications of Cancer Therapy ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies ONS course: Treatment and Symptom Management—Oncology RN ONS Huddle Cards™ American College of Cardiology information on water bottle heart National Comprehensive Cancer Network guidelines for patients To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Early detection of bleeding directly affects survival rates for patients with cancer, but oncology nurses can improve outcomes by providing education and treatment for oncologic emergencies like thrombosis. ONS member Carrie Moore, MSN, OCN®, NE-BC, nurse manager at the Medical University of South Carolina in Charleston, and member of the South Carolina Low Country ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss bleeding disorders and thrombosis and their current management and treatment strategies. This episode is part of a series about oncologic emergencies; the previous episodes are linked in the episode notes. 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 myoutcomes.ons.org by February 25, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS Voice article: Hematologic Cancers Have Higher Long-Term Risk of Clots and Bleeding ONS Voice article: Manage Thrombosis in Patients With Cancer Clinical Journal of Oncology Nursing article: Cancer-Associated Thrombosis: Improving Patient Adherence to Low-Molecular-Weight Heparin Therapy Clinical Journal of Oncology Nursing article: Putting Evidence Into Practice: Prevention and Management of Bleeding in Patients With Cancer Clinical Journal of Oncology Nursing article: Thrombosis: Risk Factors Among Pediatric Patients With Cancer ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies ONS course: Treatment and Symptom Management—Oncology RN ONS Huddle Cards™ American Cancer Society information on blood clots Centers for Disease Control and Prevention information on venous thromboembolism Leukemia and Lymphoma Society To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Today on MedNet21, we're going to discuss Oncologic Emergencies.

Hypercalcemia of malignancy (HCM) affects about 30% of all patients with cancer. Patients with breast cancer that has metastasized to bone and patients with squamous cell lung cancer together account for more than half of all HCM cases. ONS member Marcelle Kaplan, RN, MS, CNS, CBCN®–Emeritus, AOCN®–Emeritus, breast oncology clinical specialist and member of the Long Island/Queens ONS Chapter, and Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, discuss hypercalcemia of malignancy and its current treatment strategies. This episode is part of a series about oncologic emergencies; the other episodes are linked in the episode notes. 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 myoutcomes.ons.org by January 28, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS Voice article: Diagnose and Treat Hypercalcemia of Malignancy ONS Voice article: Oncology Nurses' Role in Recognizing and Addressing Oncologic Emergencies Clinical Journal of Oncology Nursing article: Hypercalcemia of Malignancy: Part I Clinical Journal of Oncology Nursing article: Hypercalcemia of Malignancy: Part II ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS course: Oncologic Emergencies ONS course: Treatment and Symptom Management—Oncology RN Journal of Oncology Practice article: Cancer-related hypercalcemia To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net.Today on the emDOCs cast with Brit Long, MD (@long_brit),  we cover two more oncologic emergencies, including tumor lysis syndrome and neutropenic fever. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

ONS member Diane Cope, PhD, ARNP-BC, AOCNP®, director of nursing and oncology nurse practitioner at Florida Cancer Specialists and Research Institute in Fort Myers, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss tumor lysis syndrome and its current prevention and management strategies. This episode is part of a series about oncologic emergencies; the previous episodes are also linked in the episode notes. The advertising messages in this episode are paid for by clonoSEQ.  Episode Notes  Check out these resources from today's episode:  NCPD contact hours are not available for this episode.  Previous Oncology Nursing Podcast episodes on oncologic emergencies  ONS Voice article: What Oncology Nurses Need to Know About Tumor Lysis Syndrome  Clinical Journal of Oncology Nursing article: Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes  Clinical Journal of Oncology Nursing article: STAT: Tumor Lysis Syndrome  ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses third edition   ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider   ONS course: Treatment and Symptom Management—Oncology RN  JAMA Oncology patient page on tumor lysis syndrome  Medscape information on managing tumor lysis syndrome  UpToDate information on preventing and treating tumor lysis syndrome  To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. 

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover several oncologic emergencies, including SVC syndrome, malignant pericardial effusion, malignant spinal cord compression, and hypercalcemia. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

ONS member Susan Bruce, MSN, RN, AOCNS®, clinical nurse specialist at Duke Raleigh Cancer Center in North Carolina and member of the North Carolina Triangle ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss febrile neutropenia and nursing considerations for its management and prevention. This episode is part of an ongoing series about oncologic emergencies; the previous episode is linked in the episode notes. The advertising messages in this episode are brought to you by G1 Therapeutics, Inc.  Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes Check out these resources from today's episode: NCPD contact hours are not available for this episode. Oncology Nursing Podcast Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome ONS Voice article: Oncology Nurses' Role in Recognizing and Addressing Oncologic Emergencies ONS Voice article: ONS Members See Beyond Barriers and Understand Benefits of Guidelines ONS Voice article: Put Evidence Into Practice to Prevent Infection Clinical Journal of Oncology Nursing article: Febrile Neutropenia: Decreasing Time to Antibiotic Administration in a Community Hospital Emergency Department ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS Communities thread on febrile neutropenia and COVID-19 ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider  ONS course: Treatment and Symptom Management—Oncology RN ONS Putting Evidence Into Practice resources on prevention of infection for general and post-transplant patient populations American Society of Clinical Oncology guidelines on febrile neutropenia Surviving Sepsis campaign To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

ONS member Theresa Latchford, RN, MS, AOCNS®, BMTCN®, clinical nurse specialist at Stanford Health Care in Palo Alto, CA, and member of the Silicon Valley ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss cytokine release syndrome and its associated immunotherapies. This episode is part of a new series about oncologic emergencies. We'll add a link to future episodes in the show notes after the second episode next month. 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 myoutcomes.ons.org by October 8, 2023. Theresa Latchford discloses receiving a speaker honoraria from Kite Gilead and Bristol Myers Squibb. The financial relationship has been mitigated. No other planners or faculty members have anything to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. ONS Voice article: A Body of Evidence Helps Nurses Manage CAR T-Cell Therapy Toxicities ONS Voice article: Learn the Nursing Considerations for Cytokine Release Syndrome ONS Voice article: Nurses Help Patients Weather the Storm of CAR T-Cell Therapy ONS Voice article: Oncology Drug Reference Sheet: Tocilizumab Clinical Journal of Oncology Nursing article: Cytokine-Release Syndrome: Overview and Nursing Implications Clinical Journal of Oncology Nursing STAT sheet on cytokine release syndrome ONS clinical practice resource on cytokine release syndrome ONS course: Essentials in Oncologic Emergencies for the Advanced Practice Provider  ONS video: Cytokine Release Syndrome BMT Infonet Leukemia and Lymphoma Society 2021 study on cytokine release syndrome and associated neurotoxicity in cancer immunotherapy To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Oncologic EmergenciesSpecial Guest: Siu Yan Amy Yeung, PharmD, BCPS, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2021/02/oncologic-emergencies-show-notes-1.pdf Reference List: https://pharmacytodose.files.wordpress.com/2021/02/oncologic-emergencies-references.pdf 06:00 – Oncologic emergency overview; 10:12 – Tumor lysis syndrome; 46:40 – Hypercalcemia of malignancy; 67:12 – Superior vena cava syndrome; 75:05 – Take-home points PharmacyToDose.Com@PharmacyToDose on Twitter/InstagramPharmacyToDose@Gmail.com

A look at oncology-related emergencies in the ICU, with Leon Chen (@CCMNP), NYC nurse practitioner specializing in oncology critical care. Takeaway lessons Extremely elevated leukocyte count should always raise suspicion for a “liquid tumor” such as leukemia. The principal acute complication is leukostasis from poor flow, potentially causing hyperviscosity issues such as stroke, MI, pulmonary … Continue reading "Episode 18: Oncologic emergencies with Leon Chen"

In this episode of Run the List, Walker Redd (host) and Jakub Glowala (case presenter) talk with Dr. Rebecca Zon, a hematology/oncology fellow in the Dana-Farber/Mass General Brigham program, about solid oncologic emergencies. We learn to think anatomically about where tumors arise, where they may subsequently present, and how that can clinically manifest in an emergent situation. They then focus in on neurologic complications of solid malignancies and discuss how to triage, manage, and consult with other medical and surgical teams to provide rapid care to these patients. The episode then closes with clinical pearls from Dr. Walker Redd who highlights the need to quickly assess the severity of the patient in these contexts. https://www.runthelistpodcast.com/hematologyoncology/#onc-emergencies

Each month, EMedHome.com presents EMCast, the 90-minute podcast hosted by Dr. Amal Mattu, the premier educator in Emergency Medicine. Subscribe to EMedHome.com for an array of clinical content that will impact every shift. This month's EMCast covers:(1) Compartment Syndrome(2) Post-Bariatric Surgery Complication(3) Oncologic Emergencies

Happy February everyone! The emergency medicine in-training exam is next week and we want to make sure you get a great score by covering 2% of the test in 30 minutes. Yes, yes, you’re welcome.   Now oncology is not a huge part of the exam but cancer patients are a common occurrence in the ED. Our biggest plea is that you be aware of the specific emergencies that relate to cancer and look for them. You can always phone your friendly neighborhood oncologist for help, but recognition is the first step in management.   Best of luck on the test!   The AZEMCast Team  Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast   https://itunes.apple.com/us/podcast/arizona-emcast/id685439303?mt=2 https://azemcast.podbean.com/feed/

Don't miss this high yield review of acute oncologic care needs!

A conversation with Christopher Coyne, MD to discuss Oncologic Emergencies in the ED. Dr. Coyne is an Assistant Professor of Emergency Medicine at UC San Diego Dr. Coyne's interests include critical care, resuscitation, and EMS.

Author: Rachel Brady, MD Educational Pearls: Hypercalcemia of malignancy: Hypercalcemia of malignancy can present with lethargy, muscle weakness, hyperreflexia, altered mental status, cardiac dysrhythmias, and even cardiac arrest. Treatment is based both on calcium level and symptoms Intravenous rehydration is first line treatment Other options include steroids, bisphosphonates and calcitonin.  Tumor Lysis Syndrome Occurs due to the breakdown of tumor cells after chemotherapy/radiation Presents as hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia Treatment is very similar to severe hypercalcemia - hydration with crystalloids Hyperuricemia can be treated using rasburicase or allopurinol   References: Ñamendys-Silva SA, Arredondo-Armenta JM, Plata-Menchaca EP, Guevara-García H, García-Guillén FJ, Rivero-Sigarroa E, Herrera-Gómez A. Tumor lysis syndrome in the emergency department: challenges and solutions. Open Access Emerg Med. 2015 Aug 20;7:39-44. doi: 10.2147/OAEM.S73684. eCollection 2015. Review. PubMed PMID: 27147889; PubMed Central PMCID: PMC4806807. Zagzag J, Hu MI, Fisher SB, Perrier ND. Hypercalcemia and cancer: Differential diagnosis and treatment. CA Cancer J Clin. 2018 Sep;68(5):377-386. doi: 10.3322/caac.21489. Epub 2018 Sep 21. Review. PubMed PMID: 30240520.   Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD  

The purpose of this podcast is to facilitate ongoing learning for early recognition, diagnosis, and management of oncologic emergencies in the palliative care setting.

This 123rd episode of CRACKCast covers Rosen’s 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself.

This 123rd episode of CRACKCast covers Rosen’s 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself.

PEM Fellow Claudia Talks Pediatric Oncologic Emergencies by Maricopa Emergency Medicine Podcast

John Patlan, M.D., Associate Professor, General Internal Medicine

John Patlan, M.D., Associate Professor, General Internal Medicine

In this episode on Oncologic Emergencies Dr. John Foote (University of Toronto's CCFP(EM) residency program director) and Dr. Joel Yaphe (the director of the University of Toronto's Annual Update in Emergency Medicine conference in Whistler), review 5 important presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome. The post Episode 33: Oncologic Emergencies appeared first on Emergency Medicine Cases.

In this episode on Oncologic Emergencies Dr. John Foote (University of Toronto's CCFP(EM) residency program director) and Dr. Joel Yaphe (the director of the University of Toronto’s Annual Update in Emergency Medicine conference in Whistler), review 5 important presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome. The post Episode 33: Oncologic Emergencies appeared first on Emergency Medicine Cases.

As bonus to Episode 33 on oncologic emergencies, Dr. John Foote, the CCFP(EM) residency program director at the University of Toronto tells us about his Best Case Ever in which he missed an important cancer-related diagnosis. In the related episode with Dr. Foote and Dr. Joel Yaphe, we will review 5 common presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome. The post Best Case Ever 16: Oncologic Emergencies appeared first on Emergency Medicine Cases.

As bonus to Episode 33 on oncologic emergencies, Dr. John Foote, the CCFP(EM) residency program director at the University of Toronto tells us about his Best Case Ever in which he missed an important cancer-related diagnosis. In the related episode with Dr. Foote and Dr. Joel Yaphe, we will review 5 common presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome. The post Best Case Ever 16: Oncologic Emergencies appeared first on Emergency Medicine Cases.

Charissa Cordon talks to ecancer at ICCN 17 in Prague about the development of the Oncologic Emergencies course and the importance of understanding adult learning principles. Originally offered as a two-day workshop, the course built on foundational knowledge where newly hired nurses, as well many experienced nurses, learnt how to identity risk factors not normally seen in their specific field. In total eleven different emergency areas were discussed. Because many nurses wanted to attend but could not due to various limitations such as nursing shift schedules, staffing issues, presenter availability and physical space , the workshop was developed into an educational module that was made available online, thus making it more accessible for nurses. Ms Cordon also talks about importance of elearning formats and accessibility, as well as her presentation on adult learning principles for designing the course.

Deborah A. Boyle RN, MSN, FAAN Magnet Coordinator and Practice Outcomes Nurse Specialist Banner Good Samaritan Medical Center Phoenix, AZ

Deborah A. Boyle RN, MSN, FAAN Banner Good Samaritan Medical Center, Phoenix, AZ