The ONS Podcast

"A good way of thinking about this is this is the survival of the fittest clone. There could be a portion of a cancer that naturally has some resistance or ability to survive a particular drug. And over time, as the other cells around it are dying off, that particular clone is able to replicate and continue to survive in the face of that drug therapy and eventually take over as being the fittest clone. At that point, we're often seeing disease progression," Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services at the Allegheny Health Network Cancer Institute in Pittsburgh, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about resistance pathways. 
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.5 contact hours of nursing continuing professional development (NCPD), including 30 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by August 7, 2027. Roman has served on advisory boards for Genetech, Pfizer, Regeneron, and Daiichi Sankyo and received honoraria payments from Pharmacy Times and Decera for faculty lectures. These financial relationships have been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report increased knowledge related to resistance pathways in oncology care.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Pharmacology 101 series
Episode 423: Pharmacology 101: Interaction Pathways
Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices

ONS Voice articles: Predictive and Diagnostic Biomarkers
Scientists Identify Protein Implicated in Tumor Growth, Treatment Resistance

ONS book: Guide to Cancer Immunotherapy (second edition)
Genomics and Precision Oncology Learning Library
ONS Biomarker Database
Pharmacogenomics Huddle Card
CancerQuest: Cancer Drug Resistance
National Comprehensive Cancer Network
OncoKB.org
Research To Practice
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
"As we look at drug resistance, this is the concept that cancer cells are no longer able to respond to a cancer treatment. The downstream of this is that we could end up with progression of the disease and need to look at alternative therapies that may be beneficial for the patient. This is unfortunately a very common phenomenon. Drug resistance is a major cause of treatment failure and poor patient outcomes with treatments. Unfortunately, this is an issue we see that increases over time on treatment." TS 2:29
"Genetics play a really big role in drug resistance. We know that drug resistance can be due to different things. It could be epigenetics. It could be the tumor microenvironment factors. But genetics often play a very big role in resistance pathways. It's generally considered to be a critical contributor to resistance, particularly in the way of acquired variants to drug targets or amplifications of certain oncogenes that can lead cancers to have progression. A well-known genetic alteration is the BRCA1/BRCA2 variant that helps to make the cancer more efficient at fixing DNA damage. So we're trying to get DNA damage with chemotherapy, and this particular variant helps at fixing that damage to allow the cancer to progress. So that is one genetic variant we see that plays a big role in a number of different cancers." TS 4:51
"These pathways are not mutually exclusive. Oftentimes we have multiple resistance pathways involved. I think it's important to understand some of those individually, but kind of thinking about this as we might be facing multiple resistance pathways. ... We can see resistance mechanisms that vary based on the type of treatment we use, for example, traditional cytotoxic chemotherapy. We may be more likely to see some resistance mechanisms that are working at DNA: repairing broken DNA or working on those efflux pumps that are being used to push chemotherapy out of cells. If we're talking more about the targeted therapies such as tyrosine kinase inhibitors or monoclonal antibodies, we may be more likely to see resistance mechanisms that are what we discussed with that drug target alteration: changing the way that the target agents are able to bind to the tumor cells to activate or inactivate pathways so we may see some changes there." TS 12:39
"One way to overcome this and to help to decrease the resistance from developing is using combination therapy: drugs that are targeting different pathways at once or potentially using combinations with things like chemotherapy in addition to immunotherapy. In this way, as we're getting these different targets, we can hopefully decrease the mechanism of resistance that may be developing." TS 14:48
"Biomarker testing is an incredibly important part of our practice. In many situations now, we are getting upfront, comprehensive biomarker testing to identify whether the patient may have any of those intrinsic or primary resistance mechanisms that might make it so a patient is never going to respond to a particular type of treatment. And in that case, we can spare the patient from the potential toxicities of that treatment if we don't think that there's going to be benefit there. So I think that that has become a really important way that we can tailor patients for understanding what treatments are going to be more effective. And then after that, there's usually additional biomarker testing that may be warranted at the time of progression in certain types of cancer. And that really helps us to understand that acquired resistance that might be developing." TS 17:32
"Nurses are really helpful with filling in the gaps and bringing back patient concerns that might be shared with them. And these might be early signs of progression. Better understanding how our patients are feeling and what's going on with them may help us to identify a patient that we need to do some additional testing for to understand whether there is drug resistance ongoing and potential progression of disease." TS 21:52

"When people with PTSD [post-traumatic stress disorder] get quite avoidant—and that can be expressed in so many different ways—the implications can be really profound. I think an important invitation to oncologists and oncology nurses and primary care providers who care for people battling cancer is let's explore what's underneath these avoidant behaviors. Is it a very practical thing? Or is it that underneath this avoidant behavior is really profound fear?" James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about addressing medical trauma in oncology.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 31, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to medical trauma in oncology care.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Episode 421: Medical Trauma in Oncology
Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
Episode 264: Stop the Stressors and Improve Your Mental Health as a Nurse
ONS Voice articles:
Help Caregivers Control the Chronic Stress of Cancer Care and Manage PTSD [post-traumatic stress disorder]
Past Trauma Lowers Hope, QOL, and Coping Ability During Cancer
Managing Cancer-Related PTSD Starts With Acknowledgement
Moral Injury and Trauma in Nursing
Trauma-Informed Care Provides Person-Centered Support for Patients During Deep Distress
Clinical Journal of Oncology Nursing articles:
How Can a Trauma-Informed Care Approach Be Applied to Patients With Gynecologic Cancer?
Psychosocial Barriers to Care: Recognizing and Responding Through a Trauma-Informed Care Approach
Oncology Nursing Forum articles:
Post-Traumatic Distress and Symptom Experience in Patients With Head and Neck Cancer–Related Tracheostomy and Family Caregivers
The Effect of Neuroticism, Fear of Progression, and Self-Efficacy on Post-Traumatic Growth in Patients With Lung Cancer Undergoing Chemotherapy
The Relationship Between Colorectal Cancer Survivors' Positive Psychology, Symptom Characteristics, and Prior Trauma During Acute Cancer Survivorship
ONS course: Psychosocial Dimensions of Cancer Care™
ONS Huddle Card: Coping
Screening tools
Clinician-Administered PTSD Scale for DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, 5th edition] (CAPS-5)
Hospital Anxiety and Depression Scale
Primary Care PTSD Screen for DSM-5
PTSD Checklist for DSM-5
Trauma Screening Questionnaire
International Society for Traumatic Stress Studies: Free Resources
PESI
Reclaiming Your Life From Medical Trauma by James C. Jackson
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"For many people who have been traumatized, if they can avoid it, they will. They may not avoid the annual evaluation that is so hugely consequential—they might not avoid that. But they may well avoid a routine visit for a checkup to their oncologist. They very well may avoid a visit with a psychologist who is wanting them to talk about hard things. They may avoid visiting a friend in the hospital because it reminds them of really upsetting things. So, this issue of adherence and compliance is a really big problem." TS 3:19
"Screening tools for things like PTSD can be very useful. They're quite practical, and they're appropriate to use. I really like something called the Post-Traumatic Stress Disorder Checklist. ... Using it is going to be very straightforward. You're going to want to map it onto a 30-day window, and you're going to employ it with patients. It's a 20-item self-report. It assesses 20 DSM-5 symptoms of PTSD. It's not diagnostic, but if people score in this range of 30, 31, 33, we typically are going to believe that that is very suggestive of significant PTSD." TS 9:17
"One of the things we should be doing all the time is modeling and attempting to normalize this idea of being open about mental health difficulties. When I say modeling, this is a complicated issue. ... I'm very open talking about my own battles with mental health. And in some ways, that invites my patients to do the same. I don't recommend necessarily that a nurse says, 'Oh, by the way, I have PTSD. I'm going to tell you about mine. I want you to tell me about yours.' That's a boundary issue. But I think it does behoove us as clinicians to create a culture as much as we're able, where we can talk about mental health difficulties in a matter-of-fact way, acknowledging that mental health is health. These tools, to me, go a long way in that direction." TS 13:41
"The survivorship process is ongoing. I think a nurse can assist a patient in so many ways longitudinally over time. ... One of those ways is to continue checking on mental health outcomes in patients. Continuing to check on mental health outcomes, continuing to explore them, and continuing to invite patients to talk about things that other people might not be asking about. It's easy for family members to assume, 'Hey, you know, you're cancer free now. You look fine, so you must be fine.' It's very possible that the patients we're talking about are not fine. They're far from fine. For that oncology nurse at a follow-up clinic or in an oncology setting to talk about this, continuing to affirm that it would be okay for patients to struggle, continuing to put this issue on a front burner—I think that's really important." TS 21:17
"I'm aware of nurse-led support groups where nurses can talk very freely about their own challenges, in a safe space. ... Working to build cultures in the context of the intensive care unit, let's say, where we have a lot of patients with cancer that prioritize well-being nurse driven programs. ...  The bottom line is if there is a warning light that is blinking, nurses need to attend to that. And in attending to it, they're going to be more present for their patient. They're going to be better able to support their patient. They're going to be better able to support each other. And I think often, in the culture of nursing and psychology, too, people just put their head down, their shoulder down, and they just plow through in ways that are really counter to their mental health." TS 29:56
"The truth is medical trauma can be well-managed. It's not simple. It's not always intuitive. There are all sorts of caveats with regard to this, but the truth is people with medical trauma can live really rich and meaningful lives. ... So, the default setting, I think, should be not one of pessimism. It should be that people with medical trauma can and do get better. If you are a patient with medical trauma and you are in my purview, until proven differently, I'm going to assume that you can get better too." TS 36:28

"In oncology specifically, where care is complex, artificial intelligence (AI) can really synthesize large volumes of clinical information, flag risks such as treatment complications, and support adherence to evidence-based pathways. For nurses specifically, this enables them more time for direct patient care, clinical judgment, and care coordination, and really practice to the top of their license while reducing repetitive time and administrative tasks," Jenn Frith, DNP, RN, OCN®, NE-BC, associate vice president of clinical operations at Duke Cancer Institute in Durham, NC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS. Weimer spoke with Frith and Emily Norboge, director of clinical and research informatics at Duke Cancer Institute, about how AI can help healthcare organizations improve the cancer experience. 
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 24, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the use of artificial intelligence in oncology nursing practice.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 284: How AI Is Influencing Cancer Care and Oncology Nursing
Episode 281: Nursing's Role in AI in Health Care

ONS Voice articles: Human Connection Creates the Power Behind AI in Nursing
If You're Using AI in Health Care, Your Patients Want to Know
Majority of Adults Use AI, But Most Distrust Accuracy of Health Information
Nurses Are Key to Quality for AI Tools in Oncology Care
One-Third of Hospitals Have Integrated Generative AI Into EHRs, With More to Follow

Clinical Journal of Oncology Nursing articles: A Case for Caution: Patient Use of Artificial Intelligence
Artificial Intelligence in Oncology Nursing: Preparing the Workforce for the Future
Artificial Intelligence: Basics, Impact, and How Nurses Can Contribute
Integrating Artificial Intelligence Into Cancer Care: Enhancing Nursing Practice and Bridging Disparities

Oncology Nursing Forum article: Artificial Intelligence for Oncology Nursing Authors: Potential Utility and Concerns About Large Language Model Chatbots
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
Norboge: "Our AI voice agent has a series of workflows that it can execute. ... If a patient needs help with medical paperwork, the agent will walk the patient through how to do that paperwork. If a patient has a question that they need sent to their provider, it can document that and then send a message to the provider. There's a series of workflows so it can route to scheduling. It can answer information about test results that is compliant with our policy around test results. The goal of that agent is that it will handle all of those administrative-type tasks that don't necessarily require a nurse to fill." TS 5:44
Norboge: "When [patients] call the nurse triage line, the nurse will have to say, 'I understand you want your test results. I can contact your provider and have them reach out to you about your results.' But that's kind of where it ends. What we worked out with the agent is if a patient calls and says, 'I really want my test results,' they will in a very nice, standard way, say something similar. You know, 'I'm not authorized to discuss your test results with you, but I'd be happy to send a message to your provider and ask them to call you.' But then the agent goes one step further and says, 'Are you experiencing anxiety about your test results? If so, I can transfer you to the nurse to discuss support for a potential referral to family medical therapy if you would like help managing that anxiety.' In a clear, helpful way, it can define and help a patient with their needs and not just have a standard of 'this is our policy and I can't share it with you.'" TS 11:14
Frith: "Really, transparency is the key. The patient should understand that AI is used more as an enhancement, but not to replace the human connection. That's not the goal. The nurses can explain that the tools will help ensure accuracy, timeliness, and safety while allowing more time for the direct interaction of the nurse. I think framing AI as an additional layer of support rather than a decision maker helps build trust. And I think maintaining strong communication and presence at the bedside just reinforces that care remains fundamentally human." TS 15:32
Frith: "I think AI in oncology is going to continue to advance in our predictive analytics, personal care planning, and probably real-time decision support. I think we'll see a greater integration into symptom management, some early detection of complications, and longitudinal care coordination across our settings. I think nurses will continue to increasingly use AI to anticipate patient needs and prioritize care. I think the role of the nurse won't diminish. Rather, it will become more elevated in allowing them to practice to scope of practice." TS 19:58
Frith: "AI represents a meaningful opportunity to strengthen oncology nursing practice by reducing burden and enhancing the clinical insight. It needs to be a very thoughtful implementation. We talked about having strong governance and continued investment in the nursing workforce. I want to reinforce that oncology care remains deeply human, and AI should only be viewed as a tool that enables the nurses to do what they do best, which I feel is deliver safe, compassionate, and high-quality specialized care to our most vulnerable patients." TS 27:31

"Think about what organs lie in the radiation field, and anything that lies in that radiation field is likely going to have some potential temporary—hopefully temporary—side effects. If you think about the pelvis, the things that live in there are the bladder, urethra, some bowel, rectum, reproductive organs, skin, some lymph nodes. And so, all of those things could potentially have associated side effects," ONS member Kayla Kafka-Peterson, BSN, RN, ROCN™, nurse navigator and leader in the brachytherapy and peri-anesthesia programs at UCLA Health, in Los Angeles, CA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about radiation side effects in cancers of the pelvis.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 17, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to radiation to the pelvis.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Radiation Site-Specific Side Effects series
Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices
Episode 298: Radiation Oncology: Nursing's Essential Roles
ONS Voice articles:
Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education
The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management
ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)
ONS courses:
Nurse Navigation and Care During Brachytherapy for Cervical Cancer: 2025 ONS Bridge™ Session
ONS ROCN™ Certification Review™
ONS/ONCC® Radiation Therapy Certificate™
Clinical Journal of Oncology Nursing articles:
Updated Interventions for Radiation-Induced Diarrhea: Putting Evidence Into Practice With the Oncology Nursing Society
Genitourinary Distress: Common Side Effect
Sexual Dysfunction: Common Side Effect
Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers
Oncology Nursing Forum article: Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer
ONS Guidelines™ and Symptom Management Resources:
Radiodermatitis
Radiation-Induced Diarrhea
Brachytherapy Huddle Card
American Brachytherapy Society
American Society for Radiation Oncology (ASTRO)
European Society for Radiotherapy and Oncology (ESTRO)
GEC-ESTRO Committee
International Gynecologic Cancer Society
Nursing Certificate Program
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Brachytherapy is delivered two main ways. The most common is LDR and HDR. LDR stands for low-dose-rate radiation, which is the older type of brachytherapy, but it is still very much practiced today. And it is where we put radioactive seeds directly into the tumor or tumor resection bed, depending on what you're treating. And those pieces of radioactive material, such as iodine-125 or palladium-103, those will give off radiation over time and treat the area that they are in, and they will place more or less seeds into the tumor, depending on that patient's needs and their anatomy." TS 3:26
"The most common [side effect] for external beam is bladder irritation—cystitis. It can be some burning, some frequency, some urgency, and it can often mimic a UTI [urinary tract infection]. We also have to make sure our patients do not have a UTI. Most of the time they don't, but we don't want to miss that. Once a UTI has been ruled out, the mucosa in the bladder and the urethra, it has a very high cell turnover rate. And things with a high cellular turnover rate like mucosal linings, they respond to radiation very quickly. They also heal very quickly, but they start to break down quite quickly during radiation." TS 16:15
"For the bladder, some things that we can teach the patients … to keep their urinary system as comfortable as possible during treatment. We really encourage hydration because the more hydrated they are, the more diluted their urine will be and the less acidic it will be. As those tissues start to respond to the radiation, they will become, for lack of a better word, a little bit raw. And if you think of something acidic going on something that is raw, it's going to burn, and these patients do get burning. And so by promoting hydration, their urine becomes less acidic; it doesn't burn as much when they do urinate. And I find a lot of patients who are experiencing the urinary side effects, they don't want to drink because they're afraid to urinate. And it actually makes the burning worse because their urine gets ultra-concentrated." TS 22:29
"Anybody who has a vagina, who receives treatment to the pelvis—it doesn't matter if it's for vaginal cancer or if it's for bowel or rectal—if they have received radiation to the pelvis, they are at risk for vaginal stenosis and adhesions. And this, of course, can be more pronounced in patients who have a higher dose in the vagina or a larger surface volume of the vagina treated. But over time, that tissue, even long after radiation is done, will undergo late changes where they will have continued scar formation, and it starts to lose its elasticity and its functionality. And at times it can stick to itself, causing these adhesions." TS 28:15
"I think a common misconception is that you cannot safely work around radiation. That is something that I have heard a lot. In certain regions of the world, the nurses actually report that they have been having trouble getting good applicants because nobody wants to work in radiation because they think that you'll get radiated, that it's not safe. We've really tried to make radiation safety a big part of our teaching to show that actually, you can safely work around radiation with today's technology." TS 41:43

"When we think of drug interactions, specifically, the National Cancer Institute actually defines this as a change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods or when taken with certain medical conditions. Drug interactions may cause the drug to either be more or less effective or cause effects on the body that are not expected," Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about interaction pathways.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD), including 30 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by July 10, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report increased knowledge related to drug interactions in oncology care.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Pharmacology 101 series
ONS Voice articles:
Are Your Patients Taking Herbs That May Interact With Their Cancer Drugs?
Pharmacogenomics Testing Helps to Ensure That Effective Therapy Is Safe Therapy
Use of Herbal Products Carries Risk for Drug Interactions, but Patient–Clinician Knowledge, Communication Remain Low
What the Research Says About Drug Interactions and Medical Cannabis
ONS books:
Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
ONS Huddle Cards:
DPYD Gene and DPD Enzyme
Pharmacogenomics
ONS Oral Anticancer Medication Toolkit
American Journal of Nursing articles:
Understanding Pharmacokinetics: Part1: Drug Absorption
Understanding Pharmacokinetics: Part 2: Drug Distribution
Understanding Pharmacokinetics: Part 3: Drug Metabolism
Understanding Pharmacokinetics: Part 4: Drug Elimination
Journal of Nuclear Medicine Technology articles:
Pharmacology, Part 1: Introduction to Pharmacology and Pharmacodynamics
Pharmacology, Part 2: Introduction to Pharmacokinetics
ClinPGx
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"One of the most notable food interactions that interacts with many different medications is actually grapefruit or grapefruit juice. This is known to be a very strong CYP3A4 inhibitor. … A lot of medications are metabolized through the CYP3A4 pathway. By inhibiting the effect of these enzymes, that can actually increase and significantly increase the concentrations of these therapies. It's not an interaction that's just limited to grapefruit. I would say grapefruit being in the food interaction is kind of one of the most well-known, but it can also be seen with other foods as well, like pomegranate juice or a very specific type of orange called Seville oranges. And this is really just due to the presence of a substance called furanocoumarins." TS 6:12
"There have been a pretty large number of genes identified that are responsible for coding some of those common enzyme families that I had been discussing, some of those CYP450 enzymes, but other enzymes as well that are important for drug metabolism. Based on the type of gene, there could be some different categories where patients are normal metabolizers, intermediate metabolizers, or poor metabolizers. There are some other categories as well based on the type of gene we're looking at. And that can ultimately impact the way you are able to metabolize drugs." TS 15:56
"Another common [geneotypic variation] that we always think about in oncology is G6PD, where if someone has G6PD deficiency, these patients can be at greater risk of hemolytic anemias when receiving certain types of therapies. Dapsone and rasburicase are just a couple that have been associated with this risk." TS 17:50
"One of the big concerns is always polypharmacy. Our patients truly can be on a lot of medications. In the field that I work in, transplant, patients automatically from their transplant are on many, many different medications that can potentially predispose them to side effects. … But I think when it comes to the many drug interactions that may flag in these situations, we really have to look at the patient as a whole. Like, how long have these patients been on these therapies? Are they having side effects? Have they been on the combination for a very long time now? So I think that not just looking at the drug reference and seeing that there are like 10 different interactions flagged, but really assessing your patient as a whole can be very important—just because real-world practice, of course, is not black and white. It's often very gray, so it's just important to use clinical judgment in those scenarios." TS 26:10