Clinical FAQ

Does a medical doctor need to be present during chemotherapy administration?

To determine whether a physician must be in the office when chemotherapy is administered, you will need to consult a couple of different sources.

  • Medicare billing requirements: If the patient has Medicare, review the requirements. They often will require that a physician be present when the chemotherapy is administered.
  • Your state board of nursing: Review your Nurse Practice Act. Many states list specific activities that must be done under a physician's "supervision." Look to see if chemotherapy administration in any form is listed.
  • Your organizational policies: Make sure that the policies and procedures that govern your practice support whether a physician should be present.

ONS does not have a position on this issue. However, if you are administering chemotherapy without a physician in the office, some things to consider are

  • Do you have standard orders or protocols for handling emergencies (e.g., who to call, what care and emergency interventions can be initiated)? For routine complications?
  • How quickly can the appropriate medical doctor respond? On the phone? In person?
  • Are other licensed prescribers (e.g., nurse practitioners) available on site?

Another resource you may want to check is the Association of Community Cancer Centers. They have multiple freestanding facilities within their group and may have policies available. They also cover issues regarding billing on their Web site. You also might want to contact home health agencies in your area that administer chemotherapy in the home.

What are the recommended staffing ratios and salary ranges for oncology nurses?

ONS does not have a position on staffing ratios or salary requirements for nurses in oncology practice areas. However, ONS has released a two-part workforce survey that may assist with this question.

Part I of the study can be found in the Oncology Nursing Forum in the November/December 2001 (Vol. 28, No. 10) issue. ONS members can access the full text of this article here.

Part II of the study can be found in the Oncology Nursing Forum in the January/February 2002 (Vol. 29, No. 1) issue. ONS members can access the full text of this article here.

Where can I find references about safe handling of chemotherapy and other hazardous drugs?

Several excellent references related to safe handling of hazardous or cytotoxic drugs are available. The ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice  (2009) includes current knowledge related to safe handling of hazardous drugs. It is also a great reference for nurses giving chemotherapy and biotherapy. Safe Handling of Hazardous Drugs (2003) is designed to help to establish proper basic practice related to the handling of cytotoxic drugs specifically for nurses.

Two other sources you should consult can be downloaded directly from the Internet. They are very technical and detailed, but are considered standards in the area. The Occupational Safety and Health Administration (OSHA) Technical Manual on Controlling Occupational Exposure to Hazardous Drugs (1999) contains the OSHA recommendations for handling of hazardous drugs. It can be viewed or printed from www.osha.gov. The American Society of Health-System Pharmacists Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs (1990, reviewed in 1996) also contains recommendations for handling of hazardous or cytotoxic drugs. You can download a copy of these guidelines at www.ashp.org.

Where can I find information about oncology nursing specialty programs?
A list of colleges and universities with graduate programs specializing in oncology nursing can be found in the Nursing Education section under "Becoming a Nurse." This list represents graduate programs that responded to an ONS survey conducted in late 2002.
What can I use for an extravasation now that Wydase® no longer is available?

Local injection of hyalyronidase is recommended by the manufacturers of vinca alkaloids. Four formulations of hyaluronidase are  now available. Three are animal-derived products: AmphadaseTM (Amphastar Pharmaceuticals, Rancho Cucamonga, CA) is a bovine (cow) derivative; Hydase (Keystone Pharmaceuticals, Laguna Hills, CA) is a bovine (cow) derivative; and Vitrase® (ISTA Pharmaceuticals, Irvine, CA) is an ovine (sheep) derivative. Hylenex (Baxter Healthcare, Deerfield, IL) is a purified recombinant human hyaluronidase.  Hyaluronidase product selection is based on prescriber preference; some prescribers prefer a recombinant human product over animal-derived products to lessen the likelihood of local reactions in certain groups of patients, such as pediatric or immunocompromised patients.

The new edition of the ONS Chemotherapy and Biotherapy Guidelines, due for release in early 2009, will reflect this updated information.

What position does ONS have on the role of assistive personnel in the care of patients with cancer?
The Oncology Nursing Society has a position titled "The Use of Assistive Personnel in Cancer Care" (read position statement). You should also check with your state's board of nursing about the specific tasks related to cancer care, such as vascular access device management. Most states closely regulate what can be performed by different types of nursing personnel.