Clinical

Chemotherapy and Biotherapy
 

Extravasation

Where do I find information on extravasation?

The ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Whitford, & Olsen, 2009) includes a detailed section on the treatment of extravasation sites (section V of the book). 

An additional reference is published in the August 2009 Clinical Journal of Oncology Nursing.  If you are an ONS member, you can view the full-text of this article.

In March 2008, the European Oncology Nursing Society (EONS) released extravasation guidelines. Please note that the EONS guidelines do not completely correlate with the ONS guidelines.  This may be in part because the availability of antidotes and chemotherapy agents vary in different countries, and the ONS guidelines are based on products available in the U.S.A..  However, the guidelines include helpful tools of reference. 

What are the current recommendations for an anthracycline extravasation?

The ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Whitford, & Olsen, 2009) summarizes the most recent evidence available for extravasation. In the event of anthracycline extravasation, the initial steps are as follows (Goolsby & Lombardo, 2006; Schulmeister, 2007).

  1. Immediately STOP administering the vesicant and IV fluids.
  2. Disconnect the IV tubing from the IV device. Do not remove the IV device or noncoring port needle.
  3. Attempt to aspirate residual vesicant from the IV device or port needle using a small (1–3 cc) syringe.
  4. Remove the peripheral IV device or port needle.
  5. Assess the site of the suspected extravasation.
  6. Assess symptoms experienced by the patient (e.g., pain, impairment of range of motion of extremity).
  7. Notify the physician or advanced practice nurse.
  8. Initiate appropriate management measures in accordance with [the ONS Chemotherapy and Biotherapy Guidelines and Recommendation for Practice’s Vesicant Extravasation Management Guidelines (see pp. 108–109)] and institutional policies (Polovich et al, 2009, pp. 106-107).

In the event of an anthracycline extravasation, an ice pack should be applied to the site. It should be removed at least 15 minutes prior to Totect® (dexrazoxane HCl, TopoTarget USA) treatment. Totect is the only pharmacologic treatment currently approved by the U.S. Food and Drug Administration (FDA) for anthracycline extravasation (Polovich et al., 2009).

References

Goolsby, T.V., & Lombardo, F.A. (2006). Extravasation of chemotherapeutic agents: Prevention and treatment. Seminars in Oncology, 33(1), 139-143.

Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice. Oncology Nursing Society: Pittsburgh, PA.

Schulmeister, L. (2007). Extravasation management. Seminars in Oncology Nursing, 23(3), 184-190.

How should vesicants be administered: IV push or short infusion?

The ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Whitford, & Olsen, 2009) allows for IV push and short-term infusion administration of vesicant agents. Because little evidence exists to identify either practice as superior, both have been used for many years with few complications. Each institution should decide which works best based on the individual setting and the nurses’ comfort with administering the drugs.

Short-Term Vesicant Infusion
Polovich et al. (2009) provide some specific recommendations about short-term vesicant infusions (Section IV: Fundamentals of Administration, pp. 73-103). When administering a vesicant drug by short infusion using a peripheral vein, avoid using an IV pump to decrease pressure on the veins. Stay with the patient and watch for signs of extravasation, verifying blood return every 5–10 minutes. Avoid using a peripheral IV site for continuous vesicant administration. A central venous access catheter or implanted access device should be used to administer any vesicant infusing for longer than 30–60 minutes.

IV Push
Vesicant administered via IV push should be given by free-flow method or side-arm technique using the following steps.

  1. Attach the syringe with the drug at the injection port closest to the patient.
  2. Aspirate the line to verify IV patency.
  3. Allow the IV solution to flow freely.
  4. Slowly administer the chemotherapy agent as an IV push, allowing the flush solution to dilute the drug.
  5. Unless otherwise indicated, administer the agent at a rate of 1–2 ml/minute.
  6. Verify blood return every 2–5 ml.
  7. When IV push is completed, check vein patency and flush the line with a compatible IV solution.

Please note that some institutions have specific policies stating that select cytotoxic medications must be delivered by IV push only.

Reference

Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice. Oncology Nursing Society: Pittsburgh, PA.

What does ONS recommend regarding the administration of vincristine since the 2005 Joint Commission Sentinel Alert was released about its administration?

In 2005, the Joint Commission published a sentinel alert and, in 2007, the World Health Organization (WHO) released a statement, both warning of the risk of inadvertent administration of vincristine into the subarachnoid space (intrathecal administration) resulting in a number of tragic deaths around the globe.  In 2006, the Institute for Safe Medication Practices [ISMP] encouraged institutions to reevaluate their preparation and delivery of vincristine and of intrathecal medications in general, including a multidisciplinary review of the process of drug preparation and administration.  Recommendations were published in the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Whitford, & Olsen, 2009) Nursing Education and Management section (pp. 343-345). They include the following.

  • Both [the Joint Commission] and WHO recommend that vincristine and other vinca alkaloids be diluted and administered via a minibag. Opponents to this approach have cited the risk of extravasation, as many institutions have policies against the administration of vesicant chemotherapy by minibag into a peripheral IV line. Some centers in which these drugs are now administered by minibag require infusion through a [central venous catheter]...
  • Vincristine must be clearly labeled. WHO (2007) recommends “FOR INTRAVENOUS USE ONLY—FATAL IF GIVEN BY OTHER ROUTES.” [The Joint Commission] (2005) recommends “FATAL IF GIVEN INTRATHECALLY. FOR IV USE ONLY. DO NOT REMOVE COVERING UNTIL MOMENT OF INJECTION,” with each syringe inside an overwrap carrying the same label warning” (p. 344).
  • Special procedures should be followed for the administration of [intrathecal (IT)] medications: IT medications should be prepared in the pharmacy as closely as possible to the time of administration ([Joint Commission], 2005). Unique packaging and delivery to a separate location can further help to prevent errors.
  • Prior to the administration of all antineoplastic medications, it is recommended that the drug, dose, and route be independently verified by at least two qualified healthcare professionals (pp. 344-345).

Bibliography

Institute for Safe Medication Practices. (2006, February 23). IV vincristine survey shows safety improvements needed. Medication Safety Alert: Acute Care. Retrieved September 3, 2010, from http://www.ismp.org/Newsletters/acutecare/articles/20060223.asp.

Joint Commission on Accreditation of Healthcare Organizations. (2005, July 14). Preventing vincristine administration errors. Sentinel Event Alert, Issue 34. Retrieved September 3, 2010, from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_34.htm

Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

Schulmeister, L. (2006). Preventing vincristine administration errors: Does evidence support minibag infusions?  Clinical Journal of Oncology Nursing, 10(2), 271-273.

World Health Organization. (2007, July 18). Information exchange system alert no. 115, QSM/MC/IEA.115. Retrieved July 6, 2008, from http://www.who.int/medicines/publications/drugalerts/Alert_115_vincristine.pdf

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Pregnancy and breastfeeding

Is it safe for nurses to administer chemotherapy if they are pregnant or trying to conceive?

The issue of whether nurses should prepare or administer chemotherapy or care for patients who are receiving chemotherapy while trying to conceive or while pregnant or nursing is one of the more controversial topics in chemotherapy administration. Several resources may be helpful.

ONS took a stance on this issue in the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (2009).

Address HD handling around pregnancy. Even when all recommended precautions are used, the potential for exposure cannot be completely eliminated. Therefore, an additional level of protection is suggested for those most vulnerable to the reproductive and developmental effects of HDs. Employers should allow employees who are actively trying to conceive or are pregnant or breastfeeding to refrain from activities that may expose them and their infant to reproductive health hazards such as chemical, physical, or biologic agents. Alternate duty that does not include HD preparation or administration must be made available upon request to both men and women in the aforementioned situations or who have other medical reasons for not being exposed to HDs. The employee has the responsibility of notifying the employer of the specific situation (e.g., pregnancy, preconception, breastfeeding). The American College of Occupational and Environmental Medicine (1996) provides guidelines for managing reproductive hazard management (p. 82).

ONS’s Safe Handling of Hazardous Drugs (Polovich, 2003) does an excellent job of reviewing the current data related to exposure and related risks, as well as precautions to lower risk.

The American Society of Health-System Pharmacists (ASHP) Guidelines on Handling Hazardous Drugs also addresses this issue in the “Background” section: "Two controlled surveys have reported significant increases in a number of symptoms, including sore throat, chronic cough, infections, dizziness, eye irritation, and headaches, among nurses, pharmacists, and pharmacy technicians routinely exposed to hazardous drugs in the workplace. Reproductive studies on health care workers have shown an increase in fetal abnormalities, fetal loss, and fertility impairment resulting from occupational exposure to these potent drugs" (p. 40).

The ASHP guidelines state the following in the “Alternative Duty and Medical Surveillance” section. "Such safety programs must be able to identify potentially exposed workers and those who might be at higher risk of adverse health effects due to this exposure. Because reproductive risks have been associated with exposure to hazardous drugs, alternative duty should be offered to individuals who are pregnant, breast-feeding, or attempting to conceive or father a child. Employees’ physicians should be involved in making these determinations" (p. 50).

The Occupational Safety and Health Administration (OSHA) Technical manual, Section VI: Chapter 2, “Controlling Occupational Exposure to Hazardous Drugs” doesn't make specific recommendations, but does address potential risks in some detail. For instance, III.C. ”Human Data at Therapeutic Levels” states the that “[m]any HD's are known human carcinogens, for which there is no safe level of exposure.” Furthermore, the report states the following.

Numerous case reports have linked chemotherapeutic treatment to adverse reproductive outcomes.7,88,91,98  Testicular and ovarian dysfunction, including permanent sterility, have occurred in male and female patients who have received CD's either singly or in combination.14 In addition, some antineoplastic agents are known or suspected to be transmitted to infants through breast milk.79"

In section VI.A. “Reproductive Issues,” the report states the following.

The examining physician should consider the reproductive status of employees and inform them regarding relevant reproductive issues. The reproductive toxicity of hazardous drugs should be carefully explained to all workers who will be exposed to these chemicals, and is required for those chemicals covered by the HCS. Unfortunately, no information is available regarding the reproductive risks of HD handling with the current use of BSC's and PPE. However, as discussed earlier, both spontaneous abortion and congenital malformation excesses have been documented among workers handling some of these drugs without currently recommended engineering controls and precautions. The facility should have a policy regarding reproductive toxicity of HD's and worker exposure in male and female employees and should follow that policy.

The OSHA manual addresses reproductive issues in other sections as well.

The National Institute for Occupation Safety and Health (NIOSH) Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings contains detailed information about safe-handling practices, including handling recommendations while pregnant or trying to become pregnant. 

References

ASHP. (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy, 63(12), 1172–1193.

NIOSH. (2004). Prevent­ing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Retrieved August 30, 2010, from http://www.cdc.gov/niosh/docs/2004-165

OSHA. (1999). OSHA techni­cal manual, TED 1-0.15A section VI, chapter 2: Controlling occupational exposure to hazardous drugs. Retrieved August 30, 2010, from http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#2

Polovich, M. (Ed.). (2003). Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.

Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

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Safe handling

Where can I find resources on safe handling of chemotherapy and other hazardous drugs?

The following resources are available through ONS.

Additional resources available from other sources.

What are the recommendations regarding personal protective equipment and chemotherapy and biotherapy administration?

Recommendations for what personal protective equipment (PPE) to wear whenever handling chemotherapy or contaminated materials are consistent across several groups including the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), American Public Health Association (APHA), and ONS.  These recommendations don’t differentiate between high- and low-risk situations, as there is always the potential for contamination and no known minimum safe exposure.

Double chemotherapy-tested gloves, protective gowns, and protective eyeware (if there is potential for splashing) should be worn whenever handling hazardous drugs or contaminated items (e.g., administration materials, body fluids).  These recommendations are based on increasingly strong research that indicates that surface and air contamination occur throughout chemotherapy preparation, administration, and disposal areas and that those who work in those areas can be exposed repeatedly to these agents at low, chronic levels.

ONS recommends the following up-to-date resources.

  • Types of apparel:
    1. Gloves: Wear disposable gloves that are powder-free and have been tested for use with HDs. Latex gloves provide protection but should be used with caution because of latex sensitivity.  Gloves made of nitrile, . . . polyurethane, or neoprene may provide protection…
    2. Gowns: Wear a disposable, lint-free gown made of a low-permeability fabric, such as polyethylene-coated materials.  … The gown should have a solid front, long sleeves, tight cuffs, and back closure…
    3. Eye and face protection: Wear a face shield or a combination of mask face and face shield that provides splash protection whenever there is a possibility of splashing (pp. 74-75).
  • The NIOSH Alert on Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings was released in 2005. These federal standards include detailed recommendations about safe handling practices. In the “Recommendations” section, the alert states the following.
    • Wear PPE (including double gloves, goggles, and protective gowns) for all activities associated with drug administration—opening the outer bag, assembling the delivery system, delivering the drug to the patient, and disposing of all equipment used to administer drugs.
  • The OSHA Technical Manual, Section VI: Chapter 2, “Controlling Occupational Exposure to Hazardous Drugs” includes more details than the NIOSH alert. In section V.C.2. Drug Administration, the manual states the following.
  • Personal Protective Equipment. The National Study Commission on Cytotoxic Exposure has recommended that personnel administering HD's wear gowns, latex gloves, and chemical splash goggles or equivalent safety glasses as described under the PPE section, preparation. 
  • Please note that non-latex gloves may be substituted if they have been tested for permeability with chemotherapy.
  • The ONS publication Safe Handling of Hazardous Drugs (2003) goes into detail about many aspects of safe handling, including evidence of risk, routes of exposure, methods for preventing exposure, medical surveillance, and staff education.
  • The American Society of Health-System Pharmacists (ASHP) Guidelines on Handling Hazardous Drugs also addresses the various aspects of this issue.

What are the guidelines regarding protection against body fluids after chemotherapy administration?

ONS’s Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Whitford, & Oslen, 2009) states that all personnel should wear personal protective equipment (PPE) to reduce exposure whenever a risk exists that hazardous drugs will be released into the environment, including handling body fluids of a patient who has received hazardous agents in the past 48 hours.  Keep in mind that some drugs may take longer to metabolize, and institutions should determine the length of time precautions will be used.  Splashing may occur at any time, and personnel should follow all PPE precautions (National Institute for Occupational Safety and Health [NIOSH], 2004).

  • NIOSH (2004) recommends the use of standard precautions (double gloves and disposable gown) when handling blood, emesis, or excreta of a patient who has received chemotherapy within 48 hours.  A face shield should be worn if splashing is possible.
  • The skin of patients who are incontinent should be cleaned well with each diaper change, with protective barrier ointment applied to the diaper area to decrease the chance of irritation from contact with urinary metabolites (Polovich, 2003).
  • When disposing of excreta, flush the toilet with the lid down or covered to prevent splashing.  Double-flushing with low-volume toilets may be helpful (Polovich, 2003).
  • If linens become contaminated, use standard precautions and handle them according to your institutional setting and policy. This special handling may or may not include using a plastic bag marked to show that the contents are contaminated and prewashing prior to adding the contaminated laundry to the regular hospital laundry. 
  • In the home setting, wear gloves when handling contaminated linens.  Wash these linens separately, preferably twice, in hot water. Disposable items should be discarded with other hazardous wastes based on local policies.

References

NIOSH. (2004). Prevent­ing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Retrieved August 30, 2010, from http://www.cdc.gov/niosh/docs/2004-165

Polovich, M. (Ed.). (2003). Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.

Polovich, M. Whitford, J.M. & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

Are safe-handling measures required when administering biotherapy agents?

Because many biotherapy agents are still relatively new in the treatment of cancer, there is still quite a bit of variability in how these agents are handled. However, it is important to note that some biologic agents are considered hazardous while others are not.

The National Institute for Occupational Safety and Health (NIOSH) and other organizations are still gathering health risk data related to these drugs. Therefore, their recommendation is that for all drugs, at the very least, standard precautions should be observed, including specific recommendations from the drug manufacturer’s Material Safety Data Sheets and drug inserts. NIOSH publishes a list of drugs that it considers to be hazardous to humans. In addition, the International Agency for Research on Cancer publishes a list that is updated regularly as new data are released.

ONS regards the drugs for antineoplastic indications as hazardous because of the potential risks to patients and staff and recommends using the same personal protective equipment (PPE) as is recommended for chemotherapy administration. Keep in mind that longitudinal data to support what is actually hazardous to humans are not complete for many drugs; therefore, consider using PPE when handling any chemotherapy or biotherapy agents.

What are the recommendations regarding safe handling of oral chemotherapy agents?

The administration of oral chemotherapy presents unique safety issues.  Recommendations for the administration of chemotherapy and biotherapy regardless of administration route can be found in the ONS Safe Handling of Hazardous Drugs (Polovich, 2003).

Recommendations for safety precautions when administering oral therapies should include the following.

  1. When available, unit dose packaging is preferred for providing oral hazardous drugs.
  2. Gloves should be worn when working with all oral therapies.
  3. Tablets should not be crushed, and capsules should not be opened.  A liquid formulation of the medication should be used if administering hazardous drugs via feeding tube or to individuals unable to take capsules or tablets. Liquid formulations should be compounded in a biologic safety cabinet, using appropriate personal protective equipment (PPE). If a biologic safety cabinet is unavailable, wear an approved respirator mask when manipulating the drug.
  4. PPE should be used to prevent potential exposure to blood or body fluids following oral therapy administration. Because oral agents are not 100% bioavailable, a portion of the drug may remain in the gut and is excreted through patients’ stools. Depending on the activity of patients’ gastrointestinal systems, precautions may be needed beyond the standard 48 hours after treatment has stopped.

Reference

Polovich, M. (Ed.). (2003). Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.

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Radiation Oncology

What resources are available for nurses new to radiation oncology?

ONS offers the following radiation oncology resources.

Other resources helpful resources include the following.

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Staffing and Policy Development

What are the recommended staffing ratios (inpatient and outpatient) for oncology nurses?

Currently no published standards for nurse-patient ratios in oncology settings are available.  In fact, ONS has made a conscious decision not to recommend staffing standards because of significant variations in institutions, patient populations, care settings, and individual patient needs. 

ONS conducted a staffing survey in 2000, funded by the ONS Foundation Center for Leadership, Information and Research (Lamkin et al., 2001).  Survey participants included RNs specializing in the care of patients with cancer, oncologists, and nurse executives in both inpatient and outpatients settings as well as free-standing ambulatory settings (2001).  The results are summarized in two parts by Lamkin et al. (2001, 2002) in the Oncology Nursing Forum (ONF). 

Part I of the survey addressed perceptions on the part of those surveyed related to work environment and staffing in the oncology setting.  Part II of the survey specifically addressed the issue of staffing ratios and why ONS did not make specific recommendations for staffing oncology nursing areas.  The authors stated, "Oncology nurses have asked ONS for data regarding staffing standards... Nevertheless, the imposition of regulations mandating minimum nurse staffing levels or ratios are not supported for a number of reasons" (Lamkin et al., 2002, p. 98).  

Oncology nurses take great pride in providing individualized patient care. The plan of care created by oncology RNs takes into account patients' and their families' physical, psychological, spiritual, and social needs.  Oncology RNs expend great effort keeping up with treatment innovations, technology, patient and family education, and individualized patient care. Nurse staffing must be based on patient acuity, setting, skill and experience of the RNs, available ancillary staff, technology, and each individual patient and family (p. 98).

In 2005, Lamkin published “Reasons for Not Establishing Oncology Nursing Staffing Standards” in Oncology Issues.  This article validated the findings from the two-part survey published in ONF.  Lamkin (2005) discussed variations in practice related to patient ratios, staff skill and experience, technology, and the practice settings.  “It is easy to conclude that individualized cancer care may not lend itself to nursing standards.  Instead care should be based on patient acuity, the care setting, the skill of the oncology nurse, the presence of other team members, and the availability of technology” (Lamkin, 2005, p. 37). 

Bibliography

Brooks, M. (2010, April). Limiting nurse workloads good for RNs and patients. Medscape Medical News. Retrieved September 3, 2010, from http://www.medscape.com/viewarticle/720583?src=mp&spon=24&uac=126323SG

Cohen, J.D. (2010, June).   How many nurses does your hospital need? Nursing Management, 41(6), 20-25.

Cusack, G., Jones, A., Chisholm, L., & Warren, G. (2004). Patient intensity in an ambulatory oncology research center:  A step forward for the field of ambulatory care, part III.  Nursing Economic$, 22(4), 193-195, 175. 

Cusack, G., Jones-Wells, A., Chisholm, L., & Warren G. (2004). Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care.  Nursing Economic$, 22(2), 58-63, 55.

Ireland,  A.M., DePalma, J.A.,  Arneson, L.,  Stark, L., & Williamson J. (2004). The Oncology Nursing Society Ambulatory Office Nurse Survey.  Oncology Nursing Forum, 31(6), E147 – E156.

Jones, A., Cusack, G., Chisholm, L., & Warren, G. (2004). Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care, Part II.  Nursing Economic$, 22(3), 120-123, 107.

Lamkin, L. (2005).  Reasons for not establishing oncology nursing staffing standards.  Oncology Issues,20(5), 37. 

Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G., & Williams, M. (2001). Oncology Nursing Society Workforce Survey. Part I: Perceptions of the nursing workforce environment and adequacy of nurse staffing in outpatient and inpatient oncology settings. Oncology Nursing Forum, 28(10), 1545-1552. 

Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G., & Williams, M. (2002).  Oncology Nursing Society Workforce Survey. Part II: Perceptions of the nursing workforce environment and adequacy of nurse staffing in outpatient and inpatient oncology settings. Oncology Nursing Forum, 29(1), 93-100.

Medvec, B.R. (1994). Productivity and workload measurement in ambulatory oncology. Seminars in Oncology Nursing, 10(4), 288-295.

Rajecki, R. (2009). Mandatory staffing ratios: Boon or bane? RN, 72(1), 22-25. Retrieved September 3, 2010, from   http://www.nxtbook.com/nxtbooks/advanstar/rn_200901/

Unruh, L. (2008). Nurse staffing and patient, nurse, and financial outcomes. American Journal of Nursing, 108(1), 62-71.
West, S., & Sherer, M. (2009). ISO: The “right” nurse staffing model. Oncology Issues, 24(6), 26-30.

Who can give chemotherapy outside of the oncology unit?

ONS’s position is that because chemotherapy can cause some unique and even life-threatening side effects and also can pose a safety risk to those handling drugs or contaminated body fluids, all nurses caring for patients receiving chemotherapy need specialized education. See the ONS Position on the Preparation of the Professional Registered Nurse Who Administers and Cares for the Individual Receiving Chemotherapy for further explanation.

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Symptom Management

Where can I find resources on symptom management?

For patients seeking information on symptom management, there are a number of resources available on the web.  Here are three to get started.

  • ONS sponsors a web site called “The Cancer Journey,” which is designed for people with cancer and their care providers.  It has an extensive section on side effects as well as other helpful information.
  • The American Cancer Society’s website provides extensive information on symptom management.
  • The National Cancer Institute also offers publications on the web.

Nurses seeking symptom management information may want to begin with the ONS PEP (Putting Evidence Into Practice) Resources.  The research available on each symptom has been analyzed to develop the most recent recommendations for care.  Summaries for each symptom studied are available on the ONS website, and detailed information is published in the book Putting Evidence into Practice Improving Oncology Patient Outcomes (2009). 

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If your clinical question is not addressed here, contact ONS Education staff at clinical@ons.org.
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