Volume 9, Issue 1, June 2005
     
Coordinator's Message
Do You Collaborate?


Judith (Judie) Kehs Much, CRNP, AOCN®, APRN-BC
Allentown, PA
Judith_K.Much@lvh.com


One of the buzzwords in nursing practice these days is "collaboration." How many of us know what it is? How many of us do it? The dictionary defines collaboration as "to work jointly with others especially in an intellectual endeavor" (Woolf, 1981, p. 217). The ability to collaborate is a core competency of advanced nursing practice (Brown, 1998). Although it sounds easy, collaboration is a complex task involving parallel communication, parallel functioning, information exchange, coordination, consultation, comanagement, and referral (Hanson, Spross, & Carr, 2000).

We in the Cancer Genetics SIG have been afforded a great opportunity to put the word "collaboration" into practice or to "walk the talk." By the time this newsletter is published, the ONS 30th Annual Congress will be history. Last year at Congress, the SIG committed itself to pursue a partnership or collaboration with our colleagues in the National Society of Genetic Counselors (NSGC) and to strengthen our existing partnership with the International Society of Nurses in Genetics (ISONG). In short, we are working to collaborate in our genetics practice, thereby strengthening it.

 
The Cancer Genetics SIG Newsletter is produced by members of the
Cancer Genetics SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  June 2005
 
   

Coordinator's Message
Do You Collaborate?

Judith (Judie) Kehs Much, CRNP, AOCN®, APRN-BC
Allentown, PA
Judith_K.Much@lvh.com


One of the buzzwords in nursing practice these days is "collaboration." How many of us know what it is? How many of us do it? The dictionary defines collaboration as "to work jointly with others especially in an intellectual endeavor" (Woolf, 1981, p. 217). The ability to collaborate is a core competency of advanced nursing practice (Brown, 1998). Although it sounds easy, collaboration is a complex task involving parallel communication, parallel functioning, information exchange, coordination, consultation, comanagement, and referral (Hanson, Spross, & Carr, 2000).

We in the Cancer Genetics SIG have been afforded a great opportunity to put the word "collaboration" into practice or to "walk the talk." By the time this newsletter is published, the ONS 30th Annual Congress will be history. Last year at Congress, the SIG committed itself to pursue a partnership or collaboration with our colleagues in the National Society of Genetic Counselors (NSGC) and to strengthen our existing partnership with the International Society of Nurses in Genetics (ISONG). In short, we are working to collaborate in our genetics practice, thereby strengthening it. By the time you read this, the SIG will have taken two giant steps toward that goal: (1) the presentation of "The Power of Partnership" Pre-Congress session, and (2) an evening networking dinner held with our colleagues from NSGC and ISONG. "The Power of Partnership" will be reworked for the genetic counselor audience and repeated at their annual conference in November. In our next newsletter, we will highlight our work toward collaboration for those unable to attend the conference. We expect a number of recommendations for joint projects to come out of the networking session, and I will be calling on some of you to help with these projects. Please e-mail me if you wish to participate.

On another note, I want to formally welcome Jennifer Loud, RN, MSN, CRNP, to the leadership of the SIG. As our new coordinator-elect, you can expect to hear more from Jennifer. I have had the pleasure of teaching with Jennifer on a number of occasions, and I assure you that the SIG will be in GREAT hands!

References

Brown, S.J. (1998). A framework for advanced practice nursing. Journal of Professional Nursing, 14, 157-164.

Hanson, C.M., Spross, J.A., & Carr, D.B. (2000). Collaboration. In A.B. Hamric, J.A. Spross, & C.M. Hanson (Eds.), Advanced nursing practice: An integrative approach (2nd ed., pp. 315-347). Philadelphia: W.B. Saunders.

Woolf, H.B. (Ed.). (1981). Webster's new collegiate dictionary. Springfield, MA: Merriam-Webster.

 
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Special Interest Group Newsletter  June 2005
 
   

Editor's Message
Nurses Stay Informed Through Networking and Education

Marilyn Kile, RN, MSN, APRN, AOCN®
Kearney, NE
marilynkile@catholichealth.net


Members of the Cancer Genetics SIG know how quickly the science of cancer genetics is evolving. One of the greatest concerns I have as an advanced practice nurse providing education and counseling to patients with characteristics of hereditary cancer is making sure that I stay current with the latest information. There are several ways to do that. One is attending conferences and ONS Congress, and other ways include reading the literature (including our newsletter!) and networking with peers. I know most of you feel the same way. I could not help but notice that in the Cancer Genetics SIG Quality Improvement and Needs Assessment, when asked "What do you value the most from your SIG membership?", respondents said access to current, accurate information. The response ratio was 74%, whereas both educational opportunities and the newsletter received a response ratio of 56%. Indeed, these are serious concerns for many of our members.

I recently attended "Cancer Genetics 2005: Focus on Colon and Ovarian Cancers" at Fox Chase Cancer Center in Philadelphia. Not only was it a good opportunity to learn but also a great opportunity to network with other nurses providing the same services. I hope many of you took advantage of the educational programs and the networking opportunities by attending the Cancer Genetics SIG meeting. I would like to invite those who attended ONS Congress this year to write a review or brief article summarizing your learning or networking experiences and submit it to the newsletter editor for inclusion in the next issue.

 
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Special Interest Group Newsletter  June 2005
 
   

Article Review
Assessing for Hereditary Cancer Syndromes: Does Ductal Carcinoma in Situ Count in the Equation?


Patricia Kelly, RN, MS, AOCN®
Dallas, TX
PatriciaKelly@TexasHealth.org


Claus, E.B., Petruzella, S., Matloff, E., & Carter, D. (2005). Prevalence of BRCA1 and BRCA2 mutations in women diagnosed with ductal carcinoma in situ. JAMA, 293, 964-969.

Study Summary

The authors of this study present one of the first population-based case-controlled studies examining the prevalence of BRCA1 and BRCA2 mutations in women with a diagnosis of ductal carcinoma in situ (DCIS).

A Connecticut Tumor Registry pool of 777 women, unselected for age, family history, or ethnicity, and with a diagnosis of pathology-confirmed DCIS, were interviewed and offered counseling and genetic testing for BRCA1 and BRCA2 mutations. After an initial counseling session, 369 women agreed to have genetic testing. Of the 369 cases, three women were found to have BRCA1 mutations, and nine women were found to have BRCA2 mutations, with one woman who had a mutation in both genes. The authors present two tables that describe the mutation carriers by histology, bilaterality, mutation site, age of onset, ethnicity, and cancer family history.

This initial study revealed that DCIS mutation carriers were similar in characteristics of age of onset, family history, and ethnicity to that of women with invasive breast cancer (IBC) who are mutation carriers. In addition, the overall prevalence of BRCA1 and BRCA2 mutations in women with DCIS is similar to the overall prevalence of BRCA1 and BRCA2 mutations in women with IBC. The conclusion from this article is that DCIS may be an important part of the breast/ovarian hereditary syndrome, specifically for BRCA1 and BRCA2 mutations. Patients with a diagnosis of DCIS who have personal and family histories that are suggestive of a hereditary cancer syndrome should be screened, assessed, counseled, and offered testing in the same manner as women with IBC.

Commentary

In 1998, I began using the software package CancerGene, a computer program that incorporates several breast cancer risk models and is helpful in assessing an individual's chance of having a hereditary cancer mutation. The CancerGene program, also known as BRCAPRO, captures only histories of IBC, not DCIS. Over the past years, I have heard cancer genetic nurses describe how they incorporate a personal or family history of DCIS into a hereditary cancer risk formula. Some nurses “pro-rate” the risk formulas for DCIS, whereas others use only IBC information.

This landmark JAMA article concerning the prevalence of BRCA1 and BRCA2 mutations in women diagnosed with DCIS provides direction concerning how to use a personal or family history of DCIS when evaluating women for hereditary breast cancer syndromes. Replicating this study will give these initial findings more statistical power and may someday change the CancerGene program. In the meantime, however, nurses should not rely on software packages to assess for hereditary cancer syndromes. Nurses should stay current with DCIS research findings and should incorporate pathology-confirmed DCIS history into their current guidelines for high-risk screening, counseling, and testing for hereditary cancer syndromes.

 
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Special Interest Group Newsletter  June 2005
 
   

News From the National Human Genome Research Institute (NHGRI)

Jean Jenkins, PhD, RN, FAAN
Bethesda, MD
Jean.Jenkins@nih.gov


Advances in Genomics to Biology
ENCODE Consortium Publishes Scientific Strategy

The ENCyclopedia Of DNA Elements (ENCODE Project Consortium, 2004) consortium detailed the scientific rationale and strategy behind its quest to produce a comprehensive catalog of all parts of the human genome crucial to biologic function. The consortium outlined its plans for achieving its ambitious goal of building a "parts list" including protein-coding genes, non-protein-coding genes, regulatory elements involved in the control of gene transcription, and DNA sequences that mediate chromosomal structure and dynamics. For more detailed information on the ENCODE project, including a complete list of participants and the consortium's data release and accessibility policies, go to www.genome.gov/ENCODE.

Reference

ENCODE Project Consortium. (2004). The ENCODE (ENCyclopedia Of DNA Elements) project. Science, 306, 636-640.

International HapMap Consortium Widens Data Access
All of the International HapMap Consortium's data are now completely available to the public, a move that will provide researchers with even easier access to tools for identifying genetic contributions to disease. The $130 million project, which was launched in October 2002 and is expected to be completed in September 2005, is a public-private partnership of scientists and funding agencies from Canada, China, Japan, Nigeria, the United Kingdom, and the United States. For more information, see www.genome.gov/12514423.

Nanotechnology and Medicine
Nanotechnology Experts Conduct Online Chat in January

Visit www.eurekalert.org/nanotalk/20050112/talk.php for the chat transcript of nanotechnology experts Dr. Richard Siegel, Dr. James Baker, and Dr. Jeffery Schloss.

Researchers Compare Chicken, Human Genomes
An international research consortium has found that chickens and humans share more than half of their genes, but their DNA sequences diverge in ways that may explain some of the important differences between birds and mammals (Hillier et al., 2004).

Reference

Hillier, L.W., Miller, W., Birney, E., Warren, W., Hardison, R.C., Ponting, C.P., et al. (2004). Sequence and comparative analysis of the chicken genome provide unique perspectives on vertebrate evolution. Nature, 432, 695-716.

Advances in Genomics to Health
U.S. Surgeon General Introduces Family History Initiative: Web-Based and Print Collection Tool

The U.S. Surgeon General launched the Family History Initiative on November 8, 2004. The purpose of this national public health campaign is to increase the awareness of the American public and their health professionals about the importance of family history in health and to provide tools to help to collect, organize, and utilize the family history. U.S. Surgeon General Richard H. Carmona declared Thanksgiving Day, when American families traditionally gather to celebrate and give thanks, to be the first National Family History Day and encouraged Americans to use their family gatherings as a time to collect important family health history information that can benefit all family members.

To help people to gather family history information, the U.S. Department of Health and Human Services released a new, free, computer-based tool that individuals can use to organize important health information into a printout that they can take to their healthcare professionals. This information will help medical professionals to determine whether patients are at higher risk for disease and, if so, will help them to craft an individualized prevention program. The printout also can become part of a patient's medical record. The new tool, called "My Family Health Portrait," is available in both English and Spanish as a Web-based program and as a printed brochure.

For more information about the U.S. Surgeon General's Family History Initiative or to access the tool, see www.hhs.gov/familyhistory/.

Scientists Detect Probable Genetic Cause of Some Parkinson Disease Cases
Two new studies strongly suggest that a mutation in a recently discovered gene is the most common genetic cause of Parkinson disease identified to date. The discovery by an international research team provides fresh evidence that genetics may contribute to the development of some cases of Parkinson disease. The research team includes investigators at the National Institute on Aging and scientists supported by the National Institute of Neurological Disorders and Stroke. The findings were published online by Lancet on January 17, 2004. For more information, see www.nih.gov/news/pr/jan2005/nia-17.htm.

Educational tools on Parkinson disease are available at www.nlm.nih.gov/medlineplus/tutorials/parkinsonsdisease/htm/index.htm and www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_research.htm.

Scientists Discover More About Progeria
In 2003, a research team from NHGRI's Division of Intramural Research discovered the genetic mutation that causes progeria, a rare disorder that results in a dramatic form of premature aging. The January 30, 2004, edition of The New York Times Sunday Magazine featured a story about the advances in progeria research. For more information, see Learning About Progeria at www.genome.gov/11007255.

Advances in Society
National DNA Day Celebrates Advances in Genetics (www.genome.gov/10506367)

National DNA Day, April 25, 2005, commemorated the completion of the Human Genome Project in April 2003 and the discovery of DNA's double helix. NHGRI, in cooperation with the American Society of Human Genetics, the Genetic Alliance, and the National Society of Genetic Counselors, hosted the event, which included the following activities.

  • NHGRI DNA Day Ambassadors: The Ambassador Program is conducted on or near National DNA Day. Faculty, staff, and postdoctoral fellows from NHGRI visit high schools across the country to talk to students about genomic science and how it will influence the future of biology, medicine, and society.
  • Genetics-related online Web casts, chat room, and teaching

NHGRI, University of Washington Hold Public Symposium
In May 2005, NHGRI and the University of Washington hosted a public symposium in Seattle. The symposium gave members of the public an opportunity to meet with experts to discuss their concerns about new genomics technology and learn more about the current state of genomics and future research directions and applications. A different site will host the symposium each year.


Recent Articles From NHGRI Enhance Genetics Knowledge

Go to www.genome.gov/10506216 to download a PDF of recent NHGRI articles, including

National Coalition for Health Professional Education in Genetics (NCHPEG) Focuses on Family History, Core Competencies
NCHPEG held its annual meeting in Bethesda, MD, January 27-28, 2005. The primary focus of the meeting was family history. Judy Lewis represented the International Society of Nurses in Genetics. Meeting slides are available at http://www.nchpeg.org/. The Core Competencies in Genetics was revised to include examples of utilization and implementation of the recommended competencies in education design and is available from NCHPEG.

 
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Special Interest Group Newsletter  June 2005
 
   

Educational Offerings
ONS Offers Genetics Short Course for Cancer Nurses



Are You Ready for the Genetics Revolution?
ONS is accepting applications from oncology nurses who have completed an advanced master's and/or doctoral nursing degree who feel the genetics revolution is happening without them. The course dates are November 8-10, 2005, March 24-26, 2006, and May 6-8, 2006. Please check the following Web site for deadline, location, and registration information: http://onsopcontent.ons.org/Meetings/GeneticsSC/geneticsapply.html.

Bibliography

Roesser, K.A., & Mullineaux, L.G. (2005). Genetic testing and hereditary cancer: Implications for nurses. Pittsburgh, PA: Oncology Education Services. Retrieved June 3, 2005, from http://www.oesweb.com/pdf/monographs/2987.pdf

 
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Special Interest Group Newsletter  June 2005
 
   

Cancer Genetics SIG Welcomes New Members



Aberle, Marie, San Antonio, TX
Althaus, Becky, Dallas, TX
Ayala, Lisandra, Chicago, IL
Bergeron, Angela, Lake Orion, MI
Bodnar, Melissa, Bloomingdale, OH
Bosch, Jill, Blairsburg, IA
Braswell, Sharon, Birmingham, AL
Bucholtz, Jennifer, Crofton, MD
Burkleo, Vicki, Liverpool, NY
Byrd, Carol, Society Hill, SC
Carano, Mary Ellen, Ames, IA
Connolley, Christopher, Pittsburgh, PA
Copeland, Nevada, Little Rock, AR
Courtney, Lila, Algona, IA
Courville, Lisa, Breaux Bridge, LA
Cox, Cheryl, Memphis, TN
Cuvilly, Edwidge, Brooklyn, NY
DeRocco, Caroll, Neptune, NJ
Douvillier, Karen, San Clemente, CA
Fish, Vicki, Salt Lake City, UT
Fisher, Lois, Grand Junction, CO
Foiadelli, Julie, North Reading, MA
Fonda, Linda, Hudson, NY
Frank, Judith, Wildwood, MO
Galarza, Lisandra, Helotes, TX
Gambrell, Jacqueline, Easley, SC
Goldstein, Leigh, Round Rock, TX
Guthrie, Sharon, Tucson, AZ
Hale-Compoli, Elizabeth, Condord, NH
Hall, Stacy, Harvest, AL
Hane, Nancy, Norman, OK
Harvey, Catherine, Mt. Pleasant, SC
Hays, Kimberly, Prairieville, LA
Heath, Kimberly, Newport News, VA
Heikens, Sarah, Ames, IA
Hsu, Arlene, Wellesley, MA
Hulstrom, Anne, Portland, OR
Hyman, Dianne, Mount Laurel, NJ
James, Margaret, Texas City, TX
Johnson, Racquel, New Orleans, LA
Jones, Ann, Council Bluffs, IA
Kayne, Marilyn, Holland, OH
Knox, Joy, Everett, WA
Lotito, Marianne, Little Rock, AR
Lyle, Jenny, Lexington, KY
Mikhail-Powe, Joanna, Yorktown, NY
Morrell, Kristie, Rochester, NY
Morrison-Hoogstede, Connie, Poulsbo, WA
Mount, Tara, Brick, NJ
Murillo-Lane, Ionie, Melbourne Beach, FL
Nastori, Lisa, San Mateo, CA
Oien, Denice, Sammamish, WA
Opsahl, Nancy, McLean, VA
Parlanti, Alicia, Bergenfield, NJ
Pasquarella, Loretta, Howell, NJ
Patek, Deanna, San Antonio, TX
Paulus, Elizabeth, Toms River, NJ
Remstein, Rona, Richboro, PA
Rovoll, Melissa, River Forest, IL
Rowe, Matthew, Morgantown, PA
Seward, Christine, Woodbridge, VA
Siegel, Jennifer, Geneva, IL
Simon, Bertha, Jarrettsville, MD
Spinellie, Alice, Melbourne, FL
Summerlin, Elizabeth, Houston, TX
Supnet, Rica, Lake Worth, FL
Tatum, Tracey, Richmond, VA
Thom, Michele, Grand Blanc, MI
Toth, Rebecca, Mountain View, CA
Turner, Linda, Burleson, TX
Walker, Barbara, Phoenix, AZ
Wilson, Edna, Avon, IN
Wynn, Lynn, Memphis, TN
 
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Special Interest Group Newsletter  June 2005
 
   

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://sig.ons.wego.net/index.v3page;jsessionid=l5nhe8e4qt77?v2_group=0&p=4918, including
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes.
Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is
  • Log on to the ONS Web site (http://www.ons.org/).
  • Select “Membership” from the tabs above.
  • Then, click on “ONS Chapters and Special Interest Groups.”
  • Scroll down to “Visit the ONS Special Interest Groups (SIG) Virtual Community” and click.
  • Now, select “Find a SIG.”
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG's Virtual Community appears on screen, select “New User” from the top left. (This allows you to create log-in credentials.)
  • Type the required information into the text fields as prompted.
  • Click “Join Group” (at the bottom right of the text fields) when done.

    Special Notices
    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
    • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.
Subscribe to Your SIG’s Virtual Community Discussion Forum

All members are encouraged to participate in their SIG’s discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,
  • Select “Log In,” located next to “New User,” and enter your information.
  • Next, click on the “Discussion” tab on the top right of the title bar.
  • Now, select “Featured Discussion” from the left drop-down menu.
  • Locate and select “Subscribe to Discussion” inside the “Featured Discussion” section.
  • Go to “Subscription Options” and select “Options.”
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click “Finish.”
  • You are now ready to begin participating in your SIG’s discussion forum.
Participate in Your SIG’s Virtual Community Discussion Forum
  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on “Discussion” from the top title bar.
  • Select “Featured Discussion” from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.
Sign Up to Receive Your SIG’s Virtual Community Announcements

As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.
  • From your SIG’s Virtual Community page, locate the “Sign Up Here to Receive Your SIG’s Announcements” section. This appears above the posted announcements section.
  • Select the “Click Here” feature, which will take you to a link to subscribe.
  • Once the “For Announcement Subscription Only” page appears on screen, select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on “Next Page.”
  • Because you have already joined your SIG’s Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click “Finish.”
  • This will bring up a listing of your SIG’s posted announcements. Click on “My SIG’s Page” to view all postings in their entirety or to conclude the registration process and begin browsing.
 
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Special Interest Group Newsletter  June 2005
 
   

Cancer Genetics SIG Officers

Coordinator
Judith (Judie) Kehs Much, CRNP, AOCN®, APRN-BC
Oncology Nurse Practitioner
Integrated Oncology Care
LVH/JDMCC
Cedar Crest & I-78, Suite 408
Allentown, PA 18105
610-402-9097 (O)
Judith_K.Much@lvh.com

Coordinator-Elect
Jennifer Loud, RN, MSN, CRNP
7417 Miller Fall Rd.
Derwood, MD 20855-1121
301-435-8062 (O)
LoudJ@mail.nih.gov

Historian
Deborah MacDonald, RN, MS, CS, APNG(c)
City of Hope Comprehensive Cancer Center
1500 Duarte Rd.
Duarte, CA 91010-3012
626-256-6882 (O)
dmacdonald@coh.org

Newsletter Editor
Marilyn Kile, RN, MSN, APRN, AOCN®
Good Samaritan Health Systems Cancer Center
10 East 31st St.
Kearney, NE 68848-1990
308-865-7199 (O)
308-865-2907 (fax)
marilynkile@catholichealth.net

 

Newsletter Co-Editors
Patricia Kelly, RN, MS, AOCN®
9649 Covemeadow Dr.
Dallas, TX 75238-1819
214-345-8324 (O)
214-345-6349 (fax)
PatriciaKelly@TexasHealth.org

Patricia B. Herman, MSN, RN, AOCN®
St. Luke's Hospital and Health Network
801 Ostrum St.
Bethlehem, PA 18015
610-954-3579 (O)
610-954-3583 (fax)
mailto:hermanp@slhn.org

ONS Publishing Division Staff
ONS Publishing Division Staff
Amy Nicoletti, BA
Copy Editor
412-859-6328
anicoletti@ons.org

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To view past newsletters click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
http://www.ons.org/

 
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