Volume 21, Issue 2, August 2010
Coordinator's Message

Margaret Rosenzweig, FNP-BC, AOCNP®
Pittsburgh, PA

It was a great pleasure to meet many of you in San Diego, CA, during the 35th annual ONS Congress. It is a great honor to be the coordinator of the ONS Nurse Practitioner (NP) SIG. I have been an NP in oncology for over 20 years and embrace the opportunity to work on projects for the advancement of oncology NPs. Let me begin by thanking Barbara Biedrzycki, RN, MSN, CRNP, AOCNP®, for her years of service and leadership to the NP SIG. Her skillful leadership has been instrumental to the SIG’s development over the past years. Thanks Barb!

At times, it is hard to keep track of the many forces shaping our practice. We discussed some of these challenges and exciting opportunities facing oncology NPs at the NP SIG meeting in San Diego. One of the recent developments in NP education is the elimination of specialty education in favor of population-specific education.

Forty-six regulatory and nursing organizations have approved a document known as the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation: Licensure, Accreditation, and Education. Many important considerations are present in this document; particularly pertinent to the oncology NP is the opinion that APRNs may specialize, sbut they cannot be licensed solely within a specialty area and that education for specialty education should be developed by the appropriate nursing organizations. These statements have great implication for oncology NP education—essentially putting the “ball in the court” of nursing organizations to develop and provide oncology content for NPs beginning work in cancer care. A recent survey conducted through ONS revealed that 80% of new NPs in oncology received their initial oncology mentorship from a physician (Rosenzweig et al., 2010). Our SIG, with its vast experience and knowledge, can and should help to shape that mentorship. If anyone is interested in working on a project to assist NPs new to oncology care or new to NP oncology care, please let me know.

Many issues pose new challenges for all of us as we strive to provide quality cancer care to patients and families. The NP SIG should be a source of education, support, and inspiration as you continue to do this challenging and, at times, difficult work. This resource is only as good and strong as its members’ involvement. Please consider getting involved at any level in the NP SIG by writing an article for the newsletter, sharing an idea for a SIG project, or by considering a topic submission to make the Advanced Practice Nursing (APN) Conference and ONS Congress particularly meaningful for NPs in oncology. A unique challenge may be to think about attending or submitting an abstract for the 11th National Conference on Cancer Nursing Research Symposia to be held February 10–12, 2011, in Los Angeles, CA. A conference setting may energize your thinking about ways to create and use evidence for practice.

The SIG goals for the upcoming year were established in a leadership meeting in late July (stay tuned for more on this in a future issue). The goals are based on feedback from Congress attendees and input from the SIG membership. If you have suggestions or comments, please let me know.

Thanks so much. I am really very excited to work with other oncology NPs to advance our wonderful profession.


Rosenzweig, M.Q., Giblin, J.M., Mickle, M., Morse, A., Sheehy, P.S., & Sommer, V. (2010). Knowledge needs of nurse practitioners new to oncology care. Journal of Clinical Oncology, 28(Suppl. 15), [Abstract No: e16532].

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

Special Interest Group Newsletter  August 2010

Editor's Message

Megan J. Wholey, RNC, APN-BC, AOCNP®
Arlington, VA

This newsletter issue is full of the stuff of our lives—dealing with changes in the way we practice, the future of our profession (and contributions we can make to it), constraints on our time, and the demands of regulatory bodies and their effect on practice. In a similar way, each of our days contains an intersection of internal and external goals and priorities. It is terrific when we can make a living doing important and valued work, but, at times, the sheer pace of change can be both breathtaking and daunting.

For example, my co-editor and I have been trying to collaborate via a shared online workspace. The most difficult task I encountered in editing the articles was retrieving them from my own computer to upload them. For some reason my computer wants to keep “temporary Internet files” very well-hidden, and I’m not doing any work for the secret service! Technology is just one of the double-edged swords that tax our brains and our patience.

Satisfaction comes from making real what your own dreams are, both personally and professionally. I began a new career in radiation oncology two months ago after nearly 16 years with a private practice medical oncology group. I’m just getting used to some of the changes and am continuing to explore the reference materials and other resources that will help educate me in this new area. I am scheduled to begin earning a PhD in September, which I believe will be a chance to synthesize 30 years of nursing practice and hopefully help me to help the profession. My progress in this respect also has been challenged by the need to learn a new software program so that I can take a statistics course.

In this issue of the newsletter, our past coordinator, Barb Biedrzycki, RN, MSN, CRNP, AOCNP®, addresses the support that the Association of American Retired Persons is providing to advanced practice registered nurses by writing a policy statement in support of our ability to practice to the top of our license. For those who attended our SIG meeting at the Advanced Practice Nursing conference in Tampa, FL, last November, this provides a wonderful counterpoint to the American Medical Association position papers on scope of practice that seem designed to limit rather than maximize our potential contribution to care. H.R.3590, the Patient Protection and Affordable Care Act, may provide the force needed to move past the supervisory status nurse practitioners in 12 states (including my home state, Virginia) currently practice under.

As Margaret stated in her “Coordinator’s Message,” your input is essential for ONS to provide the very best in leadership and education for our fellow oncology nurses and the patients we care for. Please let us know what you want to see in the newsletter by e-mailing us or using our SIG’s page on Facebook. In addition, if you have written something that you are proud of, we would love to share it with the readers. Let us know about it. Have a great summer!

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Special Interest Group Newsletter  August 2010

Co-Editor's Message

Karen Overmeyer, MS, RN, APN
Richmond, VA

Slowly the giant, silent, convention halls begin to fill with the sounds of voices. Hundreds of boxes are being carried to designated areas for unpacking, and empty meeting rooms spring to life as staff members, vital to the underpinnings of every successful ONS Congress, initiate a year’s worth of detailed planning.

It takes two days of careful onsite crafting to ready a massive convention center for the annual pre-Congress and Congress sessions. Registration details, signage, audio video systems—the list of items which must integrate seamlessly is long and meticulous. The host city’s ONS Chapter pulls together volunteers to stuff thousands of bags and to assure a presence in the coming days in the halls to help attendees with directions and to answer a host of untold questions about everything from local services and area tours to the best places to shop and dine. The local Chapter membership also helps monitor rooms during presentations. This year, the San Diego Chapter set a lively theme with “Wild About Oncology Nursing!”

Pre-Congress sessions, serving as a prologue, offered six topics presented in four-hour blocks and had a record number of attendees. The ability to attend two specialty sessions appeared to be a welcomed change.

For the Congress Planning Committee, Opening Ceremony is the culmination of an entire year of meetings that included reviewing 86 submitted session topics, 496 research abstracts (240 were accepted), and a dozen potential keynote speakers. For the 35th annual ONS Congress attendees, Opening Ceremony is the official start of four days of networking, meeting up with old friends, making new friends, and assimilating knowledge through a variety of teaching methods offered at varying levels of practice to meet the needs of the novice as well as the more seasoned and experienced nurses.

This year’s Keynote speaker, Selinza Mitchell, a clinical nurse educator and nurse consultant with 35 years of nursing experience challenged us with her quote: “If you knew you could make a difference, what difference would it make?” She touched us where we live and where we practice, across all boundaries, from the sacred to the mundane. She had the audience laughing over the size of our bladders and in tears over her analogy about a $100 bill, sometimes trod upon, wrinkled, and worn but an example of how precious and priceless each oncology nurse is and what a difference we make in the lives we touch.

The final attendance tally for the 35th annual Congress was 3,482, with 40% of that number (1,378) being first-time attendees, and 25% of all attendees coming from the host state of California. As displays were taken down and the last boxes packed for return to Pittsburgh, PA, the giant halls again fell silent. Those of us left felt a sense of awe and accomplishment, but it could not have happened without you.

As we press on to the 36th Annual Congress in 2011, in Boston, MA, I would like to acknowledge the significant contribution that nurse practitioners and advanced practice nurses bring to producing a successful Congress. Through your efforts and commitment, knowledge is disseminated, and nurses are mentored, motivated, and infused with a renewed sense of professionalism and current evidence-based practices, which they will hopefully integrate into the work setting. The ONS Planning Team extends a special thanks to you and an invitation to continue to contribute to make each Congress a memorable and valuable experience for all.

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Special Interest Group Newsletter  August 2010

Advocacy Corner
REMS—What Is It?

Wendy H. Vogel, MSN, FNP, AOCNP®
Bristol, TN

Many oncology nurses are asking the same question—What are REMS? That is a very good question because every healthcare professional needs to know about REMS. The REMS acronym stands for Risk Evaluation Mitigation Strategies. Understanding and following REMS is not an option as REMS may be legally enforced and the U.S. Food and Drug Administration (FDA) can impose civil penalties for violations. Complying with many of the REMS may require changes to current standard operating procedures. Budgets may need to include the time and cost associated with compliance for drugs used in the practice that have a REMS. This article is written as a fact sheet that may be copied and used for the education of your staff and colleagues.

REMS: Risk Evaluation Mitigation Strategies

What are REMS for? REMS are FDA-approved strategies for managing a known or potential serious risk associated with a drug or biological product. REMS are required by the FDA, if deemed necessary, to ensure that a product’s benefits outweigh its risks.

What is included in REMS? Three main components make up REMS: a medication guide (patient package insert), a communication plan for healthcare providers, and elements to assure safe use (EASU). A particular drug’s REMS may not include all three of these components as many REMS only require a medication guide. The specific components of particular REMS will vary based on the specific drug risks, the population who will be using the drug, and other safety factors.

Must all drugs now have REMS? No. as of June 3, 2010, 123 drugs have REMS. You may find the most current listing of the medications with REMS at http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformation
. To read the specific requirements of a drug’s REMS, click on the name of the drug.

What is a medication guide? This is an FDA-approved patient information pamphlet that must be distributed at time of drug dispensing. It addresses issues specific to the drug and drug class in terms of safety and use of the product. This may be given by the pharmacist when dispensing the medication or by the healthcare provider, such as an oncology nurse, who may be administering the medication.

What is a communication plan? This is a process to give healthcare providers (such as prescribers, pharmacists, infusion nurses) and patients specific safety information deemed necessary by the FDA for the safest, most effective use of a specific drug. This may be given in the form of a “dear healthcare provider” letter, a “dear pharmacist” letter, or special educational materials for prescribers to give to patients.

What are Elements to Assure Safe Use? EASU is a process by which healthcare providers receive specialized training and education in order to prescribe, dispense, and/or administer certain products. Healthcare providers must participate and complete this training for those drugs with an EASU in order to use these agents. Some drugs with an EASU may only be dispensed by certain pharmacies or administered by facilities that comply with these requirements. Some EASUs require the patient to enroll into a patient registry. Some EASUs require the prescriber and/or the dispensing pharmacy to enroll into a registry as well. Some EASUs require documentation by the facility or pharmacy of how they met the REMS requirements. Some EASUs require baseline and periodic reports from prescribers on patients receiving the drug. Patients or healthcare providers who do not comply with the REMS will not be allowed to receive or prescribe (or administer) these drugs. The drugs with REMS requiring EASUs that most oncology nurses are most familiar include thalidomide (Thalomid®, Celgene) and lenalidomide (Revlimid®, Celgene).

Are all REMS the same? No. Each drug has individualized REMS approved by the FDA. Each healthcare provider (whether physician, advanced practice nurse, RN, or pharmacist) is responsible for understanding and following the REMS for each agent.

What oncology drugs currently have REMS? The following is a list of drugs that may be used in an oncology practice that have REMS. The REMS varies from drug to drug.

  • Erythropoietin-stimulating agents (ESAs): darbepoetin (Aranesp®, Amgen, Inc.) and epoetin (Epogen®, Amgen, Inc.)
  • Romiplostim (Nplate®, Amgen, Inc.)
  • ODT (Metoclopramide, oral solution)
  • Opioids (including fentanyl, morphine, and oxycodone)
  • Eltrombopag (Promacta®, GlaxoSmithKline)
  • Varenicline (Chantix®, Pfizer Inc.)
  • Interferons (interferon alfa-2a, interferon alfa-2b in various forms)
  • Infliximab (Remicade®, Centocor Ortho Biotech Inc.)
  • Pazopanib (Votrient®, GlaxoSmithKline)

Where can I get more information about REMS? There are several resources for additional information.

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Special Interest Group Newsletter  August 2010

Association of American Retired Persons and Advanced Practice Registered Nurses

Barbara A. Biedrzycki, CRNP, AOCNP®
Baltimore, MD

Long gone are the days when the Association of American Retired Persons (AARP) conjured up visions of seniors idly gazing into a fading sunset. Now, instead of keeping the tempo rocking in their chairs to Laurence Welk’s waltz, today’s AARP is actively setting the pace for America’s healthcare policies.

The December issue of the Nurse Practitioner (NP) SIG Newsletter called for a corporate angel to strengthen nurse practitioners’ identity among the public (Biedrzycki, 2009). We are still in need of our corporate angel. Possibly, a plan similar to what Johnson & Johnson did for registered nurses would work. Johnson & Johnson’s Campaign for Nursing’s Future (Johnson & Johnson Services, Inc., n.d.) has heightened the public’s knowledge of what nurses really do and has provided resources for those interested in learning more about our valuable profession. Their campaign came at the steep cost of $30 million.

AARP is taking the lead in being an advocate, not just for us nurse practitioners, but for all advanced practice registered nurses (APRNs). As nurse practitioners, we know all too well how important it is to have an advocate. Although some people are able to be their own advocates, to speak up when needed, many may not be comfortable in doing so, or they may feel ill-equipped because of not being well-educated on the topic. They may not have the right connections or lack a strong enough voice.

AARP is a “nonprofit, nonpartisan membership organization that helps people 50 and over improve the quality of their lives” with a motto of “to serve, not to be served” (AARP, 2010b). AARP has a strong voice that is recognizing the essential roles of APRNs. The AARP 2010 Policy Supplement: Scope of Practice for Advanced Practice Registered Nurses stated “Unquestionably, nurses, especially advanced practice registered nurses, can provide much of the care we need. But first, statutory and regulatory barriers at the state and federal levels that prevent scores of nurses from practicing to the full extent of their licensure must be lifted” (AARP, 2010a, p. 1). Hallelujah! We have found our corporate angel!

The AARP is not just a strong voice; their words are backed by action. ONS is one of the national nursing organizations invited by and working with AARP to take action. We are at the table with national nursing leaders (including the American Nurses Association, the American Academy of Nurse Practitioners, the American College of Nurse Practitioners, and many more) involved in planning to ensure that the crafting of healthcare’s future not only includes APRNs but recognizes our value. Stay tuned for further updates on collaborations with our new corporate angel, AARP.


AARP. (2010a). AARP 2010 policy supplement: Scope of practice for advanced practice registered nurses. Retrieved from http://championnursing.org/sites/default/files/2010%20

AARP. (2010b). About AARP. Retrieved from www.aarp.org

Biedrzycki, B. (2009). The branding of the new and improved nurse. Nurse Practitioner Special Interest Group Newsletter, 20, 1–2.

Johnson & Johnson Services, Inc. (n.d.). The campaign for nursing’s future. Retrieved from www.discovernursing.com/home

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Special Interest Group Newsletter  August 2010

The No-Vacation Nation

Karen Overmeyer, MS, RN, APRN-BC
Mechanicsville, VA

June 21, 2010, marked the official first day of summer, and thoughts of vacation activities abound. We each define quality time off in different ways. It might be reading a trashy novel, cooling off in the pool, enjoying the beach, hiking in the mountains, and then, the ultimate luxury . . . sleeping and waking on your own sweet time.

A 2009 Expedia.com survey found that over one-third of Americans do not take all of their earned vacation time. In fact, a 2007 study of more than 30 economically advanced nations, undertaken by The Center for Economic and Policy Research, prompted the United States to be coined “The No-Vacation Nation”. Our numbers have not improved.

We are the only Western nation that does not guarantee paid vacation time off, whereas European countries establish paid time-off rights for a minimum of 20 days per year, with some countries mandating a minimum of 25 to 30 days. This does not always include as many as 13 national legal holidays, making the total even higher. Countries stipulating vacations as mandatory cite higher productivity and improved well-being of employees.

This is a stark contrast to the United States. Nearly a quarter of Americans have no paid vacation benefits and no paid holidays. Paid time off (commonly referred to as PTO), when available, is inclusive of vacation time, sick leave, and maternity leave. A seasonal illness such as flu, sick children, or special family circumstances can easily drain the coffer of leave days.

However, additional surveys show Americans choosing not to vacation because of financial concerns, increasing workload responsibilities, and feelings of associated guilt. Reports of vacation or time-off request denials were cited on nursing blogs that this author ventured into. Many employees nationwide take long weekends or stagger days off, but again, surveys show those days as time to catch up on housework, home maintenance, running errands, or other job-related activities rather than as relaxation and rejuvenation time. Europeans encourage at least two weeks off at a time citing a decrease in work- and stress-related absence and concerns about potential litigation or long-term disabilities (Mercer, 2009).

Oncology nurses are witness to illness, suffering, and death, and we are moored in chronic job-related emotional and interpersonal stressors (Sabo, 2006), which leads to burnout. In 1992, Joinson first used the term “compassion fatigue.” This term is a more encompassing description of the deep emotional and spiritual consumption associated with nursing caretaking and the personal responsibility of managing patients’ illness trajectories (Keidel, 2002).

Compassion fatigue is a physical, emotional, and spiritual fatigue that develops over time. It can be all-consuming, interfering with both life at work and life at home, characterized by overwhelming exhaustion, feelings of depersonalization, and a sense of lack of personal accomplishment, affecting the ability to fully experience joy and ultimately compromising the provision of care (Aycock & Boyle, 2009).

Research on compassion fatigue and strategies to combat the sequelae are ongoing; however, the foundation of strength and wellness for oncology nurses lies in self-care and workplace support.

I recently discovered “Take Back Your Time,” an initiative to strategize and combat time famine (TimeDay.org, n.d.). It is an interesting read and a more interesting movement to address the overall effect of the lack of quality time off. Why do we nurses deprive ourselves of the one element our patients experience as a diminishing commodity?

Not everyone is able to travel or take a vacation, but we can opt for a “staycation.” This can be a special time of strengthening family bonds, meeting up with old friends, exploring a new craft, completing a project, or returning to an activity we long ago gave up such as bicycling, tennis, or photography.

Time away is only one variable in the more complex construct of compassion fatigue and burnout. But it is now summer. Protect your time off. Take time to smell the flowers and to savor the aspects of our lives that we all too often take for granted.


Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13, 183–191. doi: 10.1188/09.CJON.183-191

Center for Economic and Policy Research. (2007). 2007 survey. Retrieved from www.cepr.net  

Expedia.com. (2009). Vacation deprivation survey. Retrieved from http://media.expedia.com/media/content/expus/graphics/promos/vacations/

Keidel, G. (2002). Burnout and compassion fatigue among hospice caregivers. American Journal of Hospice and Palliative Care, 19, 200–205. doi: 10.1177/104990910201900312

Mercer. (2009). 2009 worldwide benefit and employment guidelines. Retrieved from http://www.mercer.com/summary.htm?idContent=1360620

Sabo, B.M. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12, 136–142. doi: 10.1111/j.1440-172X.2006.00562.x

TimeDay.org. (n.d.). Take back your time. Retrieved from http://timeday.org

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Special Interest Group Newsletter  August 2010


RE:Connect is a blog written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses. This month on RE:Connect, you’ll find discussions titled Survivorship Care Plans, “My Sister Won’t Let Me Tan”, Hospice Day 5: Part of Your World, Nurse-Managed Healthcare Centers: The Primary Care World Is Your Oyster!, and Lifestyle Changes. As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

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Special Interest Group Newsletter  August 2010

ONS Article of Interest
Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service takes a look at how to Diagnose, Assess, and Manage Infusion Reactions, which appeared in the April 2010 issue of the Clinical Journal of Oncology Nursing.

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Special Interest Group Newsletter  August 2010

Membership Information

SIG Membership Benefits

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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/).
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  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
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    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
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Subscribe to Your SIG’s Virtual Community Discussion Forum
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.
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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.)
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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.
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Special Interest Group Newsletter  August 2010

Nurse Practitioner SIG Officers

Coordinator (2010–2012)
Margaret (Peg) Rosenzweig, PhD, APN-BC, AOCNP®
Sewickley, PA

Ex-Officio (2010–2011)
Barbara Biedrzycki, MSN, CRNP, AOCNP®
Baltimore, MD

Megan J. Wholey, RNC, APN-BC, AOCNP®
Arlington, VA

Karen Overmeyer, MS, RN, APRN-BC
Mechanicsville, VA


Web Page Administrator
Jennifer Wulff, RN, MN, ARNP, AOCNP®
Lynwood, WA

Legislative Issues
Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Bristol, TN

Barbara Biedrzycki, CRNP, AOCNP®
Baltimore, MD

ONS Copy Editor
Emily Nalevanko, MFA
Pittsburgh, PA

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership/Leadership Team Contact Information

Brian Theil, Director of Membership

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services

Carol DeMarco, Membership/Leadership Specialist

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

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