Volume 18, Issue 3, November 2007
The Nurse Practitioner SIG Newsletter is underwritten through a grant from Amgen Inc.
Coordinator’s Message
We Need to Hear the Full Voice of the Nurse Practitioner SIG

Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
Baltimore, MD

What an exciting time to be an oncology nurse practitioner (NP)! We are being recognized for our vital role in quality oncology cancer care by more people every day. Patients, professional colleagues, healthcare insurance providers, and policy makers are acknowledging our value.

ONS continues to recognize the importance of oncology NPs as well, as evidenced by the creation of the 2007 Oncology Nurse Practitioner Competencies, a document that recognizes the unique contributions that oncology NPs make to quality oncology care. In 2005, a multi-institutional national panel convened to draft oncology NP competencies. These were based on the framework established in other nursing competencies. In September 2005, all ONS members known to be NPs were sent electronically the draft competencies for review. To be exact, 2,024 invitations were sent. Additional reviews and validation by a team of 21 oncology NP experts and national nursing organizations gave credence to the document. Through ONS's leadership and invitation, many contributed to the effort to capture the special philosophy of practice that embodies oncology NP care. To view the 2007 Oncology Nurse Practitioner Competencies, click here.

The NP SIG is special in many ways, but I want to highlight just one in this message. There are only two SIGs that share the opportunity to meet nationally at a conference designed to meet the unique educational needs of advanced practice nurses. We have two opportunities to gather in person to talk about oncology NP issues, needs, and wants, as well as our future. Most SIGs have only one annual meeting. However, although we have this special privilege, most NP SIG members do not attend the SIG meetings. In fact, only 31 NP SIG members participated in the SIG meeting at Congress this year, despite the fact that we have about 1,200 NP SIG members. While the meetings are essential, we are not hearing the full voice of the NP SIG at these meetings. We must count on the Internet to manage most of our correspondence.

I am sharing this information because I want you to know that although we ask for volunteers at our two in-person meetings, we also want those who do not attend the meetings to become more involved with the NP SIG. The ONS Advanced Practice Nursing Conference will be occurring almost concurrently with the release of this newsletter, providing excellent timing. Those who cannot attend the NP SIG meeting on Friday, November 9, from 1-2 pm will still be able to join project teams from the start and help the NP SIG leadership by promptly responding to this call. We understand that the majority of NP SIG members will not be at the meeting, but we still need you to help achieve our mission to promote high professional standards and to foster the professional development of NPs in their role as advanced practice nurses.

Consider investing some time to work with the NP SIG. Opportunities exist to help with the newsletter, virtual community, award nominations, membership recruitment, legislative activities, project development, mentorship, archiving, poster development, research, and meeting planning. Please contact me via e-mail at NPBiedrzycki@aol.com to get more involved. ONS recognizes that the NP SIG is special, but only you can facilitate the NP SIG reaching its potential.

P.S. Remember to celebrate Nurse Practitioner Week from November 11-17! NPs have 40 years of history and an infinite future!

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  November 2007

Editor's Message
Remember the Defining Moments in Life When Caring for Patients

Annette W. Kuck, RN, MS, CNP, AOCN®
Minneapolis, MN

On August 1, the Interstate 35W bridge spanning the Mississippi River in Minneapolis collapsed, and in less than five minutes, lives were changed forever. The day also happened to be a significant birthday for me, one that I had fussed over for the previous six months. In the blink of an eye, my angst about a birthday became decidedly minor. It reinforced for me how one experience can redefine your life and expectations.

The bridge collapse is much like what our patients experience when their cancer is diagnosed or reports of progression are given. The impact is felt by them, their family, and friends. Expected supports and conceptions of life are no longer "safe." Daily patterns of life, like traffic, are altered and changed forever. However, our patients' experiences are not broadcast on national television and may not be easy to share with the larger community. As oncology nurses, we need to help provide and rebuild those supports and bridges. Remembering a defining moment in life such as the 35W bridge collapse, 9/11, or Hurricane Katrina can help us empathize and communicate with our patients.

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Special Interest Group Newsletter  November 2007

Clinical Update
New Coverage Guidelines Instituted for Erythropoesis Stimulating Agents in Cancer and Related Neoplastic Conditions


Annette W. Kuck, RN, MS, CNP, AOCN®
Minneapolis, MN

On July 30, the Centers for Medicare and Medicaid Services (CMS) instituted new coverage guidelines for the use of erythropoesis stimulating agents (ESAs) darbepoetin alfa and epoetin alfa. The original National Coverage Decision (NCD) document is 61 pages, with 36 of them designated as the bibliography. The information is long and confusing. The American Society of Clinical Oncology (ASCO) developed a frequently asked questions document about the new guidelines for Medicare and Medicaid reimbursement. The following are some of the key bullet points.

•  NCD is restricted to use of ESAs in cancer and related neoplastic conditions.

•  Myelodysplastic syndromes have been excluded from the scope of this coverage determination.

•  CMS will not consider ESA treatment as reasonable and necessary for patients with anemia associated with the treatment of acute and chronic myelogenous leukemias.

•  CMS has ultimately decided not to restrict coverage for use of ESAs in conjunction with specific drug categories.

•  A patient on myelosuppressive chemotherapy becomes eligible for ESA therapy starting with the first dose of chemotherapy within a course of chemotherapy (i.e., a planned chemotherapy regimen). Each full course of chemotherapy counts as one eligibility period.

•  The initiation phase starts with the first dose of an ESA within a course of chemotherapy and must be accompanied by documentation of a hemoglobin level of <10 g/dL prior to that first dose. This initiation phase continues for four weeks from the first dose of an ESA.

•  A patient's hemoglobin level must be <10g/dL (or hematocrit <30%) to initiate ESA treatment.

•  Medicare will cover only one dose escalation by 25% and does not consider additional rounds of ESAs within this same course of chemotherapy “reasonable and necessary” if the hemoglobin rises less than 1 g/dL (hematocrit rise less than 3%).

•  After the initial documentation of a hemoglobin level <10 g/dL during the first four weeks (initiation) of ESA therapy, CMS does not require submission of documentation of a hemoglobin level less than 10. The hemoglobin may, in fact, go above 10 during these first four weeks, and CMS will still provide coverage for ESA therapy (with the exception of patients for whom hemoglobin levels increase by more than 1 g/dL in a two-week period).

•  If the hemoglobin level is checked during the four-week initiation period and the patient's hemoglobin has risen more than 1 g/dL in two weeks, then the hemoglobin must be below 10 for coverage to continue. If the hemoglobin level remains below 10, the ESA therapy may be continued, but the dose must be decreased by 25%.

•  Starting with week 5, the patient enters the maintenance phase.

•  At the fifth week (the beginning of the maintenance phase), CMS does require documentation of a hemoglobin level <10 g/dL immediately prior to that dose of an ESA, and for every subsequent dose.

•  Medicare will cover the alternative flat dose weekly dosing schedule listed in the FDA-approved label for epoetin, and the alternative flat dose every-three-week dosing schedule listed in the FDA-approved label for darbepoetin.

•  Eligibility for ESA coverage ends at eight weeks following the administration of the last dose of chemotherapy within a course of chemotherapy.

To view the complete ASCO document and overview of NCD requirements, click here.

To view and download the entire NCD summary, click here.

CMS also issued a Q & A document on July 31. To view and download the Q & A, click here.

Check with your institution or practice about their implementation practices and stay tuned. This issue is still under discussion, and more changes could be coming.

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Special Interest Group Newsletter  November 2007

Nurse Practitioner SIG News
Oncology Nurse Practitioner Competencies Available

The 2007 Oncology Nurse Practitioner Competencies outlines specialty entry-level competencies for oncology nurse practitioners (ONPs) who care for adult and late adolescent patients throughout the continuum of cancer care. It should be used by NPs, educators, employers, physicians, nurses, and anyone else who seeks to understand the role of the ONP.

This important guide was developed by a multi-organizational national panel convened by ONS that used a nationally vetted process to develop, conduct reviews of, and revise the document. The competencies then were reviewed and critiqued by 127 ONPs as well as 20 members of a national validation panel comprised of representatives of nursing organizations and National Cancer Institute-designated comprehensive cancer centers. To learn more, click here. 

NP SIG Tied With Pharmaceutical/Industry Nursing SIG for Fifth Place in ONStat Challenge
There are always opportunities for improvement. The NP SIG has slipped to a tie for fifth place in the ONStat Challenge. At the 32nd Annual ONS Congress, we were tied for third place. Our enrollment has not declined, but the reason we are dropping in our rating is that the percentage of NP SIG members has remained steady. Other SIGs have more members signing up for ONStat than we do. We are currently tied with the Pharmaceutical/Industry Nursing SIG, with 24% of each SIG's membership enrolled in ONStat. The Clinical Nurse Specialist SIG is in first place, with 33% of its members enrolled.

Signing up for ONStat is easy: Simply click on www.ons.org/lac/onstat.shtml to register. Occasionally, ONStat members will receive requests to correspond with their legislators, most often by e-mail. ONS truly makes the process easy by providing the key points, letter format, and even the e-mail addresses of legislators. You then would have several options through the ONStat correspondence and Web site. You could learn more about the topic, choose to advocate on the issue, or decline the opportunity by not taking any action. Please take a moment to register today!

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Special Interest Group Newsletter  November 2007

Advocacy Update
Ex-Officio Demonstrates Advocacy in Action

In mid-August, NP SIG Ex-Officio Wendy Vogel, RN, MSN, FNP, AOCNP®, sent an e-mail to Genomic Health when an error was noted on its Web site. The content of the e-mail messages follows.

To Leaders of Genomic Health:

I am writing to let you know of an issue concerning your website that is quite concerning to nurse practitioners and other mid-level providers.

Several times on your website, it is stated that oncotype Dx can be ordered "only by a physician" (example: http://www.genomichealth.com/oncotype/faq/pat.aspx). This indeed is not true as Medicare and most, if not all, third party payors recognize nurse practitioners as reimbursable providers of health care.

This statement does not serve patients well. . . . many oncology patients trust and rely on their mid-level provider for their health care including ordering of laboratory tests. The statement "only by physicians" undermines this trust and is potentially inflammatory to mid-level providers.

I trust that you will promptly address this issue and we would appreciate a response as to actions taken. Thank you.

[Response from Genomic Health]

Thank you very much for your email. Indeed we want to accurately reflect which healthcare providers may order our test, and it appears that nurse practitioners and other mid-level providers can, in certain circumstances, order our test.

Please rest assured that we are currently reviewing the website and will update this issue as appropriate, within the confines of existing rules and regulations, in the near future. Thanks again.

We are pleased to report that Genomic Health's Web site has been changed already and with only one e-mail! Genomic Health is to be commended for its quick response, and Wendy is to be commended for her advocacy. Please let the NP SIG leadership know if you have other examples of advocacy in action, local or national.

State Health Policy Liaisons Needed in 11 States for 2008
ONS state health policy liaisons (SHPLs) help coordinate health policy and grassroots activities at the local, state, and national levels to help advance the ONS health policy agenda. Currently ONS is recruiting SHPLs in the following states: Colorado, Delaware, Kansas, Mississippi, Montana, Nevada, Oklahoma, South Dakota, Virginia, West Virginia, and Wisconsin. For more information, visit www.ons.org/lac/shpl.shtml.

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Special Interest Group Newsletter  November 2007

News From the ONS Publishing Division and ONSEdge
Newly Updated Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook Now Available

As a major line of defense against cancer, chemotherapy plays a vital and complex role in the treatment of this devastating disease.

Newly updated and expanded to reflect new research and clinical advances, Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (Second Edition) provides you with the detailed information you need on all facets of chemotherapy administration. The second edition of this best-selling resource addresses aspects of antineoplastic agents from cellular mechanisms to clinical trials, plus much more.

New to this edition are chapters on targeted therapy, chemotherapy regimens, complementary and alternative therapy, botanicals, and reimbursement issues. In addition, you will find at your fingertips more than 100 detailed drug monographs on current chemotherapeutic, biotherapeutic, and hormonal agents.The information provided on each antineoplastic agent is based on current guidelines from the manufacturers and the U.S. Food and Drug Administration.

Unlike many drug handbooks on the market, Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (Second Edition) delves into topics such as vascular access devices, symptom management, clinical trials, legal issues, psychosocial support, and professional oncology resources.

For more information and to order, click here.

Free Metastatic Colorectal Cancer Patient Education Magnet and Tear Sheet Set Available

Side effects in the treatment of cancer can happen, and it is important for your patients to spot the signs and seek help.

The Metastatic Colorectal Cancer (mCRC) Patient Education Magnet and Tear Sheet from ONSEdge provides your patients with easy-to-read information on spotting treatment-related side effects. The magnet alerts patients to watch for serious adverse effects of treatment, such as headache, mouth sores, and fatigue. The tear sheet provides even more detail.

The magnet and tear sheet set consists of three packets of tear sheets (25 per pad) and three bags of magnets (25 per bag).

Distribute these to your patients with cancer and better educate them on the potential side effects of their cancer treatment. To order your free set, click here.

These patient materials were produced by ONSEdge and Pfizer Oncology and meet ONS guidelines for quality educational content.

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Special Interest Group Newsletter  November 2007

News From the ONS National Office
Clinical Trial Resources Are at Your Fingertips

The ONS Clinical Trials Resource Area and the Clinical Trials Patient Resource Area provide access to information on clinical trials, including educational materials and programs, clinical trial search engines, and the ONS Clinical Trial Nurses Special Interest Group Virtual Community. Be sure to check out these great resources.

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Special Interest Group Newsletter  November 2007

News From CNE Central

Advanced Renal Cell Carcinoma Webcast Available

Don't miss this webcast recorded from a satellite symposium presented at the 2007 ONS 32nd Annual Congress in Las Vegas, NV. Highlights include an evidence-based discussion of advanced renal cell carcinoma (RCC), including treatment and symptom management strategies. Learn more about this superb webcast at www.ons.org/ceCentral/types/kidney/index.shtml.

"What's Blasting Off in CML?" Series Offers Comprehensive Review

This three-part series reveals itself in podcasts (and upcoming webcast) that reviews the history of CML and describes its treatment and patient adherence to therapy, in detail. The information gained from this comprehensive material will substantially increase your understanding of CML and help you to better evaluate and treat your patients. Visit http://onsopcontent.ons.org/meetings/podcasts/ to learn more.

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Special Interest Group Newsletter  November 2007


News From the American Academy of Nurse Practitioners

Celebrate National Nurse Practitioner Week November 11-17

The American Academy of Nurse Practitioners' (AANP) theme for the 2007 National NP Week, November 11-17, is “Your Partner in Health – The Nurse Practitioner.” Use this occasion to celebrate the vital roles that NPs play in bringing high-quality, cost-effective, and personalized health care to all populations of our country. 

AANP offers a resource guide to help you plan and execute a successful week of building awareness of the NP as well as recognizing the value and benefits of having an NP as your healthcare provider. This is your opportunity to deliver a message about NPs and to shape a perception in the minds of the general public about the advantages of choosing an NP as their partner in health. For more information, visit www.aanp.org.

Oncology Interest Group Forum Sparks Dynamic Dialogue

Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
Baltimore, MD

ONS is an organizational member of AANP. Through this collaboration, ONS receives two complimentary registrations to the annual AANP Conference. It has been customary for this benefit to be extended to the NP SIG coordinator (or someone else in the SIG leadership if the coordinator is unable to attend) and a NP SIG member from the host city. This year, the conference was in Indianapolis, IN.

Within the conference agenda, AANP provides time for “Interest Forums,” an opportunity for NPs with special interests to meet to discuss issues. The meeting is informal, and participants of this one-time gathering do not belong to a group, nor do they have the opportunity to collectively represent the host national organization, AANP, as ONS NP SIG members do.

The Oncology Interest Group Forum is a great opportunity because, for 90 minutes, NPs with an interest in oncology can interact through facilitated discussion on important topics. Oncology NPs learned that some of their issues were more common than they thought. For example, the concern caused by financial barriers to care and medications was a nationwide issue. Suggestions were made to explore prescription assistance programs through foundations, pharmaceutical companies, community organizations, and cancer survivor advocacy groups. It also was suggested that oncology NPs educate policy makers on the hardships that the high costs of medicines and health care cause daily.

While some were challenged in establishing their oncology NP identity in their practices and communities, other NPs in attendance offered practical advice that has worked for them. They highlighted educating patients, professional colleagues, and the community about the role of the oncology NP. Participants shared that they effectively utilized several strategies, including distributing oncology NP brochures, writing general health or oncology-focused articles for the local newspaper, providing a brief biosketch to patients, asking patients about their experiences with other NPs, and differentiating the NP role from that of the physician.

Perhaps one of the most heated discussions was that of salaries. While most agreed that the oncology NP's salary is not congruent with his or her responsibilities and is not just compensation for the quality of care provided, some felt strongly that health care is not available to many because of the high costs of healthcare services, due, in part, to healthcare providers' salaries. Although a lack of oncology NP salary information hinders negotiations for better salaries, potential flaws in a salary survey that was not well conducted may weaken rather than strengthen salaries. The diversity in practice settings, responsibilities, hours, on-call requirements, benefits, certification, education, experience, and geographical locations are all factors that could influence an oncology NP's salary.

Another facilitated discussion focused on how oncology NPs keep up with general NP issues and clinical updates. Some indicated that they rely on ONS for their oncology and general NP information, and others indicated that they count on either AANP or the American College of Nurse Practitioners. Because of the high cost of conference registration fees and travel expenses, some indicated that they alternate conference attendance between those focused on oncology and medicine. The financial burden of updating clinical practice through conference participation is assumed more frequently by the practitioners, as employers are becoming more restrictive in providing educational dollars. This has hindered oncology NPs from partaking in conferences from both disciplines in the same year. It was the recommendation that ONS and AANP provide more details regarding the dates and locations of future conferences years in advance to facilitate the oncology NP's educational planning needs.

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Special Interest Group Newsletter  November 2007

Employment Opportunities

The Oncology Nursing Society is hiring a candidate who possesses the following to fill the role of Education Project Manager:

  • A self-starter to drive daily implementation of educational projects.
  • An individual who can motivate volunteers and staff to collaborate and produce dynamic, innovative educational programs.
  • An individual who is able to mentor speakers, develop key opinion leaders, and facilitate group work.
  • An individual who demonstrates expertise in educational design.

Oncology Nursing Society Education Project Managers:

  • Participate in generative processes to design programs and strategies that will meet oncology nursing education needs.
  • Develop project timelines and recruit planning team members.
  • Employ principles of project management to plan and execute programs from conception through delivery and outcome measurement, ensuring completion according to the plan, within budget and on time.
  • Generate all necessary reports and correspondence documenting program progress and outcomes and leads all status update meetings and reports about projects.

This position requires a strong degree of accountability for overall success in developing and delivering scientifically rigorous educational programming for the oncology nursing audience.

Submit resume and salary history to hrdept@ons.org.

Resumes without salary history will not be considered. EOE.

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Special Interest Group Newsletter  November 2007

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.vc.ons.org, 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 (www.ons.org). Select "Membership" from the tabs above. Then, click on "Chapters, SIGs & Virtual Communities."Scroll down to "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  November 2007

Nurse Practitioner SIG Officers


Coordinator (2005-2007)
Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
Abingdon, MD

Ex Officio (2007-2008)
Wendy Vogel, RN, MSN, FNP, AOCNP®
Kingsport, TN


Annette W. Kuck, RN, MS, CNP, AOCN®
Edina, MN

ONS Publishing Division
Copy Editor
Sharon Padezanin


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 Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, MS, CAE, Director of Membership/Leadership

Diane Scheuring, MBA, CMP, Manager of Member Services

Carol DeMarco, Membership/Leadership Administrative Assistant

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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