Tips For Taking Oral Chemo Drugs For Cancer

by Jane Ashley

Many cancer patients don’t realize many of the 400 chemotherapy and targeted therapy drugs are in the form of a pill, rather than being infused via an IV. When we think of cancer treatment, we think of a chemo room and long days spent getting chemo.

Only The Patient Should Touch Their Chemo Pill

But times have been a-changing. The first oral chemotherapy pill was introduced in 1998. It is still in use today — it is the oral equivalent of Fluorouracil, usually referred to as 5-FU, a drug used in the treatment of breast, colorectal, anal, and pancreatic cancer. The oral brand name of this first oral chemotherapy agent is Xeloda.

What are some of the new oral cancer treatments?

Many of these oral cancer therapies are targeted therapies aimed at patients with specific genetic mutations. These targeted therapies have helped transform the lives of patients who had a poorer prognosis into an improved quality of life and significantly longer survival times.

• Imatinib (Gleevec) is used to treat newly-diagnosed adult and pediatric patients with Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML), some patients with MDS, and patients with gastrointestinal stromal tumors that are C-kit positive.
• Gefitinib (Iressa) is an EGFR inhibitor and is used most often for metastatic non-small cell lung cancer. It can also be used to treat breast cancer and in clinical trials for patients with cancers with mutated and overactive EGFR.
• Lapitinib (Tykerb) is used to treat breast cancer and other solid tumor cancers that are HER2 positive or overactive EBFR.
• Nilotinib (Tasigna) is another oral medication used to treat patients with Philadelphia chromosome-positive chronic myeloid leukemia. It can be used for those newly-diagnosed and for those patients who did not respond to imatinib.

Several of the newer treatments for metastatic breast cancer are also in the oral form:
• Abemaciclib (Verzenio)
• Palbociclib (Ibrance)
• Ribociclib (Kisqali)

Based on current research, about one-quarter of cancer treatments in the pipeline could be in the form of a pill.

Is oral chemo as “strong” and as effective as IV infusions?

Absolutely. Oral cancer treatments carry the same benefits and risks as the medications that we receive at our cancer center. Because oral cancer-fighting drugs are taken orally as a pill or capsule doesn’t make them weaker or less effective.

Patients receive special handling instructions from their chemo center nurse or oncologist or the pharmacist who dispenses the prescription. Be sure to follow all instructions carefully and store your cancer medication safely away from any children or pets.
What else do I need to know about oral cancer drugs?

Costs. Because these medications are in a pill or tablet form, they are dispensed by a pharmacy that might be located near your cancer center or could be mail order. Your team should help you coordinate your first order to ensure that you have the medication by the “start” date from your oncologist.

Use A Calendar

Oral chemo is costly and has to be paid for at the time that you pick it up or order it online. Contact your insurance company for an estimate of your cost. If the cost is prohibitive for you, call your oncologist and let them know. There are many patient assistance programs for oral cancer medications, but you must let your team know that you need help paying your share.

Your oncologist might even be like my oncologist. I had to take Xeloda for five weeks during pelvic radiation. My oncologist volunteered before I even thought about asking the cost. She said, “This is really expensive. I’ve already requested financial assistance for you. Someone will be calling you later today.”

And it was a good thing because the copay for a 5-week supply was just under $800.00. Don’t be embarrassed if you need financial help — virtually every person will need this kind of financial help.

Handling safety.

There are several safety tips to keep you and your family safe when you’re on oral cancer treatment medicine at home.

• Store in the original container — it’s easy to forget the dosing directions, and we don’t want anyone else in our family to mistake them for an over-the-counter pain reliever.
• Store in a safe place — out of the reach of children and pets.
• Store in a cool, dry place, out of sunlight — not in a tiny bathroom with a shower where it’s hot and humid.
• Wash hands before and after taking.
• Don’t crush or chew up tablets or capsules.

Caregivers should not handle oral cancer medications — it’s best to empty the pills into a small container or the bottle cap and give to your loved one. The patient is the only person who should come in contact with the medication.
Follow dosing directions carefully.

We’re on the honor system when we take oral cancer-fighting pills or capsules at home. There is no one to ensure that we take our doses on time, and only we can be sure that we take this critical medicine exactly according to schedule. 

Use A Smartphone

We should develop a system of checks-and-balances to ensure that we accurately take our oral cancer medication. Here are some ideas.

• Set up reminders on your smartphone or computer.
• Keep a dairy (either handwritten or on an e-calendar), confirming the time we take our pills.
• Ask your caregiver, spouse, or friends for reminders.
• Call your oncology clinic if you forget a dose, so you know what to do — don’t double up on doses without talking to your chemo nurse, PA, or oncologist.
• Don’t take fewer pills because you’re feeling better.
• Don’t skip doses or take fewer pills to “stretch” out and make the pills last longer. If you’re having financial difficulty paying for your medication, be upfront, and tell your oncologist. They will be able to get your copay assistance.
• Every medications’ dosing instructions are unique. Be sure that you understand. You might take your pills just on the days that you have radiation and skip the weekends. Or you might take your pills for two weeks and have a week off. You must follow your specific dosing schedule.

Be creative. Do whatever it takes to remember your dosing schedule. You might try putting a monthly calendar on the frig and coloring in the days that you take your pills — two weeks in red for the days you take your pills, and no color for the week that you skip your pills, and then the next two weeks in red.

The Bottom Line

Since the pandemic, the use of oral cancer-fighting pills/capsules has increased. Taking cancer treatment via pills or capsules is more convenient and often preferable to in-person visits, but convenience carries responsibility. Be sure to take your oral chemo exactly as directed.

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