Oral Chemotherapy at Home: A Safety Guide for Families

Why cancer pills need extra care at home

Chemotherapy can come as pills, capsules or liquids that you swallow. Because these are taken at home, the patient and family handle the medicine every day. The American Cancer Society says chemo taken by mouth is just as strong as chemo given by drip or injection, and can have the same side effects. It also says many of these medicines are considered hazardous, so they usually come with special instructions for handling and storage.

Taking pills at home does not mean the patient is on their own. The National Cancer Institute says patients on chemo see their doctor often, and the doctor may order blood tests and scans to check how treatment is going. The National Cancer Institute also notes that the full benefit of cancer pills depends on taking them properly, and that this can be hard because the schedules are often complicated. A clear routine at home matters.

Handling the pills safely

Cancer Research UK advises handling chemotherapy tablets and capsules as little as possible. One simple way is to push the tablet from its packet into a small cup kept only for this purpose, then tip it into the mouth. If you do touch a pill, wash your hands well afterwards. Anyone who helps the patient with the pills should wear gloves.

Swallow tablets and capsules whole. Do not crush, chew or open them unless the doctor or pharmacist tells you to, for example when a feeding tube is used. In that case, follow the pharmacist's directions on how to do it safely. Ask the team whether the medicine should be taken with food or on an empty stomach, and whether there are foods or drinks to avoid.

• Anyone who is pregnant, thinks they might be pregnant, or is breastfeeding should not touch the tablets or capsules.
• If they really must help, Cancer Research UK says they should take extra care, wear disposable gloves and tip the pills into a medicine cup.
• Change gloves straight away if they tear or get dirty, and wash your hands.

Storing the medicine at home

Ask the pharmacist or doctor how to store your specific medicine. Cancer Research UK says some drugs must be kept in the refrigerator and others at room temperature. The American Cancer Society notes that some oral chemo has to stay in the bottle or box it came in. Cancer Research UK also advises against keeping medicines in the bathroom, because the temperature changes and the air can be damp. Many Filipino homes are hot and humid, so ask your pharmacist which spot in the house is best.

Keep cancer pills out of reach of children and pets. Cancer Research UK says a locked cupboard is best if there are children around. Check that the medicine is still within its expiry date.

Keeping to the schedule, and planning refills

The American Cancer Society says oral chemo must be taken at the exact dose, at the exact time, and for exactly as long as prescribed. Do not change the dose or timing unless the doctor tells you to. Many treatments run in cycles, with days of treatment followed by rest days. The National Cancer Institute gives the example of chemo every day for one week followed by three weeks off. This is only an example, so ask the team to write down which days are pill days and which are rest days for your medicine.

Reminders help. Cancer Research UK suggests setting an alarm on a phone, watch or clock, and keeping a chart that you tick after each dose. Ask your pharmacist before using a weekly pill box, because Cancer Research UK says pill boxes are not always suitable for chemotherapy tablets. The American Cancer Society advises calling the cancer team when a refill is coming up, so the next prescription is ready in time.

If you order refills from 2MG Inc., you can upload the prescription online, and a pharmacist checks every prescription. In Metro Manila, orders confirmed before 3 PM are delivered the same day. Courier delivery elsewhere in the country takes two to three business days. Medicines that must stay cold are sent in cold-chain packaging. If you are applying for help from PCSO, DSWD, the Office of the Vice President or the Office of the President, ask the agency what it currently requires. 2MG is an accredited provider for their guarantee letters and can issue an official price quotation.

• Give each dose at the times the team has set. Linking it to a daily habit, such as a meal, can help.
• Tell the cancer team about every other medicine, vitamin and herbal product the patient takes.
• Keep the cancer team's phone numbers where the whole family can see them, including the number to call at night or on weekends.

Missed doses, vomiting and when to call the team

If a dose is missed, do not take a double dose next time, and do not take the pills for longer than planned. Cancer Research UK advises contacting the cancer specialist or chemotherapy nurse for advice. The American Cancer Society adds that the doctor or nurse should know about any missed or late dose, because it helps the team judge whether the treatment is working.

If the patient vomits after taking a dose, Cancer Research UK says not to take another dose. Call the team's advice line instead. Before treatment starts, ask the team exactly what to do in each of the situations below.

• A dose was missed, taken late, spilled, lost or vomited.
• Someone other than the patient took the medicine by mistake.
• The patient has trouble swallowing the pills. Some medicines come in other forms, so ask the team.
• Side effects begin, such as nausea, vomiting or diarrhoea. The American Cancer Society says to tell the team as soon as they happen.
• You are unsure about a side effect and cannot reach the doctor. The American Cancer Society advises not taking the chemo until you have spoken with someone on the care team.
• A fever of 38°C or higher (or the temperature your team told you to watch for), shaking chills or other signs of infection, or unusual bleeding or bruising. Many cancer pills can lower blood counts, so call the cancer team straight away, even at night. If you cannot reach them, go to the nearest emergency room and say the patient is on chemotherapy.
• Signs of a serious allergic reaction, such as trouble breathing, hives or dizziness. Call 911, the national emergency hotline, or go to the nearest emergency room, then tell the cancer team.

Other medicines, supplements and food

Some medicines, vitamins, herbal products and foods can change how cancer pills work. Cancer Research UK gives two examples. The herbal remedy St John's Wort can affect how the body breaks down drugs, and grapefruit and grapefruit juice can interfere with several drugs.

Check with the cancer team before starting anything new, including medicines bought without a prescription, vitamins, herbal teas and supplements. Tell any doctor, dentist or pharmacist the patient sees that they are taking oral chemotherapy.

Toilet, laundry and disposing of leftover pills

Traces of the medicine can be in urine, stool, vomit and blood during treatment and for some time afterwards. The American Cancer Society says it generally takes at least 48 hours for the body to get rid of most chemo. Cancer Research UK says traces can remain for several days after the last dose, depending on the drug. Ask your team how long these precautions apply to you.

Cancer Research UK advises the following: put the toilet lid down and flush twice, wash hands with soap and water after using the toilet, and wear gloves when cleaning the toilet or wiping up body fluids. Wash soiled clothes and sheets separately on the hottest, longest cycle, and run the wash twice. A pregnant or breastfeeding family member can still spend time with the patient, but should not clean up body fluids or handle soiled laundry.

Never throw cancer pills in the household trash or flush them down the toilet. The American Cancer Society also says never to give your medicine to another person. Cancer Research UK advises returning unused or partly used tablets to the pharmacist at the hospital where you got them. Ask your cancer team or hospital pharmacy where to return them in your area.