Oral chemotherapy, like IV chemotherapy, effectively helps patients fight cancer and may have similar side effects to its IV counterparts. Self-administration of oral chemotherapy may be convenient, but it is still chemotherapy and requires extra caution.
Our nurses educate patients regarding why oral chemotherapy was prescribed, correct dosing and administration (e.g., keep in a safe place in the original container; don’t mix with other pills; and not to crush, break, or chew), potential side effects, and side-effect management. Washing hands before and after taking oral chemotherapy, taking it at the same time every day, and returning unused pills to the clinic for proper disposal should also be included in patient education. Education starts in the clinic, and nurses call a few days after patients start to review the plan and discuss any issues.
Taking oral chemotherapy as directed can be harder than other regimens because the schedule can be confusing, the medication can cause side effects, and patients often are not feeling well. Adherence is an issue for 10%–60% of patients, depending on the medication. It’s important for nurses to assess adherence with oral chemotherapy, because nonadherence has been associated with inferior outcomes.
Cost may be a factor: oral chemotherapy can be very expensive, which may contribute to poor adherence. Out-of-pocket costs during active cancer treatment range from $200–$2,000 per month. Because of the expense of most oral chemotherapies, out-of-pocket costs are often substantially higher for oral regimens and will only continue to increase as oral regimens become more common.
When nurses assess adherence and find cost is an issue, they can make referrals for resources or programs to defray costs. If patients do not qualify for assistance, nurses can facilitate patient-physician discussions regarding alternative treatment options.