My 64-year-old female patient is about to go home on oral chemotherapy for her colon cancer. Her husband is in poor health, and she asked for recommendations to keep him safe as she begins her at-home treatments.-S.P., DEL.

Kayla Napier, PharmD, and Dan J. Sheridan, MS, RPh, CPPS, reply: Oral chemotherapy has become more available recently. These medications can be very dangerous if in the wrong hands, such as children or those for whom the medication is not intended. There are many considerations when handling oral chemotherapy to avoid medication errors, contamination, and accidental exposure to other individuals. Nursing staff should inform patients and caregivers about the appropriate storage, handling, administration, and disposal of oral chemotherapy to use these medications safely.1

Storage

Explain to the patient that she should store her chemotherapy in a cool, dry place, away from heat, moisture, and direct sunlight.2 Do not store in the bathroom or in areas where food or drink are stored and consumed.1 Safely store chemotherapy away from other medications, water, children, and pets.2 Also, tell your patient to keep her chemotherapy in its original container with its label.2

Handling

Inform patients that caregivers are strongly advised to wear disposable nitrile gloves when handling oral chemotherapy agents.1 If gloves are not available, the patient can tip the container to place a tablet or capsule in a disposable medicine cup.2 Caregivers who are pregnant or breastfeeding should not handle oral chemotherapy.1 Patients should be aware that if they soil linens with body fluids, caregivers should wear gloves when handling these linens or other contaminated items to minimize exposure risk and the soiled linen should be laundered separately from nonsoiled linen.1 Even if the patient or her husband is wearing gloves while handling, administering, or disposing of oral chemotherapy, remind them to also wash their hands with soap and water before wearing and after removing the gloves.1

Keep the product information from the pharmacy or manufacturer easily accessible. Also, keep the telephone number for the local poison control center readily available. The National Poison Control Center toll-free help line is 800-222-1222, which will route you to a local poison control center.

Administration

Patient understanding of the correct dosage and administration instructions is imperative. Accidently consuming an incorrect dose may result in fatal adverse reactions.3 Instruct the patient to never double doses or skip a dose unless instructed by their oncologist.1 Unfortunately, this tragedy took the life of a patient who accidentally took three cycles of her chemotherapy pills, believing the pharmacy had dispensed a single cycle.3 It is critical to always clarify unclear doses with the patient's oncologist or pharmacist.4

Disposal

It is important to safely dispose of unused or expired chemotherapy. Inform the patient that is not recommended to dispose chemotherapy in the trash or down the toilet.1,2 One option is to return the unused medication to their healthcare provider, chemotherapy facility, or pharmacy.2 Other medications used to manage symptoms associated with chemotherapy but are not chemotherapy may be thrown in the trash. When discarding, instruct the patient to mix nonchemotherapy medications with an unappealing substance like coffee grounds or cat litter. Seal the medication in a zip bag or an empty can and throw out the sealed container.5 Refer your patient to the FDA guide on medications that can be flushed down the toilet.6 Inform the patient that she may also be able to dispose of nonchemotherapy medications at local pharmacies or law enforcement agencies that offer disposal containers to best protect the environment.2

Oral chemotherapy is a hazardous medication and should be treated like such. Remind the patient to reach out to their healthcare provider or local pharmacist with any questions about medications. Since the patient's husband is in poor health, printed medication information may be especially important in this case. Consider inviting a trusted friend or family member to a patient education session so the patient can contact them if she forgets anything. Additionally, incorporate a teach-back method to ensure that the patient understands key points about her therapy.

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