Oral chemotherapy includes pills, capsules, and liquids used to treat cancer. Unlike intravenous (IV) chemotherapy, oral treatments can often be taken at home. Oral chemotherapy is usually taken in rounds or cycles to give the body breaks between treatments and cut back on side effects.
Chemotherapy works by damaging rapidly growing cells. Cancer cells grow and divide at an out-of-control rate, and chemotherapy can interrupt their cell cycles. Unfortunately, chemotherapy cannot distinguish cancer cells from healthy cells, so some healthy cells are also damaged in the process. This is what causes chemotherapy’s side effects, but most healthy cells can eventually recover.
The goal of chemotherapy is to cure cancer. If that is not possible, chemo can be used to control the growth of cancer, or in severe cases, to help ease the symptoms of the disease.
Oral chemotherapy can be used to treat early-stage cancers, metastatic cancers, and cancer recurrences. Your oncologist will recommend a specific oral chemotherapy regimen based on your specific type of cancer, how advanced it is, and any underlying conditions you may have.
Your doctor may also recommend off-label drugs as part of your treatment. This means that the drug being used is approved for other conditions but still being studied for cancer treatment. For example, the U.S. Food and Drug Administration (FDA) has approved the use of lorazepam (Ativan) for treating anxiety. While not an approved use, many oncologists prescribe it to treat nausea and vomiting during chemotherapy treatment.
Before taking oral chemotherapy treatments, talk with your doctor about how and when to take the medication. Be sure you understand your drug’s dosage and how often it should be taken. Find out if your local pharmacy is able to fill the prescription and how long it may take to receive your prescription.
Next, take some time to develop a plan for taking your medication at the same time every day. Set reminders on your phone or ask a loved one to help you remember. Once you are back in your usual routine at home, it can be difficult to stay on track with your oral chemotherapy medications, so having a plan can help.
Oral vs. Traditional (IV) Chemotherapy
Oral chemotherapy agents have been becoming more common in recent years because of their ease and convenience. IV chemotherapy requires patients to attend visits to an infusion clinic that can last for hours. Oral options can cut back on financial burdens like transportation, childcare, and IV supplies. The flexibility of oral chemotherapy allows patients to still travel and not have to miss work for extra appointments. Without the need for IV treatment, oral chemotherapy can help to reduce the pain and risks of infection that often come with cancer treatment.
One drawback of oral chemotherapy is that it switches the responsibility of administering treatment to the patient. Like with IV medications, oral chemotherapy needs to be taken at very specific times in order to effectively fight cancer. This can be difficult for many patients to adhere to. If you are concerned about your ability to take your medication consistently, talk with your oncologist about other options.
Precautions and Contraindications
Oral chemotherapy is only an option for patients who are able to swallow pills. If you had trouble taking pills or capsules in the past, talk with your oncologist. Because the medication needs to be taken at the same time every day, it’s essential that you have a good system in place. If you experience forgetfulness due to brain cancer, dementia, advanced age, or alcohol abuse, oral chemotherapy may not be a good fit. Talk with your doctor about any specific drug allergies you have and whether you are currently pregnant or nursing.
There are several different types of chemotherapy agents, and each one performs a specific job:
- Alkylating agents damage the cell’s DNA and prevent it from multiplying. They are used to treat several types of cancer, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, sarcoma, lung cancer, breast cancer, and ovarian cancer. Some of these medications include Gleostine (lomustine) and Temodar (temozolomide)
- Antimetabolites change a cell’s DNA, preventing it from making copies of itself. They are used to treat leukemia and cancers of the breast, ovaries, and gastrointestinal tract. Examples of this type of oral agents include Hydrea (hydroxyurea) and Trexall (methotrexate)
- Topoisomerase I inhibitors interfere with the enzymes that help to separate strands of DNA for multiplication. They can be used to treat certain leukemias, as well as cancers of the lungs, ovaries, colon, pancreas, and gastrointestinal tract. An example of an oral topoisomerase I inhibitor is Hycamtin (topotecan)
Your doctor will determine your dose based on your type of cancer, how advanced it is, and your general health. The goal of chemotherapy dosing is to find a value that is high enough to kill the cancer cells while minimizing side effects and harm to healthy cells as much as possible.
How To Take and Store
When taking your chemotherapy pill or liquid, wash your hands before and after handling the medication. Oral chemotherapy should always be swallowed as directed; never cut, chew, or crush it.
Chemo you swallow is as strong as other forms of chemo, and many are considered hazardous. You may be told to be careful not to let others come into contact with your medication or your body fluids while taking it and for a time after taking it. You may need to wear gloves when touching the pills or capsules.
Some drugs have to be kept in the bottle or box they came in, while some drugs and the packages they come in need to be disposed of in a certain way. Some may have to be taken back to the drug store to be thrown away safely. Some drug manufacturers will include materials for safely disposing of your medication.
Keeping your medication in a weekly pill box may help you remember to take it each day. Most chemotherapy pills and liquids can be stored at room temperature. There are some forms of oral chemotherapy that require refrigeration.
Because chemotherapy attacks fast-growing cells, it is effective against cancer, but it’s also damaging to the rest of the body. Normal cells most commonly affected by chemotherapy are in the bone marrow, hair follicles, digestive tract, and reproductive system. The heart, kidneys, bladder, lungs, and nervous system can also be affected.
While some patients may experience severe side effects, it’s helpful to remember that many experience few side effects, if any. Most side effects go away quickly once chemotherapy is stopped. Some, however, can last weeks to years after treatment has completed.
Chemotherapy in any form is hard on your gut; the most common side effects are nausea, vomiting, and diarrhea. Other common side effects include:
Chemotherapy affects our major organs like the heart, kidneys, and lungs. For this reason, severe side effects can occur. While uncommon, it is possible to experience the following severe side effects while taking oral chemotherapy:
When to Call Your Doctor
Most chemotherapy side effects are temporary, but some may be an indication of a serious health problem. It’s important to call your doctor about any new side effects, especially ones that are so severe they affect your ability to function. Call your doctor right away if you experience:
- A fever above 100.4 degrees Fahrenheit
- An allergic reaction, such as trouble breathing
- Intense headache
- Shortness of breath
- New rash or chills
- Uncontrolled vomiting or diarrhea
- Blood in your urine or bowel movements
- Bleeding or new bruises
Warnings and Interactions
Oral chemotherapy can be affected by other prescription drugs, over-the-counter (OTC) medications, and certain foods and supplements. Talk with your pharmacist about your treatment’s specific interactions and how to avoid them.
Medications that can affect chemotherapy include:
- Anticoagulants (such as coumadin) can affect your medication and need to be monitored
- Antibiotics (such as amoxicillin) affect chemotherapy and may require a pause in treatment
- Antacids and proton pump inhibitors (PPIs) can block the absorption of oral chemotherapy
- CYP3A inducers can reduce the amount of chemotherapy in your blood
- CYP3A inhibitors can increase the amount of chemotherapy in your blood
- CYP2D6 and CYP2C9 inducers and inhibitors can affect the amount of chemotherapy in your blood
- St. John’s Wort can reduce the amount of chemotherapy in your blood
Food can affect the way your body absorbs oral chemotherapy. Some medications must be taken on an empty stomach, while others work better when taken with food. Ask your physician or pharmacist about any changes to your diet during cancer treatment. The following foods should almost always be avoided since they can change the absorption of chemotherapy:
- Grapefruit juice or products
- Seville oranges
- Orange marmalade
If you realize that you missed a dose of your oral chemotherapy, talk with your doctor about how to proceed. Most medications are scheduled once or twice per day, and the missed dose can be taken if it’s within six hours of the scheduled dose. If it’s been more than six hours, the missed dose is usually skipped. The package insert from your prescription should have instructions for how to manage a missed dose.
All chemotherapy agents are quite expensive, and oral pills and liquids are no exception. Your doctor’s office may need a few additional days once it’s been prescribed to fill out a prior authorization to ensure that your insurance company covers the drug. Once the company approves the medication, you will be notified of your copayment. Even with insurance coverage, the cost can be high. Talk with your medical team about obtaining financial assistance from drug companies or copayment assistance organizations.
Monitoring Your Condition
While you will most likely be able to take your oral chemotherapy at home, your doctor will continue to monitor your health through blood tests and scans. A lab test requires a sample of blood, urine, or a body tissue to monitor how your body is responding to the treatment. Your doctor will discuss a lab schedule with you and what lab values will necessitate a change in treatment. Your specific monitoring program will be individual to you and your stage of cancer.
During oral chemotherapy treatment, your oncology team may order the following monitoring lab tests:
When you are undergoing cancer treatment, it’s vital to take care of yourself and minimize as many side effects as possible. Doing gentle physical activities such as a slow walk or relaxing yoga practice can help you feel more energized. Aim to incorporate bland, healthy foods into your diet to nourish your body without exacerbating nausea or diarrhea. If you’re experiencing constipation, warm liquids like tea or broth, as well as plenty of water, will help.
Invest in a blood pressure monitor to check your vital signs daily. This will help your medical team know if you’re developing hypertension and make changes to treatment as needed. Your medical team may also ask you to check your blood sugar every day since hyperglycemia is a common side effect of oral chemotherapy.
If you start to notice new side effects, call your medical team right away. They will most likely be able to prescribe medication to make those side effects more tolerable. For example, nausea, vomiting, and diarrhea can all be treated with medication. Mouth sores can improve with a gentle mouthwash, and a skin rash can be treated with a prescribed lotion.
A Word From Verywell
Oral chemotherapy is becoming more common. It allows you to fight your cancer from the comfort of your own home. Doing so, however, does come with a high cost and requires careful handling on your own. It may not be a suitable choice if you are prone to memory problems since oral chemotherapy needs to closely follow a preset schedule.
Each type of oral chemotherapy has its own unique directions, interactions, and side effects. Talk with your oncology team about your specific treatment plan, and don’t hesitate to bring any of your questions to them.