NCCN Task Force Report: Oral Chemotherapy

Abstract

<jats:p>Oral chemotherapy is emerging as a new option for well-selected patients who can manage potentially complex oral regimens and self-monitor for potential complications. If a choice between oral and parenteral therapy is available, patients may opt for oral chemotherapy because it is more convenient to administer, allows them to avoid multiple office visits, and gives them a sense of control over their own cancer care. Whether these potential advantages are maintained in regimens that combine oral and parenteral drugs is less clear. The use of oral chemotherapeutic agents profoundly affects all aspects of oncology, including creating significant safety and adherence issues, shifting some traditional roles and responsibilities of oncologists, nurses, and pharmacists to patients and caregivers. The financing of chemotherapy is also affected. To address these issues, the NCCN convened a multidisciplinary task force consisting of oncologists, nurses, pharmacists, and payor representatives to discuss the impact of the increasing use of oral chemotherapy. (<jats:italic>JNCCN</jats:italic> 2008;6[Suppl 3]:S1–S14)</jats:p>

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“…The use of oral chemotherapy agents adds the flexibility and convenience of self‐administration at home, prolonged drug exposure, and improved quality of life compared with traditional chemotherapy administered by intravenous infusion in a physician’s office or hospital outpatient clinic . However, the use of these agents also increases the risk of potential drug‐drug interactions, because many patients receive chemotherapy at standalone specialty pharmacies and receive other medications at other pharmacies, preventing the detection of drug‐drug interactions …”

Oral antineoplastic agents: how do we care about adherence?

“…Some cancer medications may have a narrow therapeutic index, therefore conferring increased risks of adverse effects , and oral chemotherapy turns out to be as much at risk as i.v. forms . Unfortunately, the use of oral cancer treatment has expanded more quickly than the infrastructure required to ensure safe care, leading to a new challenge for cancer centres and for patients due to their lack of preparedness for side effects and their unfamiliarity with the possible techniques to mitigate drug toxicity .…”