Taking Oral Chemotherapy Safely at Home

This page is for people taking chemotherapy pills at home, and the people who live with them. It covers taking, storing, and handling the drug safely.

A pill feels less serious than an IV drip in a hospital chair. It is not. The American Cancer Society says oral chemotherapy is just as strong as chemo given by infusion or injection. What changes is who is responsible for getting it right. That job moves from a nurse in a monitored infusion suite to you, in your kitchen, on an ordinary Tuesday.

That shift is why the practical details below matter.

Your team will give you a schedule. It may not be as simple as "one a day". Many oral cancer drugs run in cycles, such as two weeks on and one week off. Some must be taken with food, or specifically without it, at set intervals.

Get the following clear before your first dose, in writing:

• the exact times of day, and whether food is involved
• how many days on, how many days off, and the date each cycle restarts
• whether the tablet can be crushed, split, or opened
• which other medicines, supplements, and foods to avoid

Certain foods, vitamins and medicines can change how oral chemotherapy works. Check with your team before adding anything, including herbal products.

Do not take two doses to make up for one. Doubling up is a common instinct and a real risk. Call your team or specialty pharmacy and ask. The right answer depends on the drug and on how many hours have passed.

If you vomit soon after a dose, do not automatically retake it. Ask.

Missing doses, taking them at the wrong time, or stopping early can happen to anyone. The reasons are often ordinary ones:

• nausea
• mouth soreness
• forgetting
• confusion over a cycle schedule
• a refill that did not arrive
• a copay that was unaffordable that month

Concealing it is the one response that does harm. If your team believes you took every dose, they may misread a side effect. They may misread a scan. They may change your treatment based on something that never happened. Say plainly what you took and what you did not.

Keeping a simple diary, on paper or in your phone, makes that conversation easy. Note the dose, the time, and anything you skipped.

Keep the drug in its original labeled container. Do not leave it loose, and do not mix it into a family pill box unless your team has agreed. Store it away from heat and moisture, so a steamy bathroom is a poor spot. Follow the storage label for your drug.

Keep it well out of reach of children and pets. A locked box is reasonable if either is in the house.

You may need to wear gloves when handling the pills. Ask your team. Wash your hands afterward either way. If anyone who might handle the medicine is pregnant or breastfeeding, ask your team first.

After chemo, small amounts of the drug leave your body in urine, stool, vomit and sometimes sweat. The American Cancer Society says it generally takes at least 48 hours for the body to get rid of most chemo. Close the toilet lid before flushing. Wash your hands thoroughly. Anyone helping you with body fluids should wear 2 pairs of disposable gloves and wash their hands after. Wash clothing or bedding soiled with body fluids separately, in hot water.

Ask your team how many hours these precautions apply for your specific drug. The answer varies.

Do not flush unused tablets or put them in household trash. Return them to your pharmacy or clinic, or ask your team how to dispose of them. This applies to doses left over after a dose change. It also applies to anything remaining when treatment stops.

• Call 911 or go to an emergency department if vomiting or watery stools will not stop and you are too dizzy or drowsy to drink anything. Do not drive yourself.
• Call your care team right away if you realise you took a double dose, or a child or another adult in the house swallowed one of your tablets. For emergencies call 911 or go to the ER.
• Ring your cancer team immediately, at any hour, if your temperature reaches 100.4°F (38°C) or higher, or shaking chills come on. The CDC treats a fever during chemotherapy as a medical emergency, because it may be the only sign of an infection that can turn life-threatening fast. If you cannot get through quickly, go to an emergency department and tell the staff you are on chemotherapy.
• Call your care team right away if mouth soreness or sickness has stopped you eating, drinking, or keeping the tablets down at all.
• Call your care team within a day or two if a refill has not arrived, the copay has become unaffordable, or you have missed doses. Each of those has a practical fix, and each changes what your team should do next.

• American Cancer Society: Oral Chemotherapy
• American Cancer Society: Chemotherapy Safety
• CDC: Fever during chemotherapy