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Open Access Article

Safe Handling and Administration Considerations of Oral Anticancer Agents in the Clinical and Home Setting

Joanne Lester
CJON 2012, 16(6), E192-E197 DOI: 10.1188/12.CJON.E192-E197

The use of hormonal, chemotherapeutic, and targeted biologic oral agents has exponentially increased since the early 2000s. Oral therapies have the advantage of persistent exposure of the cytotoxic drug to tumor cells and the tumor environment. The use of oral anticancer agents provides therapeutic drug treatment for patients with cancer in the comfort of their home or alternative settings, such as retirement homes and assisted living or extended-care facilities. Practices to ensure safe storage, handling, administration, and disposal of oral agents are necessary to prevent additional exposure of hazardous substances to the environment, professionals, patients, family members, and caretakers. Providers should consider potential barriers to adherence and compliance, and develop strategies to ensure optimal therapeutic benefit prior to initiation of oral agents.

References 

American Society of Health-System Pharmacists. (2002). <i>ASHP guidelines on handling hazardous drugs.</i> Retrieved from <a target="_blank" href='http://www.ashp.org/doclibrary/bestpractices/prepgdlhazdrugs.aspx.pdf'>h...

Bartel, S. B. (2007). Safe practices and financial considerations in using oral chemotherapeutic agents. <i>American Journal of Health-System Pharmacy, 64</i>(Suppl. 5), S8-S14. doi:10.2146/ajhp070036

Barton, D. (2011). Oral agents in cancer treatment: The context for adherence. <i>Seminars in Oncology Nursing, 27</i>, 104-115. doi:10.1016/j.sonen.2011.02.002

Birner, A. M., Bedell, M. K., Avery, J. T., & Ernstoff, M. S. (2006). Program to support safe administration of oral chemotherapy. <i>Journal of Oncology Practice, 2</i>, 5-6. doi:10.1200/JOP.2.1.5

British Oncology Pharmacy Association. (2004). Position statement on care of patients receiving oral anticancer drugs. <i>Pharmaceutical Journal, 272</i>, 422-423.

Cooper, C., & Depledge, J. (2004). Cytotoxic chemotherapy: What do community nurses need to know? <i>British Journal of Community Nursing, 9</i>, 26-32.

Faiman, B. (2011). Medication self-management: Important concepts for advanced practitioners in oncology. <i>Journal of the Advanced Practitioner in Oncology, 2</i>, 26-34.

Goodin, S., Griffith, N., Chen, B., Chuk, K., Daouphars, M., Doreau, C., … Meier, K. (2011). Safe handling of oral chemotherapeutic agents in clinical practice: Recommendations from an international pharmacy panel. <i>Journal of Oncology Practice, 7</i>, 7-12.

Grampians Integrated Cancer Service. (2008). <i>Clinical guidelines for the administration of oral chemotherapy agents in the community setting.</i> Retrieved from <a target="_blank" href='http://grpct.grampianspalliativecare.com.au/portals/3/policy/Clinical%20...

Hohneker, J., Shah-Mehta, S., & Brandt, P. S. (2011). Perspectives on adherence and persistence with oral medications for cancer treatment. <i>Journal of Oncology Practice, 7</i>, 65-67. doi:10.1200/JOP/2010.000076

Jacobson, J. O., Polovich, M., Gilmore, T. R., Schulmeister, L., Esper, P., LeFebvre, K. B., & Neuss, M. N. (2012). Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards: Expanding the scope to include inpatient settings. <i>Oncology Nursing Forum, 39</i>, 31-38. doi:10.1188/12.ONF.31-38

Jacobson, J. O., Polovich, M., McNiff, K. K., LeFebvre, K. B., Cummings, C., Galioto, M., … McCorkle, M. R. (2009). American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards. <i>Oncology Nursing Forum, 36</i>, 651-658. doi:10.1188/09.ONF.651-658

Jatoi, A., Smith, E. L., Gunderson, H. D., Hartgers, M. L., Looker, S. A., Santana-Davila, R., & McWilliams, R. R. (2010). Capecitabine and temozolomide: Design, implementation, and preliminary outcomes from a pilot project to ensure safe prescribing of oral chemotherapy. <i>Journal of Oncology Practice, 6</i>, 210-212.

Lam, M. S. (2011). Extemporaneous compounding of oral liquid dosage formulations and alternative drug delivery methods for anticancer drugs. <i>Journal of Human Pharmacology and Drug Therapy, 31</i>, 164-192. doi:10.1592/phco.31.2.164

Maloney, K. W., & Kagan, S. H. (2011). Adherence and oral agents with older patients. <i>Seminars in Oncology Nursing, 27</i>, 154-160. doi:10.1016/j.sonen.2011.02.007

Matthew, A. G., Currie, K. L., Ritvo, P., Nam, R., Nesbitt, M. E., Kalnin, R. W., & Trachtenberg, J. (2007). Personal digital assistant data capture: The future of quality of life measurement in prostate cancer treatment. <i>Journal of Oncology Practice, 3</i>, 115-120.

Mattson, M. E., & Friedman, L. M. (1984). Issues in medication adherence assessment in clinical trials of the National Heart, Lung, and Blood Institute. <i>Controlled Clinical Trials, 5</i>, 488-496.

Moody, M., & Jackowski, J. (2010). Are patients on oral chemotherapy in your practice setting safe? <i>Clinical Journal of Oncology Nursing, 14</i>, 339-346. doi:10.1188/10.CJON.339-346

Moore, S. (2010). Adherence to oral therapies for cancer: Barriers and models for change. <i>Journal of the Advanced Practitioner in Oncology, 1</i>, 155-164.

National Cancer Institute. (2011). Straight from the source: Electronic patient-reported outcomes. Retrieved from <a target="_blank" href='http://www.cancer.gov/ncicancerbulletin/051711/page5'>http://www.cancer....

Oakley, C., Lennan, E., Roe, H., Craven, O., Harrold, K., & Vidall, C. (2010). Safe practice and nursing care of patients receiving oral anti-cancer medicines: A position statement from UKONS. Retrieved from <a target="_blank" href='http://ecancer.org/ecms/4/177/full'>http://ecancer.org/ecms/4/177/full</a>

Occupational Safety and Health Administration. (1999). OSHA Technical Manual, Section VI, Chapter 2: Controlling occupationalexposure to hazardous drugs. Retrieved from <a target="_blank" href='http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html'>http://www.osha.g...

Palmieri, F. M., & Barton, D. L. (2007). Challenges of oral medications in patients with advanced breast cancer. <i>Seminars in Oncology Nursing, 23</i>(4, Suppl. 2), S17-S22. doi:10.1016/j.soncn.2007.10.004

Partridge, A. H., Avorn, J., Wang, P. S., & Winer, E. P. (2002). Adherence to therapy with oral antineoplastic agents. <i>Journal of the National Cancer Institute, 94</i>, 652-661.

Partridge, A. H., Wang, P. S., Winer, E. P., & Avorn, J. (2003). Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. <i>Journal of Clinical Oncology, 21</i>, 602-606. doi:10.1200/JCO.2003.07.071

Patton, J. (2008). Increased use of oral chemotherapy drugs spurs increased attention to patient compliance. <i>Journal of Oncology Practice, 4</i>, 175-177. doi:10.1200/JOP.0843002

Prostate Cancer Research Institute. (2011). Glossary of prostate cancer-related terms. Retrieved from <a target="_blank" href='http://prostate-cancer.org/resources/glossary/'>http://prostate-cancer.o...

Schneider, S. M., Hess, K., & Gosselin, T. (2011). Interventions to promote adherence with oral agents. <i>Seminars in Oncology Nursing, 27</i>, 133-141. doi:10.1016/j.sonen.2011.02.006

Simchowitz, B., Shiman, L., Spencer, J., Brouillard, D., Gross, A., Connor, M., & Weingart, S. N. (2010). Perceptions and experiences of patients receiving oral chemotherapy. <i>Clinical Journal of Oncology Nursing, 14</i>, 447-453. doi:10.1188/10.CJON.447-453

Simmons, C. C. (2010). Oral chemotherapeutic drugs: Handle with care. <i>Nursing, 40</i>(7), 44-47.

Society of Hospital Pharmacists of Australia. (2007). SHPA standards of practice for the provision of oral chemotherapy for the treatment of cancer. <i>Journal of Pharmacy Practice and Research, 37</i>, 149-152.

Spoelstra, S. L., Given, B. A., Given, C. W., & Grant, M. (2011). Policy implications of oral agents. <i>Seminars in Oncology Nursing, 27</i>, 161-165. doi:10.1016/j.sonen.2011.02.008

Streeter, S. B., Schwartberg, L., Husain, N., & Johnsrud, M. (2011). Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. <i>Journal of Oncology Practice, 17</i>(Suppl. 5), S46-S51. doi:10.1200/JOP.2011.000316

Thompson, A. M., Dewar, J., Fahey, T., & McCowan, C. (2007). Association of poor adherence to prescribed tamoxifen with risk of death from breast cancer [Abstract]. Retrieved from <a target="_blank" href='http://www.asco.org/ASCO/abstracts+&+virtual+meeting/abstracts?&vmview=a...

Walsh, K. E., Dodd, K. S., Seetharaman, K., Roblin, D. W., Herrinton, L. J., Von Worley, A., … Gurwitz, J. H. (2008). Medication errors among adults and children with cancer in the outpatient setting. <i>Journal of Clinical Oncology, 27</i>, 891-896.

Warren, S. R., Raisch, D. W., Campbell, H. M., Guarino, P. D., Kaufman, J. S., Petrokaitis, E., … Jamison, R. L. (2011). Medication adherence assessment in a clinical trial with centralized follow-up and direct-to-patient drug shipments. <i>Clinical Trials</i>. Advance online publication. doi:10.1177/1740774511410331

Weingart, S. N., Brown, E., Bach, P. B., Eng, K., Johnson, S. A., Kuzel, T. M., … Walters, R. S. (2008). NCCN Task Force Report: Oral chemotherapy. <i>Journal of the National Comprehensive Cancer Network, 6</i>(Suppl. 3), S1-S14.

Weingart, S. N., Flug, J., Brouillard, D., Morway, L., Partridge, A., Bartel, S., … Connor, M. (2007). Oral chemotherapy safety practices at US cancer centres: Questionnaire survey. <i>BMJ, 334</i>, 407. doi:10.1136/bmj.39069.489757.55

Weingart, S. N., Spencer, J., Buia, S., Duncombe, D., Singh, P., Gadkari, M., & Connor, M. (2011). Medication safety of five oral chemotherapies: A proactive risk assessment. <i>Journal of the Oncology Practice, 7</i>, 2-6. doi:10.1200/JOP.2010.000064

Wilkes, G. M., & Barton-Burke, M. (2011). Appendix 1: Controlling occupational exposure to hazardous drugs. <i>Oncology Nursing Drug Handbook</i> (p. 1196). Sudbury, MA: Jones and Bartlett.