Oral Chemo At Home
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By Mitzi Baker

Keeping Up With Oral Meds

Sticking it out with at-home treatment can prove daunting

By Mitzi Baker

“Will I actually take my prescribed drugs?” may not be a question many people consider after receiving a cancer diagnosis. But as new oral chemotherapies come on the market, more patients may be taking their drugs at home, rather than at a doctor’s office—making it a lot easier for them to fall off track with their treatment.Medicine

“We’ve known for decades that people don’t take their medications for other chronic conditions, such as hypertension and diabetes,” says Cary Gross, an internist at Yale School of Medicine in New Haven, Conn. With therapies for colon, breast and other cancers now available in an oral form, similar challenges will likely apply to people undergoing cancer therapy, he says.

One problem is that complicated regimens of multiple drugs can lead patients to miss doses, says Ellen Hollywood, a clinical research nurse at Memorial Sloan-Kettering Cancer Center in New York City. “We just keep asking more and more of patients,” she says. “It can become overwhelming.”

For many patients, a drug’s side effects may present the biggest obstacle to staying on course, says Dawn Hershman, an oncologist from Columbia University Medical Center in New York City. On Sept. 20, Hershman published a study in the Journal of Clinical Oncology, which found that among nearly 9,000 women with early stage breast cancer, fewer than half completed their full course of hormone therapy. “It’s a huge issue not just for breast cancer and hormonal therapies,” she says, “but also as we move to other types of oral chemotherapy,” for other cancers.

Another barrier can be the prohibitive cost, says Hershman, especially of newer medications, which routinely require thousands of dollars for a month’s supply. For example, Revlimid (lenalidomide), prescribed as a second-line therapy in the treatment of multiple myeloma, can cost more than $7,000 for a month’s supply. Even patients who have insurance may have expensive copayments—estimated to be an average of about $1,400 per month, according to Mary Kruczynski, the director of policy analysis for the Community Oncology Alliance and a breast cancer survivor. While intravenous chemotherapy is a procedure that’s frequently covered by medical insurance, oral treatments are usually considered a prescription benefit requiring copays.

Rose Gerber, the director of patient advocacy for the Community Oncology Alliance and a breast cancer survivor, contends that patients also may not be as serious about taking a pill as they are about other treatments. Some think that once their primary treatment—surgery, radiation, intravenous chemotherapy—is completed, they have “survived and beat cancer,” she says, making them less inclined to adhere to a long course of medication at home.

“Oral medications are not always the right fit for everyone,” notes Hollywood. But “if we can reassure our patients that they can always call us, that we are not going to be upset with them, that we will try to counsel them through it and make them feel like they have a partner, it can work out.”

(photo: © Fotografiabasica / istockphoto)