ver the past few months, John, a 58-year-old with advanced gastric (or stomach) cancer, has been undergoing intravenous (IV) chemotherapy, requiring regular hospital visits for infusions. Recently, his doctor introduced the option of oral (i.e., taken by mouth) chemotherapy in tablet form, allowing John to take his medications at home.
Chemotherapy involves the use of drugs to target and kill cancer cells. Chemotherapy can be delivered in different routes of administration, depending on the type of drugs involved, the treatment objectives, and what and where the cancer is. Most chemotherapy drugs are given IV or intravenously (i.e., directly into the bloodstream via a vein using a needle or a small plastic tube – a catheter). Oral chemotherapy involves taking chemotherapy drugs by mouth, usually in the form of tablets or capsules, which are absorbed through the digestive system before entering the bloodstream. While both forms of chemotherapy may serve the same purpose, sometimes the route of administration may affect the patient experience in significant ways.
Imagine being able to receive treatment without regular visits or commute to the hospital, without needles or tubes, and without hours spent in a chair or bed connected to an IV, etc., oral chemotherapy is an option of taking cancer treatment at home. Understanding these two options could be the key to not just a more convenient but a more empowered approach to managing health and wellness.
Why oral chemotherapy?
Instead of frequent visits to the hospital for IV infusions, patients can take their chemotherapy medication(s) at home. This is particularly valuable for individuals who may have logistical barriers to frequent hospital visits. Oral chemotherapy reduces the time/costs spent on commuting, waiting for appointments, and/or undergoing IV infusions, which may significantly improve a patient’s quality of life.
However, it is important for patients to follow their prescribed regimen carefully. Missing doses or taking the medication incorrectly may impact effectiveness of oral chemotherapy. Readers can learn more about “Taking Oral Chemotherapy at Home” on the Cancer Care Society website.
Comparing oral and IV chemotherapy
Several studies have investigated the efficacy of oral chemotherapy in comparison to IV treatments. For example, in the case of John’s advanced gastric (or stomach) cancer, a 2018 study was conducted in 126 Chinese patients. It was found that the oral chemotherapy option could be just as effective, if not more so, than the IV option and have similar safety profile in certain cases.
However, in 2019, a U.S. study reported that when patients experienced challenges in adherence to their oral chemotherapy at home, they experienced higher number of cancer-related symptoms and lower quality of life, suggesting that oral chemotherapy may not be as effective if patients are not able to adhere to the medication regimen accordingly.
Safety considerations
Both oral and IV chemotherapy come with side effects, and these can vary depending on the drug(s) and the patient’s individual response. Common side effects of oral chemotherapy include nausea, vomiting, and diarrhea, while IV chemotherapy may lead to neutropenia, which may increase the risk of infection. [Our July 2024 edition covered “common side effects of chemotherapy and safe medication use considerations”)
One of the advantages of oral chemotherapy is the reduced risk of infection, as patients do not require a tube or catheter for drug administration, which are common sources of complications in the IV treatment option. However, oral chemotherapy also comes with the expectations of patients adhering strictly to their medication regimen/schedules at home, which can sometimes be more challenging than attending scheduled IV sessions at the hospital. In addition, it is also important to store and handle oral chemotherapy drugs at home safely.
The Financial aspect
Cost is another factor that patients need to consider when deciding between oral and IV chemotherapy. While oral chemotherapy reduces the number of hospital visits and associated costs, the medications could be more expensive. Patients should consult their healthcare providers and/or their third-party insurance (if applicable) to understand the financial implications of their treatment options.
A new horizon for cancer treatment
Oral chemotherapy represents a significant advancement in cancer treatment, providing patients with a convenient alternative to traditional IV methods. In John’s scenario, oral chemotherapy has demonstrated comparable efficacy to IV chemotherapy, offering a valuable option for his advanced gastric cancer treatment. However, patients must carefully weigh the benefits of convenience and reduced hospital visits against the importance of adhering strictly to their medication regimen, managing potential side effects, storage, and safe handling of their medications at home.
As with any cancer treatment, it is essential to discuss all options and your concerns with your healthcare providers to determine the best possible medication therapy management. Oral chemotherapy may not be suitable for everyone, but for many, it offers a new level of freedom and flexibility in their cancer care journey.
By Hyun Uk Lee and Certina Ho
Hyun Uk Lee is a PharmD student at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.