Some patients aren’t taking their oral chemotherapy as prescribed.
Cancer treatment is changing. Some people now get their chemotherapy from the medicine cabinet instead of going to the hospital for hours of IV treatment. WHYY reports on the convenience, price tag and some complications of oral chemotherapy.
Some older, IV drugs now come in pill form and nearly all of the new, targeted tumor-killing medications are tablets. University of Pennsylvania oncologist Angie DeMichele prescribes oral chemotherapy to about 10 percent of her patients.
DeMichele: They are able to take a pill just like they’ll take a pill for high blood pressure and integrate this much more into their daily lives.
Oral treatments are generally less toxic and most don’t cause hair loss, which can be a particularly distressing side effect of traditional chemotherapy. Patients are also relieved to spend less time at the hospital.
DeMichele: Not only the inconvenience of finding someone to drive them in and paying for parking and taking a day off work, but also just the emotional side of coming in. A lot of patients have what we call anticipatory symptoms, they may even get nauseated just coming to the building.
In the next five years, about a quarter of cancer patients could take some kind of oral chemotherapy. But there are some downsides. At-home regimens are complicated, and DeMichele says it’s hard to know if a patient is following doctor’s orders.
DeMichele: Many patients will say well maybe I’ll just take this after dinner, instead of before dinner, but that drug may really require an empty stomach. And so there are about a million ways that you can take a drug incorrectly without even meaning to.
Bill Minyard was diagnosed with leukemia in 2008 and now takes oral chemotherapy to keep the cancer from coming back. He charts his pill schedule on a calendar and gets nudges from his wife, Rhonda.
Minyard: She’ll say: ‘Did you take this, did you take that? Did you remember that it’s Wednesday, did you take the Wednesday pill today?’ And on one hand you’re thinking, you know, I’m a grown man I’ve been doing this for a year, but you do forget sometimes.
Minyard used to see his doctors and nurses every week but not anymore.
Minyard: You know, in the back of your head, are you thinking: ‘Are these pills doing what they’re supposed to be doing.’ The downsides to doing it at home is you have a little bit of withdrawal that you are not as close to your doctor as you were in the past.
Some of Bill’s other medical care has also shifted to his home in Old City Philadelphia. When Bill got a serious infection, Rhonda says a nurse came over to give him the treatment.
Rhonda Minyard: I innocently made the comment that it’s a really great service and wonderful for them to come out and do it. And she looked at me and smiled and said: ‘Honey, I’m here to teach you how to do it.’
As at-home chemotherapy becomes a larger part of cancer care, health professionals say they’re pushed to change. too.
Pelusi: We’re so used to saying: ‘Well, we want to put our eyes on the patient; we want to be in control.’
Oncology nurse Jody Pelusi …
Pelusi: But what we’ve learned over time is that patients really want to be part of their care, they want to take responsibility.
Pelusi says the health system needs to give patients more help at home. One drug company offers free phone support. A nurse calls regularly, and Pelusi says that check-in helps patients take their medication correctly.
Oral chemotherapy is not only complicated, the out-of-pocket expense can be huge. Bill Minyard has a $600 co-pay each month for just one of his oral treatments. When he was taking IV chemotherapy in the hospital, his insurance covered the full cost.
DeMichele: We have a life-saving treatment for cancer that our health system has spent millions of dollars developing, and we finally find a drug that’s a real winner it’s really a shame when a patient simply can’t afford to take it.