Use of oral therapies requires healthcare teams to monitor patients for issues such as unreported side effects, medication nonadherence, and incorrect administration of medications. Although many patients do very well with this form of treatment, some patients, even with a significant amount of education before starting therapy, may have challenges. 

Oral agents offer many patient benefits, one of which is the freedom to take the medication at home, allowing them to keep their daily routine and gain additional time and independence they would have spent traveling to the clinic for treatment. However, with that freedom comes additional patient responsibilities, and preparation from advanced practice RNs (APRNs) is necessary to ensure patients can self-manage symptoms and adhere to administration regimens. Research shows that patients experience severe symptoms on oral agents that may cause them to miss as many as one-third of the prescribed doses. How can APRNs empower patients to adhere to the treatment plan and ensure safe symptom self-management at home? 

Oncology nurses know the challenges of patient adherence to oral cancer therapies. Every dose a patient misses can affect their outcomes and chance of survival. But in clinical trials, oral adherence has even broader implications: when a study is evaluating the efficacy of a drug, it depends on study participants taking it exactly as the trial outlines.

Oral cancer treatments are effective and practical and can provide a level of flexibility for patients, allowing them to seamlessly continue their treatments without the burden of infusion visits. With many patients receiving oral chemotherapy, oncology nurses must recognize complications that can arise regarding procedure and documentation in practice.  

Administration of chemotherapy drugs has shifted dramatically in the past 15 years from parenteral to oral administration. This change requires patients to self-manage their chemotherapy. Patients need to understand important medication administration tasks: right dose, right time, right route, and right drug.

Oral chemotherapy, like IV chemotherapy, effectively helps patients fight cancer and may have similar side effects to its IV counterparts. Self-administration of oral chemotherapy may be convenient, but it is still chemotherapy and requires extra caution.

Adherence to oral agents for cancer (OACs) is an important issue in the oncology setting. Unlike IV agents, which are typically administered in a controlled environment by oncology nurses, OACs are self-administered at home with little professional oversight. The potential for medication error or nonadherence cannot be underestimated, but oncology nurses are in a key position to spearhead initiatives aimed at improving patient education and adherence for OACs.

As the use of oral oncolytics has increased in cancer care, so has the amount of time oncology nurses spend educating and counseling patients and caregivers on their use. Studies have shown that although it’s challenging for nurses to carve out, the time is well spent.

As chemotherapy administration has shifted from IV delivery in the infusion center to oral delivery at home, so has the burden for the five rights of medication administration.

Oral agents are changing oncology treatment, and along with it, who’s responsible for the safety of those treatments. “With oral agents, the onus is now primarily on patients and their caregivers,” says ONS member Kathy Leifeste. This is quite a shift from the nurse-administered IV chemotherapy and biotherapy we’ve grown accustomed to.