The advantages and disadvantages of oral chemotherapy: What patients need to know

Oral chemotherapy
Trying to decide between oral and IV chemotherapy? Read about the advantages and disadvantages in this article.

If your recommended cancer treatment includes chemotherapy, you may be surprised if your oncologist offers you a choice for how it’s administered: via intravenous (IV) infusion or in an oral form that you take at home.

Many patients assume that if they need chemotherapy, they’ll have to make regular visits to an infusion center to get it. But today, oral chemotherapy medication is an option to treat almost all cancer types, including:

The number of cancer patients opting for oral chemotherapy drugs over intravenous chemotherapy is increasing. That decision, however, isn’t something to take lightly.

Chemotherapy drugs are powerful. Mishandling them or not taking them as directed may have serious consequences.

For many patients, choosing between these chemotherapy treatment options often comes down to a matter of weighing personal preferences. What one person considers an advantage may look like a disadvantage to another.

To provide you with the information you’ll need to make an informed decision, this article answers some common questions, including:

If you have questions about chemotherapy or other types of cancer treatment options, or if you’d just like to talk with someone about your cancer care, call us or chat online with a member of our team to schedule an appointment.

What’s the difference between oral chemotherapy and IV chemotherapy?

The main difference between oral chemotherapy and IV chemotherapy is in the way it’s administered.

To receive IV chemotherapy, you’ll usually go to an infusion center at a hospital, cancer center or another outpatient facility. You may have to get some bloodwork done before each round of treatment. A health care provider administers the drug through an IV or chemo port, though some chemotherapy is given by injection.

Oral chemotherapy comes in a pill or liquid gel form. You take it at home, by mouth, making sure to follow safety precautions as directed. Oral chemotherapy is sometimes taken daily, whereas IV chemotherapy is usually (not always) given once every few weeks.

When trying to understand the difference between oral chemotherapy and IV chemotherapy, patients also frequently ask:

Is oral chemotherapy as effective as IV chemotherapy?

Yes, the potential results are the same no matter which method you choose. The purpose of chemotherapy is to kill cancer cells. It has the potential to reduce the size of tumors, control disease progression and, in some cases, may lead to cancer regression.

Chemotherapy may be used before and/or after another treatment, such as surgery, or alone as the primary treatment method. It’s sometimes used in combination with other treatments, such as radiation therapy or immunotherapy.

How long do you take oral chemotherapy?

Chemotherapy in either form is usually given in cycles over a period of a few weeks at a time, but this may vary depending on the specifics of your treatment plan.

If you have advanced cancer and chemotherapy is being used to slow the progression of cancer or to relieve its symptoms, it may be used for longer periods of time if you’re tolerating it well and it improves your quality of life.

What are the side effects of oral chemotherapy?

The possible side effects of oral chemotherapy are the same as those of traditional chemotherapy, and may include fatigue, nausea, diarrhea, constipation or hair loss.

The potential side effects you may experience depend on the type of chemotherapy drug you’re taking and how often you’re taking it. Not everyone experiences the same ones or in the same way. Patients are sometimes surprised to find out that not all chemotherapies cause hair loss, for example, or that men and women may experience different side effects of chemotherapy.

We also have more ways to help patients tolerate treatment these days. Anti-nausea medications have improved significantly over the years and are frequently given along with chemotherapy drugs. Supportive care therapies are designed to help prevent and manage side effects of cancer and its treatment. At CTCA®, for example, our patients have access to our integrative care services, including:

Your oncologist may be able to change the dosage of your medication or even prescribe a different chemotherapy if necessary. Talk to your care team about your options if you experience side effects.

What are the advantages of oral chemotherapy?

Oral chemotherapy

The primary advantage of oral chemotherapy is the convenience of being able to take it at home. You (and your caregiver, if someone accompanies you) don’t have to go to an infusion center for treatment.

For some patients, this means not having to take time off work for treatment appointments. Those who live some distance from their treatment center don’t have to deal with the time and stress of frequent travel. Others simply prefer to reduce disruptions to their regular schedule.

Maintaining a normal routine as much as possible provides a psychological benefit to some patients. Being able to take oral chemotherapy at home helps them maintain a sense of normalcy.

Oral chemotherapy may reduce the number of blood draws you have to undergo—a benefit to patients who are averse to needles. You may also avoid having to get a port-a-cath, which appeals to some patients.

When oral chemotherapy is taken daily, it also may change the way you experience side effects of treatment. Some patients find their side effects are less severe, but more constant, than with IV chemotherapy.

What are the disadvantages of oral chemotherapy?

While the oral administration of chemotherapy has the advantage of convenience and flexibility, it comes with a few potential disadvantages.

By choosing oral chemotherapy, you may miss out on the personal connections and support that develop spontaneously in an infusion center. Some patients are surprised to find that they look forward to the time they spend there. Nurses and other members of the care team are generally positive and upbeat. Some patients benefit from talking with them on a regular basis. Patients may form relationships with other patients as well, supporting one another through treatment.

The potentially significant disadvantages of oral chemotherapy, however, are associated with a patient's ability to take their medication properly and with cost or access to the medication itself.

Adherence: Carefully following instructions

Taking a pill to treat your cancer may sound easier than it is. Non-adherence, or not taking the drug correctly and on time, may have serious consequences, including the inability to treat your cancer and/or harm caused to yourself or others. Patients who choose to self-administer their chemotherapy must be committed to doing so correctly, and need to be organized enough to follow through on that commitment.

Chemotherapy drugs may be toxic and must be stored and handled very carefully. They must be kept away from children. You may have to wear gloves when handling them. You must be able to follow all safety precautions.

You also need to take oral chemotherapy drugs according to precise instructions. Some need to be taken at a certain time every day, with or without food. Others may need to be taken on a rotating schedule, similar to that of an infusion schedule, depending on your treatment regimen. It’s even more challenging if, like many patients, you’re juggling multiple medications, especially if the schedule differs daily and/or weekly.

The ability to do this is crucial, however. Not taking chemotherapy drugs correctly could increase their toxicity, which is very dangerous, or it could decrease the absorption, which means you’re not getting the right amount to treat your cancer. Missed doses mean the drugs can’t adequately fight cancer.

Caregivers also need to be considered when making this decision if they’re going to be taking an active role in managing medication. Choosing oral chemotherapy could mean their responsibilities increase significantly. Is this something they’re willing and able to take on?

Even with the best of intentions, it may be difficult to properly adhere to an oral treatment regimen.

At CTCA, we regularly call patients and their caregivers with specific questions that help us determine whether patients are complying with instructions and/or having any difficulties. We want to be sure they’re not suffering from any unreported adverse effects. Ask if your care team has a similar practice in place.

Some patients and caregivers are capable of taking on these responsibilities and are willing to do so for the advantages oral chemotherapy provides. Others prefer to go to a treatment center every few weeks, where they know an experienced, trained medical professional is taking care of everything.

Cost of oral chemotherapy

Oral chemotherapy

Getting access to oral chemotherapy drugs may be somewhat complicated, depending on your prescription drug insurance coverage.

IV chemotherapy drugs have been part of cancer treatment for a long time, and the health insurance system is set up to process and approve these prescriptions relatively quickly and easily. An established system is in place that allows pharmacies to get pre-certification from the insurance company. They then fill the prescription, knowing they’ll very likely be reimbursed by the insurance company. The patient doesn’t usually have to be involved in this process.

Many oral chemotherapy drugs, however, aren’t part of this system yet. The pharmacy may not give you the drug unless you have confirmation that the insurance company has already approved it. If not, you’re required to pay the pharmacy directly when you pick up the prescription. Most people are unable to pay cash for drugs that may cost between $6,000 - $12,000 per month.

We help our patients at CTCA with this process through our CTCA/Rx oncology pharmacy. Our pharmacy communicates with your insurance provider to get the authorizations you need to receive your medication, including oral chemotherapy drugs. Our pharmacy staff will also work with patient assistance programs to try to help you find financial support for your medications if your insurance denies coverage.

Our pharmacists also look for potential drug interactions, keep track of when prescriptions need to be refilled, send the prescriptions to patients and make sure patients know how to take their medications correctly. Providing this type of service helps relieve the burden patients face when they may already be feeling stressed and overwhelmed. It’s just one less thing to worry about.

If you’re unsure whether the oral chemotherapy drug your oncologist is recommending is covered by your insurance, and/or if you need confirmation of coverage to pick up your prescription, you may want to contact your medical insurance company directly before making a decision to avoid an unpleasant surprise.

Ask your care team whether they have resources to assist you with this process. It’s sometimes possible to get assistance directly from the pharmaceutical company that manufactures your prescribed cancer drug. Some nonprofit cancer organizations provide helpful information, including:

Check with the nonprofits related to your specific type of cancer, too.

Who may not be a good candidate for oral chemotherapy?

Not everyone is a good candidate for oral chemotherapy. If you know you’ll struggle to take your medication correctly, for example, avoid oral therapy and choose another treatment option.

Patients who are experiencing nausea, vomiting and/or who have difficulty swallowing are going to have a difficult time physically taking oral medications.

Some drug interactions may prohibit you from taking oral chemotherapy because certain drugs increase or decrease the absorption of other drugs. That could lead to toxicities, or it could cause the chemotherapy to not have as good of a result as it should.

If oral chemotherapy isn’t a good option for you, but you have serious obstacles getting to an infusion center, ask your doctor about alternatives. For example, our Atlanta hospital is piloting our Oncology Clinic at Home program. This program allows certain patients who qualify to receive some chemotherapy or immunotherapy infusions or injections at home. Treatment is administered by licensed nurses who are trained in chemotherapy administration.

Making a decision: A few final thoughts

Before you make a decision, take some time to think about it. Talk to your family and/or caregivers about the pros and cons.

If you haven’t yet, ask your doctor questions about oral chemotherapy, such as:

  • How long will I be on this drug?
  • Where do I store it?
  • How often do I take it?
  • What if I forget to take it?
  • What are the potential side effects?
  • Are you going to give me anything ahead of time to deal with potential side effects?
  • Who do I call if I have a question?

No matter which decision you make, if you find it’s not working out for you for some reason, go back to your doctor and have a conversation. You may be able to switch to the other method. Or ask, “What can we do instead?” Cancer treatment drugs continue to improve, and we have more options to choose from than ever before.

If you have questions about oral chemotherapy, or if you’d like to talk with someone about your cancer treatment options, call us or chat online with a member of our team to schedule an appointment.