Getting Oral or Topical Chemotherapy

While many chemotherapy (chemo) drugs are given by infusion or injection, there are also oral chemo drugs (taken by mouth) or and topical chemo drugs (rubbed on the skin).

The information below describes traditional or standard chemotherapy that might be given by mouth or applied to the skin. There are also other drugs that are used to treat cancer in different ways, including targeted therapy, hormone therapy, and immunotherapy.

Oral chemo

If chemo is taken by mouth, you swallow the pill, capsule, or liquid just like other medicines. Like other types of chemo, sometimes chemo is given in rounds or cycles. This cuts down on the harm to healthy cells and allows the chemo to kill more cancer cells.

Oral chemo is usually taken at home. Because of this, it’s very important to make sure you know exactly how it should be taken. If you and your doctor have decided oral chemo is the best treatment option for you, be sure to ask about and have instructions about:

• How and when to take it. You should have clear instructions on how much and when to take your chemo. You need to take the exact dosage, at the exact right time, for exactly as long as you’re supposed to do so. Oral chemo doses are set up so that the same level of drug stays in your body to kill the cancer cells. Not taking your chemo the right way can affect how well it works. Sometimes dose changes are needed, but don’t make any changes unless your doctor tells you to do so. If you miss a dose or are late taking one, tell your doctor or nurse about it. They need to know about this when deciding if treatment is working. It may also help the doctor decide whether to change how much of the medicine you take or when you take it.
• Special handling. Chemo you swallow is as strong as other forms of chemo. Many are also considered hazardous. There are usually special precautions for storing and handling chemo drugs. You might be told to be careful not to let others come into contact with it or your body fluids while taking it and for a time after taking it. Sometimes you need to wear gloves when touching the pills or capsules. Some drugs have to be kept in the bottle or box they came in. And some drugs and the packages they come in need to be disposed of in a certain way. Some might have to be taken back to the drug store to be thrown away safely. To learn more, see Chemotherapy Safety.
• Cost. Oral chemo drugs can be expensive. Make sure you ask your doctor about the cost of your treatment so you are not surprised when you get to the pharmacy or when you get your bill if the treatment is not available at pharmacies. Depending on the type of drug, some insurances don't cover the full cost, or may not cover it at all. Sometimes you can get assistance but many people have to pay more of their own money for them than what they would pay for chemo that’s given with a needle in the hospital or clinic. If you have health insurance, this might mean a higher co-pay. Make sure you know how much you’ll have to pay for each treatment. You can call the American Cancer Society at 1-800-227-2345 for more information about financial assistance.

Be sure to tell your doctor or nurse about any problems you have taking your chemo. For instance, if you’re throwing up or feel sick to your stomach, you may feel too sick to take your chemo. Or, you may not be able to keep your chemo down and may throw it up. Your doctor needs to know about any problems so they can change your treatment plan, if needed.

Topical chemo

Topical chemo is put right on the skin in an area where certain cancers are. Topical chemo can be a cream, gel, or ointment.

Chemo drugs you use on your skin are as strong as other forms of chemo. Many are also considered hazardous. If you are using topical chemo, be sure you know the precautions you need to take when storing, handling, and disposing of the tube or container it comes in. You also need to take precautions when putting it on your skin, such as wearing special gloves. To learn more, see Chemotherapy Safety.

Will I still need to see my doctor?

Even though you take oral and topical chemo at home, you will still need to see your cancer care team. They will watch for changes in the cancer and see how you are doing with your chemo plan. Blood tests and scans will be done to see how your body and the cancer are doing with the chemo.

How often will I need to take oral or topical chemotherapy?

How often you take oral or topical chemo and how long your treatment lasts depend on the kind of cancer you have, the goals of the treatment, the drugs being used, and how your body responds to them.

You may need treatments daily, weekly, or monthly, but they’re usually given in on-and-off cycles. This means, for example, that you may take chemo the first 2 weeks and then have a week off, making it a cycle that will start over every 3 weeks. The time off lets your body build healthy new cells and regain its strength.

Your cancer care team can tell you how many cycles are planned and how long they expect your treatment to last.

Many people wonder how long the actual drugs stay in their body and how they’re removed. Your kidneys and liver break down most chemo drugs which then leave your body through urine or stool. How long it takes your body to get rid of the drugs depends on many things, including the type of chemo you get, other medicines you take, your age, and how well your kidneys and liver work. Your cancer care team will tell you if you need to take any special precautions because of the drugs you are taking.

If your cancer comes back, you might have chemo again. This time, you could be given different drugs to relieve symptoms or to slow the cancer’s growth or spread. Side effects might be different, depending on the drugs, the doses, and how they’re given.

What can I expect from oral or topical chemo?

The side effects of any form of chemo vary from drug to drug and from person to person. Your cancer care team may not be able to tell you what side effects you’ll have, but they can tell you what to watch for.

Telling your team about side effects as soon as they happen can help make sure that they don’t get too bad. Your doctor may have to change how much you take or give you other drugs to help you feel better. If you aren’t sure about a side effect and can’t reach your doctor, don’t take your chemo until you talk to someone on your cancer care team.

Taking chemo at home gives you more freedom without having a lot of treatment visits. You may not be seeing your doctor and nurses very often, but be sure to call them with any questions or concerns you have.

Are you ready to start your oral or topical chemo?

Here are some things you may want to talk to your cancer care team about when starting oral or topical chemo:

• What’s the name of the chemo? Is there more than one name for the same drug?
• How do I use it or take it?
• When should I use it or take it?
• Is it safe to take it with other drugs, food, vitamins, herbs, supplements, skin lotions, or other treatments I use?
• What should I do if I miss a dose?
• How should I store it?
• Is there a special way it needs to be handled to protect me and others?
• What do you expect it to do?
• What are the likely side effects? What should I do if I have side effects?
• How can I get in touch with you if I have trouble late at night or on the weekend?
• How long will I need to take the chemo?
• Will my insurance pay for my chemo? If not, how much will it cost? How will I pay for it?
• Will my other health problems stop me from being able to take the chemo the way I should? Is there a chance my other health problems could make me forget to take my chemo?
• Will you be calling me to find out how I’m doing with the chemo?
• How often will you need to see me in person?

For oral chemo, be sure to also ask about certain questions about the pills, such as:

• What if I have trouble swallowing or keeping down the pills?
• Can they be opened, broken, or crushed?
• Can I mix it with food or liquid to take it?

Before starting chemo, talk to your doctor or nurse about any concerns or questions you have. Get answers to all of your questions about chemo before you start taking it.

The success of chemo taken at home really depends a lot on you – it’s important to take the right dose of the drug, at the right time, just as you’ve been told. Your cancer care team is there to help you do this.