During a May 31st, 2009 session at the annual meeting of the American Society of Clinical Oncology (ASCO), Dr. Angela DeMichele chaired a session and presented her own research on reasons why so many people who are taking oral chemotherapy medication for cancer don't take their drugs as prescribed. As more and more individuals with cancer are prescribed oral chemotherapy, which is chemotherapy taken in pill form, at home, getting to the bottom of why some aren't able to take their medications as intended is vitally important.
It turns out that there are many things that can get in the way of taking oral chemotherapy, but one of the most important is money. Most of these newer oral chemotherapies are very expensive and some may not be covered by regular medical insurance. This can put the cost completely out of reach for the typical cancer patient.
Also, many of these medications have unpleasant or uncomfortable side effects. And unlike more conventional chemotherapy which is given intravenously (into the blood vessels, by IV) in a cancer center, clinic, or hospital, oral chemotherapy taken at home can be skipped or stopped. A person taking oral chemotherapy may experience side effects, change their mind about the treatment plan, and simply stop taking the pills.
Other reasons for missing doses of chemotherapy include forgetting to take it and not understanding the prescription instructions. If the schedule for taking oral chemotherapy is complicated or involves many doses per day, some patients cannot manage this well on their own.
Why This Matters
This may not seem like a major problem, because after all, many people who take prescription medications miss a dose now and then without harm. But cancer is not like other chronic diseases such as high blood pressure, heart disease, or diabetes. While skipping a single dose of your cholesterol-lowering medication isn't likely to cause an immediate problem such as a heart attack, with cancer, the stakes are much higher.
Some cancers grow very quickly and become less treatable in a very short period of time. Other cancers only are responsive to the chemotherapy at a certain stage of their development, so that if this "window of opportunity" is missed, the drugs may not help at all. Still other cancers can become "resistant" to chemotherapy. By taking chemotherapy only occasionally, people may inadvertently speed up how quickly a tumor becomes resistant to the drug.
Your Action Plan
If you are taking oral chemotherapy to treat your colon cancer, it is extremely important that you take your drugs exactly as prescribed. The ideas listed below will help you reach this goal:
- Take Notes. When your doctor or nurse is explaining how to take your medications, jot down some notes (or have a friend or family member do this), in your own words, to capture the details. Don't assume that you can simply read the prescription bottle label for clarification: These labels don't have much space, typically they don't include all the fine details of your dosing schedule, and they may contain medical terms or abbreviations that don't make sense to you.
- Let go of embarrassment. Many people are embarrassed if they don't understand what they've been told in the doctor's office, but they shouldn't be! It is very common to have questions about prescriptions and doctors and nurses are used to explaining things in different ways. It is their job to make sure their patients understand their instructions. If you don't understand, get those instructions a second, third, or even fourth time to clarify any confusion.
- Ask for financial help if needed. The financial stresses of cancer treatment are well-understood by anyone who has gone through this and by people who work with individuals affected by cancer. Even for people with health insurance, co-pays alone can quickly overwhelm the budget. And if you don't have coverage or your medications aren't covered by your insurance, treatment costs can skyrocket. But help is available:
- Many cancer centers offer free financial counseling. Ask if this is available and if so, make an appointment early to get a handle on how you'll manage your treatment costs.
- Pharmaceutical companies sometimes will provide financial assistance to lower-income patients. Ask if this might be an option for the medications you're taking.
- If you do not have any insurance, meet with a social worker at your cancer center to find out if you may be available for government sponsored insurance coverage such as medicaid or medicare. Many people who are eligible for these programs don't even know it.
- If you do not have any insurance, meet with a social worker to ask about other financial support programs. Some cancer treatment facilities have money set aside to help patients who cannot cover all of their own treatment costs. Also, local community, regional, and even national organizations also may be able to help cover treatment costs for patients with financial needs.
The most important thing is to keep the lines of communication with your medical team open. If for any reason you are unable to take your cancer medications as prescribed, whether due to side effects, cost, or confusion about the dosing schedule, talk to your doctor or nurse right away. Don't wait until your next appointment. You can make a quick phone call to get the help and answers you need. Your health is worth it!
