6 Evaluation of oral anticancer medication handling, storage, and disposal practices among cancer patients and their caregivers in the home setting at princess norah oncology center

Background Oral chemotherapeutic agents are hazardous drugs that are commonly prescribed for a variety of indications. Using oral anticancer medications may ensure better therapy adherence, but there is not much knowledge about the safety and risks of accidental exposure with subsequent fatalities. Unintentional exposure can take place at different phases of treatment by splitting, crushing, transporting, unpacking, storage, and disposal. Although there are several well-established guidelines for safe handling of parenteral chemotherapy in the healthcare setting, there are few recommendations concerning proper handling of oral chemotherapy at home for patient and environmental safety. This survey aimed to evaluate the handling, storage, and disposal practices of oral anticancer medications among cancer patients and their caregivers in the home setting. Methods A questionnaire-based cross-sectional study was done in all adult cancer patients/patient caregivers receiving oral anticancer medications and visiting the oncology outpatient pharmacy. Oncology pharmacists interviewed patients after obtaining consent. Survey responses were analysed using descriptive statistics. Results A total of 201 participants agreed to be interviewed, of whom most were female (67%). Nearly 44% of participants were aged between 40 and 60 years. The majority of participants were educated (157 responses, 78%) while only 44 (22%) had never been to school. The top five oral anticancer medications taken by patients were tamoxifen, capecitabine, letrozole, dasatinib, and imatinib. All participants reported that medications were kept away from children and pets (100%). 196 (97.5%) patients responded that the medication was stored away from extreme heat, cold, and humidity. 195 (97%) patients reported keeping their medications in the original container. Hand washing and wearing gloves were not a consistent practice among patients and caregivers. Among all participants, only nine (4.5%) reported ‘always’ wearing gloves; 48 (24%) reported ‘always’ washing hands after handling anticancer medications. Patients and caregivers reported that they had been informed about safe handling and storage by their physician (47%) and pharmacist (30%), while 40% of them had not been informed. In terms of disposal practice, more than half (66%) of patients had not had unused or expired medications, 29% of patients dispose of them in the trash, and 27% return them to the pharmacy or doctor’s office. Conclusion Our findings, while preliminary, suggest that patients’ and caregivers’ awareness regarding handling practices are inconsistent with the published recommendations. Appropriate and comprehensive education is needed to mitigate exposure risk to these agents in the home setting.