Understanding Oral Chemotherapy


What is oral chemotherapy?

Chemotherapy is a treatment that’s designed to destroy cancer cells, no matter where they are in your body.

When you think about chemotherapy, you may envision needles, intravenous (IV) administration of drugs, and long hours in a doctor’s office or clinic. But many chemotherapy drugs come in oral form, either as a liquid you can drink or a tablet you can swallow.

Most people with cancer need more than one type of treatment. Other treatments may include surgery, radiation therapy, and immunotherapy. You can take chemotherapy before, during, or after other treatments.

How much chemotherapy you need depends on the type of cancer you have, how far it has spread, and other health factors.

Oral and traditional chemotherapy

You and your doctor must consider many factors when deciding on oral versus traditional chemotherapy. This is how they compare on some key points:

Oral chemotherapy Traditional chemotherapy
Convenience You can take it at home in a matter of seconds, so there’s less disruption to your life. It requires a visit to a doctor’s office or clinic for a treatment that may take hours. Over time, this can become burdensome.
Comfort It’s less invasive and causes little to no physical discomfort when you take it. Getting IV medications can be uncomfortable or even painful. It can take several hours and may increase your anxiety levels.
Compliance You have to keep track of dosing and administration, making sure to take it exactly as directed, usually several times per day. Your healthcare team takes care of dosing and administration.
Cost Your health insurance plan might list it as a pharmacy benefit instead of a medical benefit. This could increase out-of-pocket costs. Major medical benefits usually cover it.

Not all chemotherapy drugs have an oral version, so it’s not always an option.

What are the side effects of oral chemotherapy?

As chemotherapy kills cancer cells, it can damage some of your healthy cells as well. Side effects of oral treatments are similar to those of traditional ones. They vary depending on the particular drug.

Some of the most common side effects of oral chemotherapy are:

  • trouble sleeping
  • fatigue
  • general weakness
  • nausea
  • vomiting
  • a loss of appetite
  • diarrhea
  • weight loss
  • hair loss
  • finger and toenail changes
  • mouth sores
  • bleeding gums
  • skin changes
  • low blood counts
  • neuropathy, or nerve damage
  • lack of a menstrual period
  • fertility problems
  • vulnerability to infection and illness due to a compromised immune system

Less common serious side effects include kidney damage and a weakened heart.

What are some oral chemotherapy drugs?

Not all chemotherapy drugs are available in oral form. Currently, there are dozens of oral cancer therapy drugs that treat a variety of cancers, including the following:

Drug (generic name) Cancer type
altretamine ovarian
capecitabine breast, colorectal
cyclophosphamide breast, ovarian, lymphoma, leukemia, multiple myeloma
etoposide small cell lung cancer

Doctors often prescribe chemotherapy drugs in combination.

What do you need to know before starting oral chemotherapy?

Before starting chemotherapy, you’ll have an opportunity to consult with your doctor. This is a good time to ask questions and discuss your concerns.

What to ask your doctor before starting oral chemotherapy

Here are some questions you may want to as your doctor:

  • What is each drug expected to do?
  • Exactly how should I take this medication? (You may be provided with a diary to keep track of times and doses.)
  • Can the pills be broken or crushed? Do they need to be taken with a meal?
  • Are there any particular foods I should avoid while taking this medication?
  • What should I do if I miss a dose?
  • What happens if I throw up after taking it?
  • How should I handle and store the drug?
  • What side effects can I expect from this drug, and what should I do if I have them? What are the warning signs of serious problems?
  • How often should I check in with your practice? When will I need blood tests or scans?
  • How long will I need to take it?
  • How will we know it’s working?

What to know about paying for oral chemotherapy

Most oncology practices help you figure out your health coverage and how you’ll pay for your treatment.

If you have health insurance, there’s a good chance that traditional chemotherapy is covered under major medical benefits. Depending on your policy, oral chemotherapy may fall under pharmacy benefits, which could mean you’ll have a much higher copay.

Make sure you understand your coverage so you’re not blindsided by bills. If you do have high out-of-pocket costs, these services may be able to help you:

What to know about leftover oral chemotherapy drugs

You might be left with unused drugs when you finish treatment or if your treatment plan changes. These are powerful drugs, so you should never flush them down the toilet or sink. You also shouldn’t put them in the trash.

Check with your pharmacist or doctor’s office. Many will take them off your hands or let you know how to dispose of them properly.

Can I drink alcohol while on chemotherapy?

Many substances have the potential to interact with your chemotherapy medications. This includes:

  • over-the-counter or other prescription medications
  • herbal supplements
  • certain foods
  • alcohol

Some can affect the potency of your medication and others can cause dangerous side effects. With many medications, an occasional alcoholic beverage is harmless, but you shouldn’t assume it is.

Each drug acts differently, so read the instructions and warnings that come with your prescription. It’s a good idea to double check with your doctor or pharmacist. Be sure to mention any other medications you take in addition to chemotherapy.

Can oral chemotherapy be effective?

Oral chemotherapy can be as powerful and effective as traditional chemotherapy.

When it comes to oral therapy, following directions and not skipping doses is key. It takes commitment to track your medications and take them on time and in the right dose. It also takes a lot of communication between you and your oncologist.

How effective your therapy is depends on:

  • the type of cancer
  • how far the cancer has spread
  • other treatments
  • your age
  • your overall health
  • how well your body responds to therapy
  • the severity of your side effects

Talk to your doctor about what you can expect from oral chemotherapy.

The takeaway

Even though you’re taking a quick pill instead of an IV drip that takes hours, these are very powerful drugs that can affect you in many ways. Here are a few things to keep in mind while you’re on chemotherapy:

  • Keep in mind that your immune system is not at its best, so you’re at a higher risk for infection and illness. Try to avoid people who have contagious conditions.
  • Your body is working hard, which means you need a good night’s sleep. If you’re fatigued, a few rest periods during the day can help.
  • Even though your appetite may be low, don’t stop eating. Having a nutritious diet will help you heal and maintain your strength.
  • Getting a little exercise each day will help you feel better.
  • It’s okay to ask for and accept help with chores and tasks.
  • You can share experiences and tips with others by joining an online or in-person cancer support group. Ask your doctor or visit the for more information.