# Oral anticancer medicines at home: prescribing, teaching, adherence, storage, handling and disposal

Source: https://onco.cc/protocols/oral-anticancer-medicines-at-home/  
OnCo record `oral-anticancer-medicines-at-home` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Many cancer treatments are now tablets taken at home. Ask for a written plan: what to take and when, what to do about a missed dose, what to avoid, and which side effects mean stopping and calling. Keep tablets in their labelled container away from children; carers should not touch them bare-handed; take care with toilets and laundry for two days after a dose; return leftovers to the pharmacy.

## Summary

ASCO-ONS (2024) sets the safety standards, and extends them to home administration. Oral anticancer medicines are ordered on electronic or preprinted forms, with the quantity to dispense, the number of refills (zero as the preferred default) and the schedule. Labels give the dosage form, quantity, pills per dose, the schedule with days on and off, food instructions and handling warnings. Before the first dose, patients receive verbal and written education in their preferred language covering the schedule, missed doses, interactions with drugs, herbal products and foods, side effects that require stopping self-administered treatment and calling, safe handling at home including disposal, body secretions and spills, and whom to contact; carers are included where needed. Adherence is assessed at the start and during treatment (standard 4.4).

The ONS adherence guideline (2022, GRADE) makes conditional recommendations, mostly on very low-certainty evidence, for an adherence risk assessment at the start, education addressing adherence, ongoing assessment, proactive follow-up for those at risk, coaching and motivational interviewing (low certainty), and a structured oral anticancer medication programme; it makes no recommendation on reminder technology (knowledge gap). Product information adds handling rules, such as not crushing or cutting capecitabine tablets.

No graded guideline sets out the household detail of storage, handling and disposal; that rests on nursing and patient guidance. ACS (2025, ASCO-reviewed) and Macmillan (2022) say to read the labels before leaving hospital, store tablets as instructed (some away from light or in a fridge), keep them in the original container and out of reach of children, ask whether tablets can be crushed or opened, and report missed doses. ACS and the ONS safe handling toolkit (2018) describe body-fluid precautions for at least 48 hours after a dose: sit to use the toilet, lid down and flush (twice for a low-volume flush), wipe the seat, wash hands, carers wear gloves (ACS says two pairs) for fluids, wash soiled laundry separately and twice in hot water, and double-bag disposable waste. For leftover medicine, ONS says never put cancer drugs in the bin, drain or toilet and to return them to the pharmacy or clinic; the FDA's general advice for medicines (take-back first, then the flush list, then the household bin) is not written for cancer drugs and conflicts with this.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: oral chemotherapy at home; cancer tablets; oral anticancer medication adherence; OAM; capecitabine at home; missed dose of chemotherapy tablets; oral SACT; oral SACT at home; oral chemotherapy safety at home; storing chemotherapy tablets; disposing of chemotherapy tablets; safe handling of oral chemotherapy; chemotherapy body fluid precautions at home

## Connected records

- protocols: [Ambulatory chemotherapy pumps at home: set-up, checks, spills and disconnection](https://onco.cc/protocols/ambulatory-chemotherapy-pumps-at-home/), [Consent and education before anticancer treatment](https://onco.cc/protocols/consent-and-education-before-anticancer-treatment/), [DPD deficiency testing before fluorouracil, capecitabine or tegafur, and dosing by the result](https://onco.cc/protocols/dpyd-testing-before-fluoropyrimidines/), [Drug, herbal and food interaction review for anticancer treatment](https://onco.cc/protocols/anticancer-drug-interaction-review/), [Medicines reconciliation at the start of anticancer treatment and at each move between care settings](https://onco.cc/protocols/medicines-reconciliation-in-cancer-care/), [Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids](https://onco.cc/protocols/hazardous-drug-handling-in-clinical-areas/), [Sex, contraception and barrier protection during and after chemotherapy](https://onco.cc/protocols/sex-and-contraception-during-chemotherapy/)
- ideas: [A structured support programme for everyone taking cancer tablets at home](https://onco.cc/ideas/idea-upgrade-oral-anticancer-medicine-adherence-programme/), [Pharmacist interaction check before every oral cancer-drug prescription](https://onco.cc/ideas/idea-acc-pharmacist-interaction-review-oral-anticancer/)
- technologies: [CDK4/6 inhibitors](https://onco.cc/technologies/cdk46-inhibitor/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Etoposide](https://onco.cc/drugs/etoposide/)

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