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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.
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.
Why: Automatic repeat prescriptions let people keep taking a drug after it should have been stopped or the dose changed.
“Number of refills, with zero being the preferred default value for oral antineoplastics”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: Cycles with days off are a common cause of taking too much or too little.
“Administration schedule, including number of times per day to take medication and days on or off medication (cycle length) when applicable, and when follow-up is scheduled”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: Patients at home make these decisions without a nurse present.
“Planned duration of treatment, schedule of treatment administration, plan for missed doses, drug names and supportive medications, and drug interactions with prescribed drugs, integrative therapies, over the counter drugs, and foods”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: Severe diarrhoea, mouth sores, fever or hand-foot skin damage can become dangerous if tablets are continued.
“Symptoms or events that require immediate discontinuation of oral or other self-administered treatments”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: The drugs that harm cancer cells can harm others in the household who touch them.
“Procedures for safe handling medications in the home, including disposal of waste, handling body secretions, storage, safe handling, and management of unused medication, and clean-up of drug spills”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: Carers often handle the tablets and notice side effects first.
“Education includes family, caregivers, or others on the basis of the patient's ability to assume responsibility for managing therapy.”
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024
Why: Taking the right dose at the right time matters, and crushing or opening some tablets releases drug into the air or onto skin.
“read the labels on the drug boxes before you leave the hospital and speak to your nurse, doctor or pharmacist if any instructions are unclear”
Macmillan Cancer Support 2022 · Not graded (patient information)
Why: Crushing releases drug dust that the patient or carer can inhale or absorb.
“Xeloda tablets should not be crushed or cut.”
Why: Some drugs spoil if stored wrongly, and the original container keeps the label and warnings with the medicine.
“Some chemotherapy tablets, capsules or injections may need to be stored in a certain way, such as away from direct light or in a fridge. Always follow the instructions given by your nurse or pharmacist.”
Macmillan Cancer Support 2022 · Not graded (patient information)
Why: A dose meant for an adult with cancer can seriously harm a child who swallows it.
“All drugs must be stored out of the reach of children, as they could cause serious harm if taken by accident.”
Macmillan Cancer Support 2022 · Not graded (patient information)
Why: Many oral anticancer drugs are hazardous to the people who handle them, not only to the person taking them.
“When assisting patients with oral HDs, family members should use “no-touch” technique (e.g., pour tablets into the cap of the container) or wear gloves for handling.”
Oncology Nursing Society 2018 · Not graded (nursing toolkit)
Why: Doses are timed to keep a steady level of drug; the team decides whether to change anything.
“If you miss a dose or are late taking one, tell your doctor or nurse about it.”
American Cancer Society (with ASCO medical review) 2025 · Not graded (patient information)
Why: Most of the drug leaves the body in urine and stools over about two days, and splashes can reach other people.
“It generally takes at least 48 hours for your body to break down and/or get rid of most chemo.”
American Cancer Society (with ASCO medical review) 2025 · Not graded (patient information)
Why: Drug in body fluids can irritate or harm skin with repeated exposure.
“If others need to touch any of your body fluids or something that has been in contact with your body fluids (like a bucket or basin), they should wear 2 pairs of throw-away gloves.”
American Cancer Society (with ASCO medical review) 2025 · Not graded (patient information)
Why: Washing separately and twice removes drug residue without spreading it to other laundry.
“Wash them twice in hot water with regular laundry detergent. Do not wash them with other clothes.”
American Cancer Society (with ASCO medical review) 2025 · Not graded (patient information)
Why: Bagging keeps others from touching drug residue; empty containers still carry traces of the drug.
“Before putting this waste in the trash, double bag it to help make sure others don’t inadvertently come into contact with it.”
Oncology Nursing Society 2018 · Not graded (nursing toolkit)
Why: Leftover anticancer drugs are a hazard to others and to the environment, and pharmacies can destroy them safely.
“Never throw cancer drugs in the trash or down the drain, and don’t flush them down the toilet.”
Oncology Nursing Society 2018 · Not graded (nursing toolkit)
Why: Cost, complex schedules, low mood and side effects all make missed doses more likely and can be planned for.
“In patients starting a new OAM, the ONS Guidelines panel suggests an adherence risk assessment in addition to usual care rather than usual care alone (conditional recommendation, very low certainty of evidence).”
Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 · conditional recommendation, very low certainty of evidence
Why: Problems with tablets often show up between clinic visits.
“In patients with additional risk factors for nonadherence taking OAMs, the ONS Guidelines panel suggests proactive follow-up addressing adherence in addition to usual care, rather than usual care alone (conditional recommendation, very low certainty of evidence).”
Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 · conditional recommendation, very low certainty of evidence
Why: Talking through goals and barriers helped some patients keep taking their treatment in small trials.
“In patients taking OAMs, the ONS Guidelines panel suggests motivational interviewing in addition to usual care rather than usual care alone (conditional recommendation, low certainty of evidence).”
Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 · conditional recommendation, low certainty of evidence
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
A structured oral anticancer medicine programme (ONS 2022, conditional, very low certainty): order and label to the ASCO-ONS standards (2024), with zero refills as the default and the schedule, days off and food instructions on the label; teach patient and carer before the first dose, in writing, including missed doses, interactions, stop-and-call symptoms and safe handling and disposal at home; assess adherence risk at the start and adherence at every contact; follow up proactively those at risk; offer coaching and motivational interviewing. The evidence for each adherence intervention is low or very low in certainty, and ONS makes no recommendation on reminder technology. For the household detail ASCO-ONS requires to be taught but does not specify, the convergent nursing and patient guidance (ACS 2025, ASCO-reviewed; Macmillan 2022; NCI 2023; the ONS safe handling toolkit 2018) agrees on original containers, storage as labelled, keeping drugs from children, a no-touch technique or gloves for carers, 48 hours of body-fluid precautions, and returning leftovers to the pharmacy. The ISOPP 2022 standards cover handling but could not be read, so their wording is not used here.
ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024 · Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 · American Cancer Society (with ASCO medical review) 2025 · American Cancer Society (with ASCO medical review) 2025 · Macmillan Cancer Support 2022 · National Cancer Institute (US) 2023 · Oncology Nursing Society 2018
Where it differs: Uses automated reminders or interactive apps to support taking oral anticancer medicines.
Evidence: ONS (2022) makes no recommendation, citing a knowledge gap; it notes adherence improved in studies only where technology came with follow-up from a healthcare worker.
Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022
Where it differs: For most unused medicines, use a take-back option first; if there is none, flush medicines on the FDA flush list, and put others in the household bin.
Evidence: FDA consumer guidance (content current 31 October 2024), written for medicines in general and not for anticancer drugs. It conflicts with ONS, which says never to bin or flush cancer drugs; for anticancer drugs, the team's or pharmacy's return route comes first.
Where it differs: Asks household members to use a different toilet from the patient for 48 hours after a dose; ACS says to do this if possible and otherwise to wipe the seat after each use.
Evidence: Nursing toolkit, not graded; ONS gives the 48-hour period, citing a nursing text. No study compares the two approaches.
Oncology Nursing Society 2018 · American Cancer Society (with ASCO medical review) 2025
Where it differs: Lists the same precautions (lid closed and flush twice, sit to urinate, gloves for body fluids, separate laundry, condoms during sex) but leaves the duration to the centre and the drug.
Evidence: NCI booklet: the time 'might differ depending on the policy where you receive treatment and the drugs that you receive.'
More cancer treatment now comes as tablets taken at home, where nobody sees missed doses or side effects building up. A nursing guideline recommends a structured programme: a check at the start of who may struggle, teaching, follow-up calls from the team, and coaching. The trials behind it are small and mixed, so this is promising rather than settled.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Education addressing adherence in addition to standard education “In patients taking OAMs, the ONS Guidelines panel suggests education addressing adherence in addition to standard education rather than standard education alone (conditional recommendation, very low certainty of evidence).” | conditional recommendation, very low certainty of evidence | Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 |
| Ongoing assessment of adherence “In patients taking OAMs, the ONS Guidelines panel suggests ongoing assessment of adherence in addition to usual care rather than usual care alone (conditional recommendation, very low certainty of evidence).” | conditional recommendation, very low certainty of evidence | Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 |
| Coaching “In patients taking OAMs, the ONS Guidelines panel suggests coaching in addition to usual care, rather than usual care alone (conditional recommendation, very low certainty of evidence).” | conditional recommendation, very low certainty of evidence | Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 |
| A structured oral anticancer medication programme “The ONS Guidelines panel suggests implementation of a structured OAM program rather than no structured OAM program.” | Conditional; very low certainty | Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 |
| Reminder technology “The ONS Guidelines panel makes no recommendation for the use of technology, either interactive or noninteractive, based on a knowledge gap.” | No recommendation; knowledge gap | Oncology Nursing Society (Oncology Nursing Forum, Belcher et al.) 2022 |
| Organisation policy for monitoring adherence “The health care organization policy outlines the procedure to monitor initial and subsequent assessment and documentation of patients' adherence to antineoplastic therapy” | Standard (not graded) | ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024 |
| Home administration within the scope of the ASCO-ONS safety standards “The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance.” | Standards (expert panel and literature review); not graded | ASCO and the Oncology Nursing Society (JCO Oncology Practice) 2024 |
| Home storage, handling and disposal steps | Not graded: patient information and a nursing toolkit, without a grading scheme | Oncology Nursing Society 2018 |
| Body-fluid precautions for 48 hours after a dose “Family members should use separate toilets from the patient for 48 hours after HD administration to eliminate the risk of contact with contaminated body waste.” | Not graded (ONS toolkit, citing a nursing text) | Oncology Nursing Society 2018 |
Shares DPD deficiency testing before fluorouracil, capecitabine or tegafur, and dosing by the result.
Shares A structured support programme for everyone taking cancer tablets at home, CDK4/6 inhibitors.
Shares DPD deficiency testing before fluorouracil, capecitabine or tegafur, and dosing by the result.
Shares Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids, Cyclophosphamide.
Shares DPD deficiency testing before fluorouracil, capecitabine or tegafur, and dosing by the result, Capecitabine.