Usually oncologists want you to come to their clinic to get your chemotherapy. Ask if you can do it at home and you might get a “yes”.  You are more likely to get a yes if you have a home health care helper or part-time nurse. You are also more likely to get a “yes” if your medication is in the form of a pill – as an increasing number of chemotherapy agents are. Other types of administration are complicated and anything involving an IV should not be done by the patient.

Storage

It’s worth thinking about where and how medicines are stored in your house if only to keep track of them and to reduce the chances of others taking them or pets getting into them. Most people keep them in the bathroom – the well-known “medicine cabinet” – or perhaps the kitchen. Medicines taken for other maladies are often simple pills and can be kept in the bottle from the pharmacy. Some people transfer pills from the bottle to a dedicated pill box. Some boxes or dispensing devices can help patients remember all the pills they have to take in one day and reminds them once the pills have been taken. This is great for chemotherapy drugs and related oncology treatment medications that are in the form of pills.

Other chemotherapy drugs are in fluids and require injections or infusions.  (These fluids may be liquids or suspensions or slurries).  Some medicines must be kept at a low temperature and patients are told to keep them in the refrigerator.  A common procedure is to remove the medicine from cold storage 30 minutes before administration, but ask your medical team what is right for you and the medicine you take.

How much of an inventory do you need?

Consult with your oncology team.  It is doubtful you need more than a month’s supply, and pharmacies almost never give patients more than three months’ worth of any medicine. One month is a more realistic upper limit for oncology drugs because of their cost, hazards, and relative fragility.  Regular pharmacies do not carry chemotherapy medicines.  You will get them through your healthcare team or a specialty pharmacy at a hospital, or directly from a specialty pharmacy through the mail.

Administration

See our page on administering chemotherapy.  Home administration follows the same patterns as clinic administration but the people giving the treatment probably don’t have the same training.  This is why intravenous administration is rarely done at the patient’s home unless there is a nurse available.  But injections and pills are administered at home more often.

For injected drugs (subcutaneous), the skin should be wiped with alcohol just before injection.  Your medical team can advise on which parts of the body the injection can go.  The Cleveland Clinic advises not using the exact same site every time, but instead moving an inch and a half.   This will reduce the chances of hardening setting in at the injection area.  If another person (not the patient) administers the injection, that person should wear gloves.

Another good idea is to keep a log or diary of home administration of anti-cancer medicines.  Record the date and time and for subcutaneous injections location of each dose.  Also note side effects.

Pay special attention to old needles and syringes.  The best solution is to put them in a hard plastic jar with a sealable top.  You can also buy “sharps containers” which are basically the same thing.  Consult with your care team, local drugs stores, or local or state safety authorities about what to do when these containers get full.  Some pharmacies will take them from you free of charge.

Disposal

If there is leftover medicine, you should not simply throw it in the trash, and certainly never flush it down the drain.  Recycling of drugs is not feasible and probably not legal,  However, you may be able to deliver unused medication to the pharmacy you got it from.  Some drug stores have take-back programs.  You don’t get paid for the medicine, but you know it will be responsibly disposed of.  In some areas the local government or other agencies run depots where you can take old medicine.  This website http://disposemymeds.org/ lists many in the US.  The Environmental Protection Agency has a page on what to do with unwanted medicine.  The pharmaceutical infrastructure in the US includes reverse distributors which are businesses that take old or unwanted drugs from pharmacies and return them to manufacturers.

If you must throw away medicine, be sure to make sure animals or human scavengers will not pick it out of your garbage can.  The website Easth911 recommends pouring medication into a sealable plastic bag, adding water and kitty litter or sawdust, sealing the bad, and putting it in the trash.  Destroy labels that identify the medicine and your personal info.  Never flush medicine down the toilet.  (The only exception is that opioid pain relievers should be flushed, according to government guidelines, to prevent desperate addicts from getting them from the trash.)

Did you know some chemotherapy drugs are classified as hazardous waste by the federal government? The U-list of the Resource Conservation and Recovery Act includes Chlorambucil (U035),  Cyclophosphamide (U058), Daunomycin (U059), Melphalan (U150), Mitomycin C (U010), Streptozotocin (U206), and Uracil Mustard (U237).  Diethylstilbestrol, which is no longer used as a chemotherapy drug, is also on the U-list.  The P-list includes Arsenic Trioxide (P012). Additionally over a hundred chemo drugs are classified as hazardous waste because of their toxicity, even though they are not specifically listed in the federal code.   Home users are not subject to the same rules as businesses are so you do not have to take the same measures for storing these wastes a hospital would have to, but the home user is advised to be aware of the dangers waste chemotherapy medicines can pose.

Bodily Fluids

A rule of thumb is that bodily fluids should be considered dangerous and contaminated with medicine for 48 hours after treatment.  If your oncology team advises you otherwise, follow their instructions as the time for your body to process your particular medicine may differ.  During this time, the patient and other members of the household should be careful to contain the patient’s bodily fluids.  Special attention should be paid to laundering the patient’s clothing.  The University of Pennsylvania’s Oncolink website has recommendations.

Spills

Home users should also keep a spill kit in the house in case of an accident.  Search the internet for chemotherapy spill kit. They are not expensive.

Use gloves when handing spilled cancer drugs and wash your hands after removing  the gloves.  If you don’t have a dedicated medical waste container, put the spilled medication in a plastic bag and put that bag inside another bag.  This applied to both spilled chemotherapy medicine (whether solid or liquid) and bodily fluids within 48 hours of treatment.