More cancer patients are able to receive chemotherapy, including both oral and intravenous agents, in the home setting. Clearly, the option to self-administer therapy in the absence of an oncology nurse or other healthcare provider poses a potential safety risk.
Bernadette Lore, RN, BSN, OCN
Memorial Sloan-Kettering Cancer Center
More cancer patients are able to receive chemotherapy, including both oral and intravenous agents, in the home setting. Clearly, the option to self-administer therapy in the absence of an oncology nurse or other healthcare provider poses a potential safety risk. In 2008 the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published chemotherapy administration standards to address concerns about patient safety during chemotherapy. Many cancer centers, however, still need to determine how to optimize communication and patient education regarding safe handling of cytotoxic chemotherapy agents by patients and their families at home.
The Chemotherapy Practice committee at Memorial Sloan-Kettering Cancer Center (MSKCC) identified the need to provide patients and their family members/caregivers with consistent, easy-to-read instructions about how to safely handle cytotoxic drugs at home, to help them avoid inadvertent drug exposure. To address this issue, a multidisciplinary task force was established at MSKCC, with representatives from the departments of medicine, pharmacy, nursing, safety, and patient education.
The MSKCC patient guidelines were developed using the ASCO/ONS guidelines as a framework, together with best available evidence found in a literature search (eg, guidelines from other hospitals), MSKCC’s standard operating procedure for safe handling of cytotoxic drugs, and safety recommendations from the National Institutes of Health, “Handling Hazardous Drugs Safely at Home.”
A patient education fact card appropriate for patients of all ages and their caregivers was created and is now completing review by MSKCC’s nursing leadership, Chemotherapy Practice committee, and department of patient education. The card advises on chemotherapy drug storage, safe handling of the drugs, safe use and disposal of needles and other equipment used in drug administration (for injected agents), safe handling of body waste (eg, emesis, urine, stool), and safe patient contact with family members. Specific instructions are provided on when and how to use safety gloves. Oncology nurses at MSKCC will review safe handling of cytotoxic chemotherapy drugs with patients before they are discharged to their homes.
Important Tips for Patients Receiving Chemotherapy at Home
As advances in technology and drug development allow increasing numbers of patients to receive cytotoxic chemotherapy outside of the cancer center setting, it is imperative that, before patients are discharged, they receive appropriate comprehensive education regarding how to handle their chemotherapy drugs at home, how to manage drug spills, and how to safely dispose of chemotherapy waste materials and body waste. It also is necessary to teach patients and their caregivers why safety precautions are so important, given that exposure to cytotoxic agents can occur through the skin and by inhalation, in addition to ingestion and injection.