Increasingly, oral medications are used to treat chronic lymphocytic leukemia (CLL). Oral therapies such as ibrutinib, idelalisib, and venetoclax are appealing because they are less disruptive to daily routines than therapies given by intravenous (IV) infusion.
With oral medications, patients are likely to spend less time at the clinic and more time doing what they want. Oral therapies are also less troublesome to patients’ work schedules and are more convenient when traveling.
A review of 13 studies assessing cancer patients’ preferences with regard to route of drug administration found that in 11 (84.6%) studies, patients preferred oral over IV administration and only 2 (15.4%) had a preference for IV over oral.
In studies included in the review, “convenience and ability to receive treatment at home were the most frequently reported factors associated with patient preference for oral treatment, possibly relating to the fact that oral treatments may allow patients to forgo or reduce the number of hospital visits in comparison to IV treatment,” the authors concluded.
Cost may be an issue in patient preference for an IV treatment, however. Unlike IV chemotherapy, which is covered as part of your medical benefits coverage, oral chemotherapy is treated by most insurers as a prescription drug benefit. Under the prescription drug benefit, a “tiered” payment structure is often used that increases patients’ cost-sharing responsibility as the price of the medication increases. For more expensive oral drugs, patients may be responsible for copayment amounts.
Many states, however, have tried to level the playing field by enacting oral parity laws. These laws are designed to ensure that orally administered cancer drugs are not costlier for patients than anticancer drugs given by infusion at a clinic or hospital. These laws have been found to modestly reduce out-of-pocket spending. An oral parity law at the federal level is pending in the Senate.
With oral medications, patients share the responsibility to make sure that their pharmacy ships medication refills on time. Since most medications must be taken on a daily basis, patients should keep careful track and call their pharmacy if they begin to run low. Remember, pill bottles typically have the pharmacy’s phone number and other vital information needed to identify the prescription.
In addition to refills, patients should follow the correct dosing schedule and take their medication per their oncologist’s instructions. Some oral medications need to be taken at a certain time or on an empty stomach instead of with food, and it is patients’ responsibility to know the correct way to take your oral cancer drug.
It is vitally important that patients communicate effectively with the healthcare team to ensure that they are keeping on track with their oral cancer treatment. Patients should not hesitate to contact their oncology team to clarify treatment issues or to notify the team about side effects from oral medications. If in doubt, it’s always best to ask.