How to Safely Handle and Dispose of Medications, with Paul Celano, MD

May 8, 2018
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In this podcast, Dr. Paul Celano discusses what patients should know when taking medication for cancer treatment, including tips for safely storing the medication, special considerations for oral chemotherapy and opioids, as well as resources to help dispose of unneeded or expired medications.


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In this podcast, Dr. Paul Celano discusses what patients should know when taking medication for cancer treatment, including tips for safely storing the medication, special considerations for oral chemotherapy and opioids, as well as resources to help dispose of unneeded or expired medications. Dr. Celano is Division Head of Medical Oncology at the Sandra & Malcolm Berman Cancer Institute at the Greater Baltimore Medical Center.

ASCO would like to thank Dr. Celano for discussing this topic.

Dr. Celano: Hello, my name is Paul Celano, I'm a Medical Oncologist at the Greater Baltimore Medical Center in Baltimore, Maryland.

Today, I would like to talk about how patients can safely handle and dispose of cancer medications. As you know, there are many kinds of chemotherapy. They're strong medicines that are used to kill cancer. Oral chemotherapy has become an increasingly utilized means of treating patients with cancer. Traditionally, chemotherapy has been given as an intravenous infusion in either a hospital in-patient unit or clinic or physician office. But over the past decade or so, the self administration of oral chemotherapy has increased. This is mainly because of advances in the novel targeted therapies. And in fact, up to one-third of all chemotherapy today is given orally. And that list is continuing to grow. So this will more a more common way in which we treat patients with cancer. There's a lot of advantages to using oral chemotherapy. The patients have increased control over their medications, convenience, potentially increases in quality of life, actually more sustained use of medications in terms of not just being given every week or so in an office, but every day, improvement in travel cost, health care resources, lots of advantages.

But to balance out those advantages, there's also some issues around patient safety that can contribute to medication errors, contamination, unintended exposure to other individuals who shouldn't be getting chemotherapy. I think it's important to understand that chemotherapy, although very useful in the treatment of cancer, has a lot of risks to it. We certainly appreciate that in the IV forms, but also in the oral forms, and it's important that these medicines be properly used.

The difference, and I think one of the biggest differences in giving chemotherapy in a hospital or physician office or clinic, is that when the medication's given in the office setting, there's a prescribed dose regimen, response to treatment, and it's very closely monitored. Whereas the oral medications, although patients are and should be given instruction, they are susceptible to either taking too much medications or not enough medications, so-called non-adherence, not taking enough of it, or taking it properly, and also the increased risk of adverse reactions, side effects of the medicines.

So when patients are given oral chemotherapy, we always are concerned about incorrect dosing, limited monitoring of them, and the potential for serious side effects including things that could even result in death related to these medications. So we take it extremely seriously. Not taking the medication properly, either not enough of it or stopping it, is also of concern. And this needs to be properly monitored. We also have concerns about accidental exposure of oral chemotherapy agents, particularly to other family members.

So, what do you need to know as a patient with cancer that's receiving chemotherapy, I think the key thing is that patients should get clear instruction as to how they should take their medications: how often, how the dosing should be done, should it be done with food or not, what are the side effects or things that you might expect to happen, to occur from these medicines, including some of the stuff we see with IV chemotherapy, such as stomach upset, nausea, vomiting, diarrhea, hair loss, skin rash, and low blood counts that could result in infections or needs for transfusions. And I think all patients who are receiving oral chemotherapy should get very explicit instruction, and really, education.

The American Society of Clinical Oncology recommends that all patients receiving chemotherapy whether it's intravenous or oral, should have very specific instructions about their medications. The basics, like what is the name of the medicine, how do you take it, what if I'm having trouble swallowing these pills, can they be broken or crushed, when should I take it, can I take it with other foods, how should it be stored, what are the side effects, how long am I going to be on this medication? So it's a fairly long list of things that patients-- and it's very important to have an open communication with your physician or health care provider. Sometimes it's a nurse educator or pharmacist even, to help with these medications.

There are a bunch of sort of dos and don'ts in terms of oral chemotherapy to ensure that this is being done safely. And I will say, this should apply to practically any medication we take because there's a reason why someone needs a medical license to prescribe a medication, or at least these kinds of medications because they have all serious consequences, so I think this is even important for any medication. But, obviously when you receive the medicine, you should make sure it's labeled properly, that it's the proper name and dosage that you were told, that you understand how to take the medication, things like understanding how to store the medication properly, should it be in your medicine cabinet, should it be in a refrigerator, although it's not common. What to do if you take too much of the medicine? What happens if the medication's damaged? And also it's very important to communicate to your physician what other medicines that you're on. So those things are extremely important.

It's also important to know to not to just leave the medicines out, particularly when they can be accessed by other, particularly children. To store the medication properly. Almost none of these medications should be crushed or broken or chewed, and if there's an issue about taking the medicines, that clearly needs to be discussed. And then also importantly, what should happen if you need to discard the medications.

Some issues that come up regarding the chemotherapy in a patient on chemotherapy, oral chemotherapy particularly, is what should happen with various body waste issues? Certainly things like, the toilet should be watched closely, that the lid should be closed on flushing, that someone should wear gloves when cleaning things like the toilet or areas of urine or stool or vomiting, etc. If a bedpan or urinal is used, the person handling that should use gloves. And if a patient has an ostomy, a colostomy, or a ureterostomy, for urine, again that should be handled carefully because the chemotherapy agent can be placed in there.

If the medication spilled, or left on the floor, et cetera then, again, proper gloves and cleanup should occur. But also, it's important to hear that you're not a danger to your family, that as long as you're not sharing bodily fluids, that hugging and close contact is certainly acceptable. Birth control is an issue, and that is something that should be carefully discussed with your physician.

So those are kind of the basics of handling oral chemotherapy, and again, very important, good communication, and just ask lots of questions.

When talking about medicines these days, one can never not think about other medications that could be important in patients. And with our patients with cancer, that often they're on opioids. It's probably no news to anyone listening to this that the opioid abuse has become a major epidemic in the United States and throughout the world. And it is important that these medications also be greatly respected. I think it's important to understand that more than 70% of patients using opioid analgesics have gotten them through family or friends on a prescription. It's astounding that although we think about these as people buying them on the street—they certainly do—it's important that many of them, the majority of them come from our own medicine cabinets. It's very important that these medicines be stored out of reach and out of family members. In fact, some have argued, and I think I could argue this, is that they should be in a locked place because of the great potential for abuse and obviously great damage that can occur to patients who receive opioids. It's a sad fact that many prescription medications are abused, and really need to be carefully watched and away from people.

And this brings us down to the what to do with all these medicines. Sometimes as we go through, whether it's the illness and the medication is not necessary anymore, or it's become ineffective, or there's side effects related to it, that they're often left with unused medications. Or sometimes they'll expire, the date on the medications will expire. And there's often an issue what to do with these medicines. And it's important that these medicines be properly disposed of.

You can bring them to your physician's office. Each locality actually also has information on how to safely dispose of medications. Usually through the police departments usually have some form of lockbox of some kind that patients can drop these off. Each each year, or twice a year the DEA has announced so-called Take Back Day. And it's really—the initiative is to announce that there is a proper way of disposing medications and also brings to light the high number of accidental poisonings, overdoses related to prescription medications. If you go to the DEA website, the, it has lots of specific information on drug take back.

A crazy statistic is last fall, the Take Back Day netted 456 tons of unused or unwanted medications. Astounding number, and it's actually grown each year, so every year, we're hoping that more people will bring their medications that are unused and will keep them away from people that don't need them.

So that's all for today. There's lots of issues around this, and it's very important to be careful with these medications, when you're ingesting them, the exposure to your family and friends, and to properly protect the medication so that there isn't any abuse and unfortunate damage to people. Thank you very much.

ASCO: Thank you, Dr. Celano. Learn more about handling your medications at If this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play.

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