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Medication Management

Medication Management

What are the medication issues related to cancer?

People with cancer often take many medications both for their cancer as well as for other chronic health problems. Following the doctor’s orders can be hard when some need to be taken with food, some without, some in the morning, some at bedtime, some as needed, some once a day, and others multiple times a day or even around the clock. Now there are a number of cancer treatments that can be directed to be taken at home by the patient with the help of the family.

Some medications may be taken by mouth; others injected. There are topicals, eye drops, transdermal patches, etc. It can be complicated! Some of the newer oral anticancer agents have very complicated schedules for administration. Patients may have a hard time keeping track and need your help. Dealing with multiple medications can be a challenge.

Also, cancer drugs may cause side effects. These can make the patient feel unable or unwilling to take them as prescribed. Medication interactions can occur even when the patient is taking everything as prescribed. Patients need to know how they can try to manage the side effects of their medications. Caregivers can assist patients with symptom management.

Cancer patients often see several healthcare providers who may not know what else the patient has been prescribed. Family members assume major responsibility for helping the patient. Caregivers should be sure providers know and understand what medications the patient is taking. Avoiding medication errors is a top priority for patients on medications.

How can we better manage the patient’s medications?

Keeping track

The most important thing is helping the patient keep track of medications; over-the-counter medications and supplements should be included. Labels need to be read carefully. If you or the patient have difficulty reading the pharmacy labels, request large print labels. Work with your loved one to create a record with the following information for each medication:

  • Name of the medication
  • Prescribed by (doctor)
  • Prescribed for (purpose)
  • Instructions (how much to take, when to take, for how long, how many times a day)
  • Possible common side effects
  • How long it takes for certain medications to work, such as pain medications
  • How medication should be stored
  • Foods to avoid and how to take medication in relation to food and fluids
  • What to do if dose missed
  • Pharmacy (try and use the same pharmacy for all prescriptions)

You can use this medication worksheet as a starting point. You can also ask another friend or family member—someone who is very well organized!—to handle this.

Whoever manages the medication records should be sure to include over-the-counter medications, vitamins, and herbal supplements. These can interact with prescription medication, so the patient’s healthcare providers need to know about them. And, be sure to write down when prescriptions need to be refilled.

Do not mix different medications together in the same container.

If possible, encourage the patient to use the same pharmacy to fill all prescriptions. The pharmacist can identify any drugs that might interact badly. Know where and how to get the medications.

Make sure your loved one knows to take his or her medication record to all medical appointments and asks his or her healthcare provider to update it as needed.

Get prescriptions filled early or use a medication delivery service.

Help the patient take their medication

You—or another person on the care team—can help the patient take medications day-to-day. Try to have a reminder system. For example, create a calendar together. Or suggest the patient set an alarm or daily phone reminders at medication times. Reminders are important.

Some people with cancer find it helpful to prepare (or have someone prepare) their medications on a weekly basis. Setting up a system using pill containers can help patients keep on track with times and pills per day. For oral medications, you can pick up a pill organizer with different slots for morning, noon, evening, and bedtime at any pharmacy. This can save time and make it easier to keep track.

But be sure to store medications as directed. Some need to be refrigerated; others must be kept out of the light, etc.

Ask the patient's doctor or nurse about the safe handling of medication. Oral cancer medications can be toxic and should be handled with care. Keep medications stored in a secure place, out of the reach of children.

Be sure to check all medication expiration dates and discard any expired medication according to the doctor's or pharmacist’s advice.

Medication reconciliation

Medication reconciliation is the process of comparing current and older lists of medications. With a cancer diagnosis, new medications are often added or discontinued. It means making sure everything is on the list, nothing is missing, there are no contra indicators, and changes are noted. This should be done after hospitalizations, ER or urgent care visits, and physician visits. Caregivers need to keep an up-to-date medication record and know when changes occur and why.

When should I talk to the patient's healthcare provider about medication?

You or the patient should contact his or her healthcare provider if:

  • The patient has missed a dose, and you don’t know what to do.
  • The patient is having symptoms that may be side effects of medication, like rashes, drowsiness, confusion, depression, insomnia, incontinence, muscle weakness, loss of appetite, balance problems, and/or changes in speech and memory that interfere with daily life.
  • The medication is not working.
  • The patient is having a hard time taking medications as prescribed (e.g., swallowing).
  • The patient’s medication is not covered by insurance, and financial assistance is needed.
  • The medication comes from a specialty pharmacy.

References

  • Polenick, C.A., Stanz, S.D., Leggett, A.N., Maust, D.T., Hodgson, N.A., & Kales, H.C. (2020). Stressors and resources related to medication management: Associations with spousal caregivers’ role overload. The Gerontologist, 60(1), 165–173. https://doi.org/10.1093/geront/gny130
  • Whitman, A., Fitch, E., & Nightingale, G. (2023). The role of oncology pharmacists and comprehensive medication reconciliation in informing treatment plans for older adults with cancer and downstream outcomes. Current Opinion in Supportive and Palliative Care, 17(1), 3-7. DOI 10.1097/SPC.0000000000000634
  • Schumacher, K.L., Clark, V.L.P., West, C.M., Dodd, M.J., Rabow, M.W., & Miaskowski, C. (2014). Pain medication management processes used by oncology outpatients and family caregivers part II: Home and lifestyle contexts. Journal of Pain and Symptom Management, 48(5), 784-796.
  • Latter, S., Hopkinson, J.B., Richardson, A., Hughes, J.A., Lowson, E., & Edwards, D. (2016). How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies. BMJ Supportive & Palliative Care, 6(3), 263-275. DOI 10.1136/bmjspcare-2015-000958