Oral Anticancer Agents: Presenting New Challenges for Family Caregivers of Patients With Cancer

Purpose: To describe the current challenges for family caregivers of patients receiving OAAs and propose strategies for clinicians to support both patients and their family caregivers for safe care in the home environment.

Methods: Focus group methodology and an extensive review of the literature specific to caregiving and oral anticancer medications were completed. Focus groups included caregivers who met the following inclusion criteria: 1) family caregivers of patients with cancer who were prescribed an OAA; 2) English speaking; 3) aged 21 years or older; and 4) able to hear and verbally communicate. Caregivers were recruited from three separate oncology clinics in the Midwest. Focus group interviews were audio recorded and transcribed verbatim. A constant comparative analysis was used to evaluate data (Krueger & Casey, 2015). Independent data analysis was carried out by two nurse researchers and discrepancies were discussed until an agreement was met, using a third nurse researcher as necessary.

Literature was obtained from PubMed, CINAHL, Medline, PsychINFO, and EMBASE databases if published between 1999 and 2018 and included studies of adults 18 years of age or older. Search terms included caregiver, oral cancer medication, oral antineoplastic, oral anticancer*, oral chemotherapy, and oral targeted agents.

Results: Evidence from focus group interviews and the review of the literature identified the following main caregiver challenges: 1) overseeing the preparation, administration, and adherence of complex OAA regimens (Bartel 2007; Lester 2012; Morris & Marshall-Lucette, 2017; Siden et al., 2014); 2) managing symptoms, side effects, and drug-drug or food-drug interactions (Bartel, 2007; Lonardi et al., 2007; Morris & Marshall-Lucette, 2017); 3) safety concerns related to potential toxic exposure to OAAs during medication preparation and administration, and from bodily fluids of the patient (Marshall et al., 2018; Rudnitzki & McMahon, 2015; Trovato & Tuttle, 2014); 4) financial concerns specific to OAAs (Bartel, 2007, Marshall et al., 2018; Morris & Marshall-Lucetter, 2017); 5) managing the treatment trajectory of OAAs including temporary and/or permanent interruptions to treatment (Marshall et al., 2018); and 6) lack of standardized OAA safety education for family caregivers during the course of treatment (Bartel, 2014; Mulkerin et al., 2016; Trovato & Tuttle, 2014).

Conclusion: Family caregivers of patients receiving OAAs, have unmet needs that may negatively impact both patient and caregiver outcomes.