Patient Welcome Packet - TEXAS ONCOLOGY PHARMACY
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TEXAS ONCOLOGY PHARMACY Patient Welcome Packet
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Contents
4 Welcome to Texas Oncology Pharmacy
8 About Texas Oncology Pharmacy
9 Our Vision
9 Our Mission
9 The Core Values of Texas Oncology
10 Our Pharmacy Services
11 After Hours and Support Services
11 After Hours Services
12 Insurance Coverage and Billing
12 Medication Cost
12 Prior Authorization Facilitation
12 Copayments
12 Lowest Cost Alternative
13 Financial Assistance
14 Key Information on Your Prescription
14 New Prescriptions
15 Refills
15 WHAT HAPPENS IF I NEED A REFILL SOONER THAN SCHEDULED?
If you need a refill sooner than scheduled, please contact us.
We will work with your insurance company to find a solution.
15 Auto Refill
15 Drug Substitution Protocols
15 Obtaining Drugs Not Available at Texas Oncology
15 Transfers
16 W HAT IF MY INSURANCE REQUIRES ME TO USE A DIFFERENT
PHARMACY?
If you are required to use another pharmacy or we cannot fill your
prescription, we will transfer the prescription to your pharmacy of
choice or the pharmacy mandated by your insurance carrier.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 1
16 Prescription Status
16 Prescription Pickup
16 Prescription Delivery
17 Quality of Your Prescription
17 Recalls
18 Emergency and Disaster Preparedness Plan
19 Storage and Handling of Medication
19 General Storage Tips
20 Storing Pain Management Medication
20 Special Handling of Oral Chemotherapy
21 Handling Body Fluids and Waste
22 Disposal of Medication
22 General Medication Disposal
22 Pain Medication Disposal
23 What You Need to Know About Oral Chemotherapy
23 Staying on Track with Treatment
23 Know What Your Medication Looks Like
24 Know How to Take Your Medication
24 When to Take Your Medication
24 How to Swallow Your Medication
25 What to Take With Your Medication
25 What to Do if You Miss a Dose
26 Make it Easy to Remember to Take Your Medication
27 Pregnancy, Breastfeeding, Sexual Activity, and Contraception
28 Coping With Side Effects
29 Diarrhea
29 Follow a Clear Liquid Diet
29 Choose Foods That Are Easy to Digest
29 Avoid Foods and Drinks That Can Worsen Diarrhea
30 When to Call the Doctor
30 Fatigue
31 Stay Active
31 Eat Well
31 Prioritize Tasks
31 Ask for Help
32 Manage Stress
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32 Get Enough Sleep
32 Ask About Medications for Treating Fatigue
32 Be Flexible
33 When to Call the Doctor
33 Nausea and Vomiting
33 Eat Well
34 Skin Reactions
34 How to Treat Dry Skin
34 How to Manage a Rash
36 Medications for Rash
37 Hand-Foot Skin Reaction
38 Patient Rights and Responsibilities
38 Patient’s Bill of Rights
39 Patient’s Responsibilities
41 Notice of Privacy Practices
41 Notice Informing Individuals About Nondiscrimination
and Accessibility Requirements
41 Texas Oncology
41 Patient Privacy
41 About Us
42 Purpose of This Notice
42 Our Responsibilities
42 How We May Use or Disclose Your Health Information
46 Your Rights Regarding Your Health Information
47 Changes to This Notice
48 Patient Satisfaction and Grievances
48 Patient Satisfaction
48 Patient Satisfaction Survey
link: www.texasoncology.com/pharmacy-satisfaction
48 Concerns or Grievances
49 Understanding Medical Directives
50 Choosing a Healthcare Advocate
50 Putting Your Wishes into Writing
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 3
Dear Patient,
Welcome to Texas Oncology Pharmacy, an integral part of your oncology care team.
Texas Oncology’s founders believed there was a better way to treat patients with cancer.
Its mission, vision, and core values reflect the practice’s commitment to providing high-
quality, evidence-based patient-centered care to cancer patients. We’re privileged to be
part of your care team and manage your pharmacy needs.
The pharmacy team understands that your medical needs are complex and require
specialized knowledge as well as active and continual collaboration with your care
team. We will provide you with the personalized service necessary to ensure that you
achieve maximum benefit from your therapy. You can expect:
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| Personalized Patient Care
Our specially trained pharmacy team will review your treatment plan with you and
address any questions and concerns you have. Our oncology patients are being
treated by a medically integrated pharmacy care services team that provides you with
coordinated, timely, and continual care, education, and counseling throughout your
oncology journey. In addition, we provide counseling and detailed instructions on how to
take your medications correctly and how to manage side effects.
| Cancer-Specific Advice and Consultation
Our pharmacists have deep knowledge of cancer medications and how they may
interact with other drugs and other forms of treatment, whether chemotherapy infusion,
radiation, or immunotherapies. With your oncology care team nearby, questions are
easily addressed, and patients receive specific instructions on how and when to take
their medications.
| Pharmacy Patient Management Program
We monitor all our patients’ medications and progress through our medically integrated
pharmacy patient management program. This program helps facilitate patient
compliance to prescribed drug therapies, manage side effects, and promote overall
health improvement. The success of the program depends upon patient engagement
and cooperation. Without your active participation and full use of the program, the
benefits will be limited. If you wish to opt out of this program, please call and speak to
our pharmacy team, and we will make the requested adjustments to your care plan.
| Coordination with Your Doctor
The pharmacy team works exclusively with Texas Oncology providers and patients.
As a medically integrated pharmacy, we are different from traditional retail and mail
order pharmacies because we coordinate many aspects of patient care and disease
management. The pharmacy provides convenient dispensing and delivery of specialty
medications to our patients. Under the supervision of a qualified pharmacist and trained
staff, we assist our patients to achieve optimal clinical outcomes while effectively
managing the cost of therapies. We are part of your oncology care team, working
directly with your doctors and caregivers to address any needs you may have with your
treatment immediately. We will always keep the lines of communication open between
you and your doctors and caregivers. We are here to make sure that any difficulties you
may be having with your treatment are addressed immediately.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 5
| Clinical Lab Value Monitoring
Due to the complex nature of many drug therapies and the need to make sure that the
therapy is as effective as possible, we may need to coordinate regular reviews of your
lab tests with your doctor. These may require a visit to your doctor to make sure that
your therapy is progressing as expected. Please be aware that pharmacy uses this
information for internal monitoring only. Your personal health information is protected as
outlined in our Notice of Privacy Practices included in this packet.
| Regular Follow-up
Getting your medications and supplies quickly and efficiently is essential. We are with
you every step of the way during your treatment to provide support and advocacy.
| Benefits
Oncology care can be costly. We’ll help you navigate the healthcare system to explore
options available to you. In addition, our relationships with insurers will help provide you
with information and explanations of your prescription and medical insurance benefits.
Finally, we help you with private insurance and Medicare paperwork, billing, and claims.
We also work with patient assistance programs on your behalf to get funding if you need
financial support. If no financial resources are available for you, we will make every
effort to get you your drug free of charge from the manufacturer.
| Timely Access to Your Oncology Treatments
Because cancer is our primary focus, our pharmacies are routinely stocked with cancer drugs
and related pain, supportive, and hard-to-find medicines that our oncologists commonly
prescribe. Special-order medications typically are available with a one-day turnaround.
| Drug Substitution Protocols
We’ll always use the most cost-efficient option for you. Occasionally, it may be
necessary to substitute generic drugs for brand-name drugs. This could occur due to
your insurance company preferring the generic be dispensed or to reduce your co-pay.
If this is the case, we will contact you prior to dispensing the medication to inform you
of the substitution. When available, our pharmacy will default to generic to save you
money. We will use brand name medication at you or your physician’s request.
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| Delivery
We offer fast and convenient delivery to you. Many times, your prescriptions will be
available at the time of your next medical appointment.
| Refill Reminders
We will not automatically refill any prescription without your permission. If a refill is
needed, we will begin working on it five to seven days before your refill due date. A
pharmacy team member will contact you to discuss your ability to remain adherent to
therapy, answer any questions you may have, confirm and update your medical and
insurance information, and set the delivery or pickup date and details. We also work
with your physician to understand their next steps in your treatment before refilling
your prescription to ensure optimal care at the lowest possible cost to you.
| 24/7 Support
As a medically integrated pharmacy care provider, we are available to coordinate with your
medical team 24 hours a day, seven days a week, including holidays and weekends. We’re
always here to answer any questions or address your concerns. Our certified, highly trained
oncology pharmacists can answer your questions and provide support whenever you need it.
| Therapy Support and Adherence Monitoring
The most expensive medication is the one that is not taken. It is vital that you take
your medications as instructed by your pharmacists and as detailed on the pharmacy
label. Pharmacy staff members will help to explain your medications and their use with
your specific disease state. We encourage all patients to become empowered decision-
makers. We are happy to provide you with information about advocacy groups and
recommendations of other helpful resources. Just give us a call.
We look forward to being a member of your care team. By using our pharmacy, your
entire oncology care team is better positioned to treat and care for you during your
oncology journey. Thank you for choosing Texas Oncology Pharmacy.
Sincerely,
Your Texas Oncology Pharmacy Team
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 7
About Texas Oncology
V I S I O N , M I S S I O N , A N D C O R E VA L U E S
8 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2Our Vision Our Mission
To be the first choice for cancer care. To provide excellent, evidence-based care for
each patient we serve, while advancing cancer
care for tomorrow.
The Core Values of Texas Oncology
The principles that guide our practice are patient centered, and encompass three spheres:
PAT I E N T C A R E
• To provide compassionate, individualized care for our patients.
• To provide care that is comprehensive and coordinated close to our patients’ home.
• To attract and nurture the best physicians.
• To recognize and support the central role of clinical research in advancing cancer care.
C U LT U R E
• That engenders a collegial physician partnership.
• That respects individuals and the collective wisdom of the group.
• That embraces openness and fairness.
B U S I N E S S – Our practice values professional management that:
• Promotes convenient access at rural and urban sites.
• Provides leadership in efficient care delivery and improves all aspects of cancer care.
• Provides a financial structure to expand services to our patients.
• Is competitive in all aspects of our business.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 9Our Pharmacy
Services
The use of oral therapeutics in cancer treatment is rapidly growing. Your doctors at Texas Oncology
currently manage and oversee your infused cancer drugs, but they can also do the same with any oral
medications that are a part of your treatment plan. As part of your treatment team, our on-site specialty
pharmacy provides oral chemotherapy, immunotherapy, and other targeted medications as ordered by your
oncologist. All these drugs require specialized knowledge and oversight. Our highly trained pharmacists
collaborate with your care team to provide the best options for you. Our on-site pharmacy provides many
convenient services dedicated solely to you and your oncology treatment plan.
We provide you with the personal service necessary to ensure that you achieve the most benefit from
your therapy including:
• Personalized patient care • Drug-specific educational and support
materials
• Cancer-specific consultation
• Close consultation with your physician to
• Comprehensive oncology formulary
manage side effects
• Patient management program
• Access to clinical research
• Timely access to your oncology treatments
• Therapy support
• Home delivery of your medications (as needed)
• Adherence monitoring and support
• Coordination of your prescriptions with your
• Access to information online
other oncology treatments and appointments
www.texasoncology.com/pharmacy
• Refill reminders
• Advocacy with insurance companies
• Access via phone to clinically trained
• Advocacy with financial assistance sources
pharmacists 24/7/365
• Cost-effective / best options for you
• Disease-specific educational and support
materials
Ask your doctor about using Texas Oncology Pharmacy and how you can take advantage of this team-based,
unfragmented, and comprehensive care approach to your treatment.
10 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2After Hours
Support and Services
| After Hours Services
For after-hour emergencies, such as running out of your medication or questions on missed doses or
potential side effects, please contact your local Texas Oncology clinic’s after-hours number. You will be
directed to an operator, and a physician or pharmacist will return your call within 30 minutes, 24 hours
a day, seven days a week.
Please contact us at any time if:
• You have questions about taking your medication. • Your therapy ends.
• You are having any adverse reactions or want • You start taking new medications, including
to consult with a pharmacist. over the counter or herbal supplements, etc.
• You need to order supplies or medication refills. • You have a billing question or need to provide
new health plan information, including
• You have questions about your current order
out-of-pocket costs, deductibles, copayments,
or experience delays with your shipment.
or co-insurance options.
• You are having problems with equipment,
• You would like additional information on ways
dressings, or experience a change in your
to access your medication, health services,
condition.
payment options, and therapy coordination.
• You are hospitalized, your condition worsens,
• You would like to learn about product
or your therapy is interrupted for any reason.
selection and availability, including current
• There is a change in your prescription or medications that Texas Oncology Pharmacy
supply needs. does not have access to.
• You need information about disposing of • You would like to understand where to refill
medication. your medication if Texas Oncology Pharmacy
is limited by your benefit plan.
• You need information about accessing
medication in the event of an emergency. • Anything causes you concern for your safety.
Patient Welcome Packet | U P D AT E D : 0 1 / 3 1 / 2 0 2 2 11Insurance
Coverage and Billing
| Medication Cost Prior Authorization Facilitation
Before your care begins, a pharmacy staff We know that payers have numerous requirements
member will work with your physician and your for prior authorizations, from documentation and
insurance company to confirm your coverage supporting literature to specific publications or
and assist with the prior authorization. The prior evidence of molecular mutation. Since we share
authorization process may take a few business a clinical expertise in oncology, we can provide
days to complete. We will inform you about payers with reasoning for a particular drug and,
medication costs that are not covered by your thanks to our strong history with these companies,
insurance, such as deductibles, copays, co- we know exactly what they need to issue an
insurances, or plan changes. approval. We’ll share their specific preferences —
such as tried-and-failed requirements — and help
Texas Oncology Pharmacy will bill your health
you submit the necessary information. We’re proud
insurance company for the cost of your medication
to have a low percentage of denials and a high
on the date your prescription is filled. If the claim
denial-overturn rate, but we’ll also remain vigilant
is rejected, we will notify you so that we can work
through the appeal process in the case of a denial.
together to resolve the issue. If your provider denies
coverage or if you disagree with the benefits coverage,
you may have the right to file an appeal with your
| Copayments
health plan. We will assist you in the appeal process In most cases, our pharmacy is required by
and provide any documentation you may need. insurance companies to collect copayments before
shipping your medication. Copayments can be
If Texas Oncology Pharmacy is an out-of-network paid by credit card (Visa, Mastercard, American
provider in your insurance plan, we will find the Express, or Discover), electronic checking account
most cost-effective way for you to receive your debit (over the phone), or by check or money order
medication. In some cases, we may transfer your (through the U.S. mail).
prescription(s) to the insurance provider or their
in-network pharmacy. We will call you if needed so
| Lowest Cost Alternative
there is no disruption in your medication delivery.
We will automatically seek less expensive generic
substitutions for your prescribed medications if
your doctor allows for it. Ask us anytime if a lower-
cost generic drug is available.
12 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2| Financial Assistance
Good care shouldn’t be out of reach due to price, and we know that treatment can be costly. We work
closely with nonprofit foundations and drug manufacturers’ programs to help you afford your medication.
If you do not have prescription drug coverage or cannot afford your copay amount, we will always do the
following on your behalf:
1. Find out which assistance programs you might be eligible for.
2. Contact you to explain each program’s details, including coverage and copay costs.
3. Assist in completing a confidential pre-screen assessment (usually required by various programs).
4. Once eligibility is confirmed, we will finish enrolling you into the program(s).
5. Keep you and the rest of your Texas Oncology care team updated throughout the process.
6. Ensure medication is available and dispensed immediately to you.
7. Track your coverage under the program and work to maximize your coverage so that you are
covered if possible, under the patient assistance program.
| If you have any questions around patient assistance, please contact our team.
Contact: Lindsey Scott, Manager, Texas Oncology Patient Assistance Program
Email: R X P A _ P A S @ u s o n c o l o g y . c o m
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 13Key Information
on Your Prescription
Texas Oncology Pharmacy patients should be advised that your physician has ownership in the
pharmacy. You are not obligated to use the Texas Oncology Pharmacy. Just let us know, and we will
transfer your prescription to your preferred pharmacy provider.
| New Prescriptions
Your physician and the Texas Oncology Pharmacy work together to help you through your oncology care
plan. When your physician determines that oral chemotherapy treatment is the best course of treatment,
they will send your prescription via an electronic prescribing process to our pharmacy team unless
otherwise requested by you or your pharmacy benefit manager.
Optimal value of the Texas Oncology care approach is best achieved by having a credible, accessible, and
consistent care team. By utilizing the Texas Oncology Pharmacy, we can stay focused on providing you the
care you deserve in a timely, comprehensive, and reliable way.
Physician orders E-Prescription is
a prescription for sent to Texas
your treatment Oncology Pharmacy
1
Prior Authorization Texas Oncology Pharmacy
is Obtained
• Focuses on you
Pharmacy Determines
2 Your Cost • Works with your physician
• Specializes in oncology as sole focus
Financial Assistance Team
3 Identifies Options • Finds best options clinically and fiscally
Pharmacy and Medical • Advocates for you to your health plan
4 Review is Completed and pharmacy benefit manager
Prescription is Prepared and • Gets your prescription fast and as
5 Available for You to Recieve requested by your physician and you
14 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2| Refills | Drug Substitution Protocols
You can expect the pharmacy to contact you about We will always use the most cost-efficient option for
your refill. We will call you about a week before you. Occasionally, it may be necessary to substitute
you are due to run out of medication. If you have generic drugs for brand-name drugs. This could
not received a call from the pharmacy within occur due to your insurance company preferring the
seven days of a refill need, you or an authorized generic be dispensed or to reduce your copay. If this
representative may call your pharmacy directly. is the case, we will contact you prior to shipping the
medication to inform you of the substitution. When
WHAT HAPPENS IF I NEED A REFILL SOONER available, our pharmacy will default to generic to
THAN SCHEDULED? save you money. We will use brand name medication
If you need a refill sooner than scheduled, please at you or your prescriber’s request.
contact us. We will work with your insurance
company to find a solution. | Obtaining Drugs Not Available at Texas
Oncology
| Auto Refill There are very few drugs that Texas Oncology
To have a prescription automatically refilled, a cannot obtain on your behalf. These drugs are
pharmacy staff member will need to speak with you usually restricted by the manufacturer to just one
or an authorized representative and ask you a short or two pharmacies in the nation. If you happen to
series of questions for the pharmacist to review. need one of these limited distribution drugs, our
During this call we will also check the day of the pharmacy team will work with all parties to ensure
week you would prefer your refill to arrive. Your you get the medication that is part of your oncology
Texas Oncology pharmacy can deliver your order to treatment plan.
your home, office, or designated destination.
| Transfers
If at any time you prefer to utilize a different
pharmacy, please just let our team know, and
we will ensure there is a quick transfer of your
prescription needs to your preferred provider. If
we cannot provide your medication due to limited
availability of the drug to our pharmacy, health and
pharmacy plan restrictions, and medication order
delays, we’ll help you transfer your prescription to
another pharmacy.
Patient Welcome Packet | U P D AT E D : 0 1 / 3 1 / 2 0 2 2 15Key Information on Your Prescription
Continued
| Quality of Your Prescription | Recalls
For us to service you appropriately, please inform Texas Oncology Pharmacy provides the highest
your Texas Oncology Pharmacy team immediately if level of pharmacy service and continually monitors
any of the following occur: drug safety alerts for drug recalls. A drug recall
is when a product is removed from the market
1. Prescription Change – Should your physician
or a correction is made to the product because
add or delete any of the items on your
the drug is either defective or potentially harmful.
prescription, or change the usage of any of
The recall may be made by the manufacturers
the products, please contact us immediately.
or distributors, by FDA request, or by FDA order.
2. Breakage – please let us know if any items For any drug recall that affects patients, Texas
delivered are damaged. Oncology Pharmacy follows FDA guidelines to
3. Unable to Perform an Inventory Check – remove the product from distribution and notify
If you are unable to take inventory of your patients identified to be at risk.
supplies as scheduled, please call Texas
Oncology Pharmacy ahead of time, and we Key Resource:
will make arrangements to assist you. 1. FDA Recalls: http://www.fda.gov/Drugs/
4. Interruption of Therapy – If your physician DrugSafety/DrugRecalls/default.htm
discontinues your treatment, or if you are
hospitalized, please notify Texas Oncology
Pharmacy so that your supplies and
equipment can be picked up or your inventory
adjusted accordingly.
5. Error in Shipment – Call the dispensing
Texas Oncology Pharmacy if you discover an
error in the shipment so that we may correct
the mistake.
16 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2WHAT IF MY INSURANCE REQUIRES | Prescription Pickup
ME TO USE A DIFFERENT PHARMACY? Many of our Texas Oncology Pharmacies are
If you are required to use another pharmacy or located at your doctor’s office location, allowing
we cannot fill your prescription, we will transfer for quick and easy pickup of your medications
the prescription to the pharmacy of choice or the at the time of your medical visits. When you pick
pharmacy mandated by your insurance carrier. up your prescriptions at our office and transport
them yourself, we will ensure you have the proper
If you are currently having your oral oncology
packaging to maintain the drug quality, including
medications filled at another pharmacy and would
ice packs.
like for Texas Oncology to fill these for you, please
contact the Texas Oncology pharmacy location
nearest to you. Our pharmacy staff will check to | Prescription Delivery
make sure that we are able to fill these medications If you cannot pick up your prescription, we will
on your pharmacy benefits plan. If we can fill the deliver your oncology medication to your home or
prescription (at the same copay amount), we will call other preferred location allowed by law at no cost
your current pharmacy to obtain the information that to you. Upon request, we can also include other
would enable us to fill all future prescriptions for you. supplies. We coordinate all refills to ensure that
you or an adult caregiver is available to receive the
| Prescription Status shipment. A signature may or may not be required
for the delivery, but is available for each shipment.
At any time, you may reach out to our pharmacy
Medication that requires refrigeration is sent in
team and inquire about your prescription status
special packaging to maintain the appropriate
by phone, email, or text. When your prescription is
temperature. Once you receive the package, store
ready for pick up, we will email or call you directly
the medicine in the refrigerator. If the box looks
with the information you have provided.
damaged or is not in the correct temperature range,
please call us. In the event of an order delay, we
will contact you and assist you in obtaining the
medication elsewhere if necessary.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 17Emergency and Disaster
Preparedness Plan
Texas Oncology Pharmacy has a comprehensive 5. The pharmacy recommends all patients leave
emergency preparedness plan in case a disaster a secondary emergency number.
occurs. Disasters may include fire to our facility 6. If you have an immediate need for medication,
or region, chemical spills in the community, we will supply your needs on a priority basis.
hurricanes, snowstorms, tornadoes, and community We will provide you with enough supply to get
evacuations. In case of severe weather or other through the emergency, whenever possible.
disaster, our pharmacies work to ensure you
receive your prescription on time. Our primary goal If an emergency occurs and we are unable to
is to continue to service your prescription care reach you, and you are experiencing difficulties
needs. Every effort is made to coordinate care with administering or obtaining your medication, please go
local healthcare agencies, when needed. Texas to the nearest emergency room for help. If you have
Oncology Pharmacy’s procedures for ensuring a personal emergency, which is not environmental,
continuity of care in the event of a disaster include: and you need your medication, please contact the
pharmacy at your convenience, and we will aid you.
1. The pharmacy will call you three to five days
before an anticipated local weather disaster To make sure an emergency does not negatively
emergency utilizing the weather updates impact your prescription needs, you should take the
as point of reference. If you are not in the following precautionary measures:
pharmacy local area but reside in a location
that will experience a weather disaster, you • Whenever possible, keep a two- to three-
are responsible for calling the pharmacy three day supply of your medication on hand and
to five days before the occurrence. a back-up power supply for your medical
equipment and/or supplies.
2. The pharmacy will send your medication via
courier, FedEx, or UPS next day delivery during • Make sure we have accurate contact
any suspected inclement weather emergencies. information, including your emergency contacts.
3. In the event our pharmacy location is forced to • In case of an emergency, seek medical attention
close because of an emergency, your services at an area hospital or by calling 911.
will be coordinated with an alternate Texas
Oncology Pharmacy branch or local pharmacy. • If traveling by air, be sure to keep a supply
of your needed medications on your person
4. If a local disaster occurs and the pharmacy
in the event there is a delay in receiving
cannot reach you, or you cannot reach
checked luggage.
the pharmacy, please listen to your local
news and rescue centers for advice on
Remember that preparation is key when facing
obtaining medication. Visit your local hospital
emergencies – please be safe.
immediately if you will miss a dose.
18 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2Storage and Handling
of Medication
During and after cancer treatment, people may have one or more medications to take at home.
These powerful medications can be very harmful if someone other than the person with cancer takes
them. Therefore, you and your caregivers need to know the safest ways to store and dispose of specific
medications.
The following are general guidelines for the storage and handling of your medication from Texas Oncology
Pharmacy. More specific information may be available at the time of dispense.
| General Storage Tips
Consider storing your medications separately from those of your other family members. You could keep
them on a different shelf or in a different cabinet or drawer.
• Store your prescriptions in a safe, cool, • Store your medications in the container it
dry place. came in. This helps you know which one is
which and keeps the information about how
• Your prescriptions should be out of the sight
often to take it right at your fingertips. Always
and reach of children and/or pets. Consider
keep the lid tightly closed.
using child-proof features on lids, if possible.
• Save and organize the information leaflets the
• Keep all your medications in a place with
pharmacy gives you with your prescriptions.
good lighting so you can read the label and
These documents remind you when and how
take the correct amount.
to take your medication, about any storage
directions, and what potential side effects you
may experience.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 19Storage and Handling of Medication
Continued
| Storing Pain Management Medication from the patches can be absorbed even after the
patches have already been used.
People diagnosed with cancer often experience
pain, either from the cancer itself or as a side effect • Only share details about your prescription(s) with
of treatment. As a result, managing and treating your caregiver or others who need to know.
pain is an important part of a person’s overall
treatment plan. This may involve the use of pain-
relief medications called analgesics. Some people | Special Handling of Oral Chemotherapy
with moderate to severe pain may use opioids, Many chemotherapy drugs are now taken by mouth
also known as narcotics. as take-home prescriptions. Although this is more
convenient, you must consider several important aspects:
Although these drugs effectively relieve cancer
pain, opioids are dangerous if a family member or • Store all chemotherapy drugs in its original
pet swallows them. And, people who abuse drugs container, in a safe place, and away from all
may seek them out. Therefore, take additional other medications. Always keep medications out
steps to store your opioid pain medication safely of the reach of children and/or pets.
and securely:
• Most oral chemotherapy should be stored at
• Always store pain medication in a bottle with room temperature, away from heat, moisture,
a child-resistant lid. and direct sunlight. This means you should not
place chemotherapy on a windowsill, near a sink,
• Keep all your opioid medication in one or in a bathroom.
location where a pet, child, teenager, or
stranger cannot easily see it or access it. • Some types of chemotherapy require special
storage or handling, such as refrigeration.
• Consider storing your pain medication in
a secure lockbox that only you and your • Ask your doctor or pharmacist how to store your
caregivers can access. Some people have medication. If you use a pill box or other type of
safes to secure cash, documents, or firearms, medication organizer, keep one for chemotherapy
and those can be used, as well. and one for any other medication(s). Clearly label
both boxes.
• If your doctor prescribes a fentanyl skin patch,
make sure that you keep even used patches • Keep the local poison control center’s telephone
away from others. After using a patch, fold it in number handy in case a pet, child, or other
half to seal the sticky parts and safely dispose member of your household accidentally swallows
of it (see below). These patches can get stuck the medication.
on the feet and skin of children and pets if
• The national number, which will route you
not disposed of properly. Opioid medication
to the local center based on your area code,
is 800-222-1222.
20 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2| Handling Body Fluids and Waste
Many oral chemotherapy drugs remain in your body for several days after being taken, so some of the
drug may be present in urine, stool, sweat, or vomit. Once you have started to take oral chemotherapy,
it is important to follow the instructions below every day for as long as your treatment lasts. This will
keep yourself, loved ones, and the environment as safe as possible.
• Pregnant women should avoid touching • If you do not have good control of bladder
anything that may be soiled with body fluids or bowels, use a disposable pad with a
from the patient. plastic back, a diaper, or a sheet to absorb
body waste.
• You may use the same toilet, septic tank, and/
or sewer that you usually use. If you have a • Wash any skin that has been exposed to body
low-flow toilet, close the lid and flush twice to waste or any oral chemotherapy drug with
ensure all waste has been discarded. soap and water.
• If the toilet or toilet seat becomes soiled • Linens or clothing that are soiled with body
with urine, stool, or vomit, clean the surfaces fluids or body waste should be washed
before other people use the toilet. separately from other linens and clothing. If you
do not have a washer, place the soiled linens in
• Wash hands with soap and water after using
a plastic bag until they can be washed.
the toilet. If you need a bedpan, be sure your
caregiver knows to wear gloves to assist with • Wash hands with soap and water after
cleanup and to wash the bedpan with soap touching linens or clothing that may be soiled
and water every day. with body fluids.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 21Disposal
of Medication
Medications are important for treating many DON’T: Flush expired or unwanted medications
conditions and diseases; however, they may be down the toilet or drain unless the label specifically
harmful if taken by someone that does not need instructs you to do so.
them. To avoid accidental exposure or intentional
DO: Return unwanted or expired medications to
misuse of prescription and over the counter drugs,
a drug take-back program or follow the steps for
it is important you dispose of them properly.
household disposal outlined in this packet.
| General Medication Disposal *Source: Information provided by the Texas
Expired or unwanted prescription or over the counter Commission on Environmental Quality.
medications should never be flushed down the
toilet or a drain. Doing so can cause contamination | Pain Medication Disposal
because Texas’s wastewater treatment systems are It is illegal for your healthcare team to personally
not designed to remove pharmaceuticals from water. accept returned opioid pain medication. Many law
enforcement agencies, such as police and sheriff’s
Household Disposal Steps* departments maintain drop boxes for disposal of
If no disposal instructions are provided on the unused pain medicines in their stations. The DEA
medication’s label and no drug take-back program maintains a website where you can search for the
is available in your area, follow the recommended nearest public disposal location.
steps below to safely dispose of your medication: The U.S. Food and Drug Administration (FDA)
1. Keep in the original container. recommends that some opioid medications be
flushed down the toilet. But some communities
2. Mark out your name and the prescription number.
have rules and restrictions against this. When in
3. For tablets or capsules: doubt, check with your local water treatment and/
add water or soda to dissolve them. or sanitation department.
For liquids:
Add something inedible, such as dirt or cat litter. For more information or to locate eco-friendly and
safe options for medication disposal in your local
4. Close the lid and secure with duct or
area, visit www.DisposeMyMeds.org.
packaging tape.
5. Place container in a non-see-through
container, like a coffee can or soup can.
6. Tape that container closed.
7. Place container in the trash. Do not put in
the recycle bin.
22 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2What You Need to Know
About Oral Chemotherapy
Learning how to manage your oral chemotherapy might feel challenging - especially at first - but
understanding what to expect can help you take charge of your health. We want to help you get the most
from your treatment. The following discusses how staying on track with your medication therapy and lifestyle
changes can help you live a full and active life.
| Staying on Track with Treatment | Know What Your Medication Looks Like
Oral chemotherapy drugs are used to slow the Make sure you are taking the right amount of
growth of cancer or kill cancer cells. Your doctor the proper medication. This is very important if
has prescribed your medication because it is the you take different medications at different times
best choice for your treatment, but you must take of day. Many cancer drugs come in different
your medication as prescribed – at the right times strengths. Some people need to take two different
and the correct doses. Certain things might make it strengths at the same time. Taking the wrong
feel hard to stay on track with treatment, such as: strength could result in taking too much of a
medication (overdose) or too little (underdose).
• A complex medication schedule that might
Different strengths of the same drug can differ in
involve taking 10, 20, or more tablets or
the following ways:
capsules a day
• Color
• Combination therapy with multiple types of
medications • Letters
• Side effects, like fatigue and nausea, which • Shape
can affect everyday life and make it hard to
• Size, words, or numbers printed on the tablet
get into a regular treatment routine
or capsule
Even after the first few weeks of treatment, it might be
hard to stay motivated. The benefits might seem like
Look carefully at your medication as you
they’re too far in the future as you deal with side effects
are about to take it. Be mindful of what you
and inconvenience in the present. Some people decide
are doing. This can help you be sure you are
on their own to cut back their dose. Others decide to
taking the right medication at the right time.
take a “break” for weeks or even months at a time.
This is especially important if your doctor
But doing this can affect the success of treatment.
changes your medication dose or schedule.
If your treatment routine starts to feel too hard, ask
your doctor, nurse, or pharmacist for help managing
your medications. Do not stop taking your medications
without asking your doctor first. Staying on track with
treatment is important to improving your health.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 23What You Need to Know About Oral Chemotherapy
Continued
| Know How to Take Your Medication How to Swallow Your Medication
This should be the easy part, right? You just Many oral medications should not be broken, cut,
swallow the medication, usually with water. While or crushed. This can make some drugs ineffective
that’s true, it also matters when you take it and or create inaccurate doses. Be especially careful if
what else, if anything, you take along with it. capsules are accidentally opened or damaged. The
contents of some oral chemotherapy capsules should
When to Take Your Medication not touch your skin or mucous membranes, including
nasal passages, because they can be very irritating.
Many oral chemotherapy drugs are taken at the
Ask your doctor or pharmacist if this precaution
same time every day. Others are taken on schedules
applies to your medication.
that can change from week to week. Be sure you
know your medication schedules. This lowers the Most oral chemotherapy drugs should be
risk of forgetting a dose. It also helps ensure the swallowed whole with water unless your doctor has
most benefit from the medication. told you otherwise. If you find it hard to swallow
tablets or capsules, the following tips might help:
• Be aware that you might need to wait a
certain number of hours between doses of • Place the tablet or capsule on the tip of your
certain medications. tongue. Drink some water. Tilt your head back
and swallow.
• Try taking your medication at the same time
as other routine tasks. For example, for • If that doesn’t work, place it on the back of
medications you must take in the evening, your tongue. Drink some water. Tilt your chin
plan to take them after brushing your teeth down toward your chest and swallow.
or as you get ready for bed. This might make
you less likely to forget a dose. • Take a deep breath before placing the
medication in your mouth. This can help stop
• Set an alarm to remind yourself to take your the gag reflex.
medication, both at home and away from home.
• Always sit up straight when swallowing
medications.
• Drink a whole glass of water while
swallowing your medication.
If your medication may be taken with food, try
taking it with a soft food like applesauce, yogurt,
or pudding. Soft foods can be easier to swallow
than liquids. If these techniques don’t help, tell your
doctor, nurse, or pharmacist.
24 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2What to Take with Your Medication? Know What to Do if You Miss a Dose
You should know if you may take your medication You should know what to do if you forget to take
with food. Some oral chemotherapy drugs should your medication, forget if you took your most recent
be taken with food, while others should be taken on dose, or throw up soon after taking a dose.
an empty stomach, and other drugs are not affected
Be prepared. Ask your doctor or pharmacist in
by food at all. Here are some points to remember:
advance what you should do if you miss a dose.
• Taking certain medications with food can Find out when to tell your doctor about missed
reduce the risk of side effects. doses. With some drugs, you might need to tell your
doctor if you miss even just one dose.
• For other medications, food can increase the
chance of side effects. Don’t simply skip a dose or take a double dose
to “catch up” if something like this happens. If
• A full stomach might affect how well the body
you aren’t sure what to do, call your doctor or
absorbs medication.
pharmacist right away.
• In most cases, taking a drug without food
means taking it either one hour before or two
hours after a meal.
• Grapefruit can affect how some drugs work.
You might need to avoid grapefruit products
while taking certain drugs.
• Other medications, including over the counter,
herbal supplements, and vitamins, can
interact with your medication. Please tell your
doctor and/or pharmacist everything that you
are taking.
Ask your doctor or pharmacist if any of these apply
to your medication.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 25What You Need to Know About Oral Chemotherapy
Continued
Make it Easy to Remember to Take Your Medication
There are many ways to remind yourself to take your medication. Find ways that work for you and your
schedule. Adjust them to suit your lifestyle.
Organize Your Medications Use Alarms and Alerts
• Use a daily medication box (pill box) to • Set an alarm on a clock, watch, or cellphone
organize your medication. A pill box can help to remind yourself to take your medication.
you see each dose and remember if you have
• Some pill boxes have built-in alarms.
taken your medication for a particular day and
time. Do this only if your medication does not • Use a computer to set up a daily calendar
need to stay in its original container and does alert or an email reminder.
not need special handling. All prescription
drugs have information about how they should • Use a medication reminder app to receive
be kept. Read and follow the storage and alerts on a smartphone or tablet.
handling requirements for your medication so • If needed, enlist the assistance of a caregiver
your medications remain safe to take. to provide reminders.
• If you take medications at different times
each day, choose a pill box with extra Write it Down
dividers for morning, evening, bedtime, • Write your medication schedule on a calendar
or hourly doses. near your medications.
• Never put your medication in an unlabeled bottle • List each medication and when to take it.
or combine different medications in a single
bottle. Even if you know what your medication • Include your medication on a daily to-do list.
looks like, it’s easy to make mistakes. Check it off when you have taken it.
• Carry an extra dose of each medication with Stay on Schedule When Traveling
you in case you misplace your medication box
• Pack extra medication and bring reminders
or are away from home longer than expected.
with you.
• Use alarms, instead of daily habits or chores,
to remind you to take your medication.
• If you are crossing time zones, ask your
doctor if you need to adjust your medication
schedule.
26 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2| Pregnancy, Breastfeeding, Sexual Activity, and Contraception
• Some cancer drugs can cause birth defects. It is important to use birth control as directed to prevent
pregnancy. This applies to men and women receiving treatment. The type of birth control to use will
depend on your individual situation. Ask your doctor which form of birth control is best for you.
• A woman who is already pregnant when receiving a cancer diagnosis should discuss treatment
options with her doctor. In some cases, treatment might be possible during certain stages of
pregnancy. In other cases, it might be necessary to wait until after the baby is born.
• Many cancer drugs can pass into breast milk. They should not be taken while breastfeeding.
This can be harmful to a baby. Ask your doctor when you can safely begin or resume
breastfeeding after chemotherapy.
• Women should not become pregnant, and men should not get a partner pregnant while taking
oral chemotherapy. Men and women of childbearing age and potential should use effective
contraception during therapy and for a minimum of eight weeks after the last dose of everolimus.
• Effective contraception could include one or more of the following: oral contraceptive,
barrier methods, etc.
• It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral
chemotherapy, and you are encouraged to ask your care provider.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 27Coping with
Side Effects
Some people don’t start taking their medication when they should.
Some skip doses because they are tired, don’t feel well, or are trying to
avoid side effects. Others have depression, anxiety, or lack of energy that
prevent them from taking their medication. If you are having challenges
like these, talk with your doctor, nurse, or pharmacist. Your healthcare
team can help, no matter how far off track you think you might be.
Many people worry about the side effects of cancer drugs. These
concerns might make it hard to stay on track with your treatment. Try
to have realistic expectations about how you will feel during treatment.
• If you already have had other types of chemotherapy, you
might have certain expectations based on that experience.
• Your current treatment could have fewer or less severe side
effects than past treatments. It might have different side
effects. Do not think of oral chemotherapy as “more of the
same” chemotherapy.
• Learn as much as you can about your medication’s side
effects. Find tips on how to deal with them. This can help you
get through your treatment.
Oral chemotherapy can have many side effects. These might include:
• Diarrhea
• Fatigue
• Nausea and vomiting
• Skin reactions
You might not have any of these side effects, but you might have
others. Your Texas Oncology team is the best source of information
about side effects and your health.
28 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2| Diarrhea | Choose Foods That Are Easy to Digest
Chemotherapy can affect the cells lining the If a clear liquid diet improves your diarrhea, you
intestine. This can lead to diarrhea. Loose or watery should be able to ease back into solid foods. Try
bowel movements can affect how you feel. They foods that are easy to digest, such as bananas,
can also dehydrate your body. In severe cases, rice, applesauce, and dry toast. This is often called
your doctor might prescribe antidiarrheal drugs. the BRAT diet. Other foods that are easy to digest
Don’t take any over the counter (OTC) products include mashed potatoes and yogurt (if dairy is
for diarrhea without asking your doctor. Changing tolerated). If your diarrhea continues to improve
your diet could reduce diarrhea. This might mean after a day or two on a BRAT diet, you might be able
following a brief diet of clear liquids or foods that to begin trying small, regular meals.
are easy to digest while staying away from other
foods. Small changes can help keep diarrhea from Avoid Foods and Drinks That Can
getting worse. Ask your doctor or nurse if changing Worsen Diarrhea
your diet might help you.
Many foods and drinks can irritate a touchy
digestive system and make diarrhea worse. You
Follow a Clear Liquid Diet might need to avoid some foods, such as:
Even when you do not feel like eating, it is
• Acidic drinks like tomato juice, citrus juices,
important to replace fluids lost through diarrhea.
and fizzy soft drinks
Trying a liquid diet for a short time might help.
• Alcohol, including beer, wine, and mixed drinks
1. Choose clear, caffeine-free, and alcohol-free
liquids like these: • Caffeinated drinks like coffee, tea, colas, and
› Apple juice, peach, or apricot nectar energy drinks
› Clear broth
• Greasy, fried, or spicy foods
› Ginger ale
› Ice pops or gelatin desserts • High-fiber foods like bran and raw fruits and
› Sports drinks with electrolytes vegetables
› Water
• Milk or milk products if they make diarrhea worse
› Weak, decaffeinated tea
2. Drink these liquids at room temperature. Let • Nuts
carbonated drinks lose their fizz before drinking • Sweets such as pastries, candy, or preserves
them. This makes them easier on the stomach.
3. Sip liquids throughout the day. Do not try to
drink a lot at one time.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 29Coping with Side Effects
Continued
When to Call the Doctor Fatigue can make you feel exhausted. It can also
The American Cancer Society recommends calling cause the following symptoms:
your doctor if you have any of the following: • Lack of energy
• Loose bowel movements several times a • Sleeping more
day or for one to four days, depending on
instructions given when treatment starts • Tiredness, even after sleeping
• Anal bleeding or blood in the stool • Trouble concentrating or feeling motivated
• New belly pain or cramps or a swollen belly • Trouble doing everyday things, like showering
• No urinating for 12 hours or more Feeling fatigued does not necessarily mean your cancer
is getting worse or that your treatment is not working.
• No ability to drink fluids for 24 hours or more
And it is not a sign of weakness or a lack of willpower
• A fever of a certain level when taken by or determination. Fatigue can affect your quality of life.
mouth, as instructed when treatment starts For some, it can affect the ability to work, care for a
family, or receive treatment. Only you know how much
• Constipation for many days followed by small it is affecting you. Managing it can help you have the
amounts of diarrhea or oozing of liquid stool energy you need for daily activities and treatment.
Always follow your doctor’s instructions about when Tell your doctor about your fatigue. Your doctor
to call with your concerns. might ask you some questions, such as:
• When did the fatigue first start?
Fatigue
Fatigue is extreme tiredness. It can happen from • When did you first notice that this fatigue is
time to time. It can also happen more regularly over different?
a long period of time. It is the most common side › How long has it lasted?
effect of cancer treatment. It can also be caused by › Does anything make it better? Worse?
other things, including: › Are there times of day that you notice
• Anemia, or low red blood cell count it more?
› How has the fatigue affected the things
• Dehydration, or extreme loss of body fluids you do every day or the activities that
• Infection give meaning and enjoyment to your life?
• Pain Your doctor might also check for other causes, like
anemia or thyroid problems. The following tips can
• Poor sleep help you manage fatigue and feel better overall.
30 TEXAS ONCOLOGY PHARMACY | U P D AT E D : 0 1 / 1 0 / 2 0 2 2Stay Active Prioritize Tasks
When you are less active, you often feel more tired. Careful planning can help you work around your
Exercise can help control fatigue and restore your fatigue.
energy. It might also help you sleep better and
• Do the most difficult or most important tasks
improve your appetite.
when you have the most energy. For some,
• Talk to your doctor about how much activity is this might be first thing in the morning. For
right for you. others, it might be in the afternoon.
• Choose activities you enjoy. • Look at your to-do list. Skip anything that
isn’t truly necessary.
• Try gentle activities, like walking or bicycling.
• Break large tasks into smaller ones.
• A physical therapist might be able to help you
design an exercise program. • If possible, consider cutting back on work hours.
• Balance activity with rest.
Ask for Help
Eat Well Though it might feel difficult at first, it is vital to ask
others for help. Do not be embarrassed. Your family and
Fighting cancer affects how your body changes
friends want you to be well and are often willing to help.
food into energy. The cancer is competing with
They might be able to help with many things, including:
the rest of your body for nutrients at a time when
you might feel like eating less. It is easy to see • Grocery shopping and meal preparation
how poor nutrition can contribute to fatigue during
• Rides to and from medical appointments
treatment. It is vital to find ways to keep a balanced
diet that meets your body’s needs. • Housework, yard work, or childcare
• Try to have protein, fiber, and fat at each meal.
• Avoid sugary foods. They might give you an
initial jolt of energy but leave you tired later.
• Drink plenty of caffeine-free fluids.
• Ask your doctor or a dietitian to help you build
a diet to fight fatigue.
• Ask your doctor if you should take a
multivitamin.
Patient Welcome Packet | U P D AT E D : 0 1 / 1 0 / 2 0 2 2 31You can also read
