Current practices around the use of oral chemotherapy in US cancer centres need to be improved, according to researchers from Boston. Common malignancies can be treated with oral chemotherapy - and the researchers set out to analyse the guidelines and practices used by comprehensive cancer centres for the provision of oral chemotherapy.

Variations in practice emerged in the prescribing methods, consent requests and the coordination and monitoring of treatment. They found that few of the safeguards which are routinely used for infusion chemotherapy were adopted for oral chemotherapy treatment. Most of the 42 organisations which took part in the study had no required elements for prescribing oral chemotherapy and few requested patients' written consent for off protocol prescribing.

Only one in three organisations required a clinician to note the body surface area or calculation of dose on the prescription, and only one in four required the patients' diagnosis or protocol. Nearly a quarter of the centres had no formal process for monitoring patients' adherence.

The authors conclude that “prescribing, monitoring and coordination, pharmacy practices and education of patients for oral chemotherapy vary substantially. Despite clinicians' concerns about oral chemotherapies, there is no apparent consensus among oncology professionals about safe practices for these drugs. The oncology community must define safe medication practices appropriate for oral chemotherapy, develop practice guidelines and accelerate their adoption.” The study is published online at www.bmj.com.