The Importance of Taking Your Pills on Schedule

Understanding Adherence

Asking questions at the time you are prescribed a new medicine will help you get the most from your treatment. It can also help open the lines of communication with your health care team.

Following are a few questions that you can ask. There are likely others, based on your specific situation. Ask your doctor to share any other guidance they may have. Make a note of your doctor’s answers and advice in your journal or on a tablet or smartphone.

How does this pill work? As an educated consumer, having a basic understanding of the pill’s “mechanism of action” (the way it works) is good information to have. This knowledge may also contribute to your maintaining a high level of adherence.

How should I take this pill? Some pills should be taken with food, while others work better if taken on an empty stomach. Some pills may need to be taken with a certain amount of liquid, or they may be most effective if taken at a specific time of day.

What are the possible side effects of this medicine? All cancer treatments can cause side effects. Ask your doctor or health care team about the possible side effects you may experience, and their potential seriousness.

What should I do if I miss a dose? Even with all of your best efforts, you may occasionally forget to take your pill on time. At the time your medicine is prescribed, ask your doctor what you should do if this happens.

Can I still take my other medicine? Make sure your doctor has a list of all of the pills you are taking, including over-the-counter medication, vitamins and supplements. They may recommend a change or adjustment. Your doctor can also provide guidance on how to “space” your pills throughout the day.

Should I change my diet? Ask if there are any specific foods, drinks or spices that you should avoid or limit while taking your cancer medicine. Also ask if there is any particular type of diet plan that would be beneficial for you to follow.

After your initial discussion with your doctor, be sure to contact a member of your health care team if anything is unclear or if you need additional information. They want to be of help to you.

Your doctor and other members of your health care team understand that you may face obstacles affecting your ability to adhere to your medication schedule. With their guidance and the following tips, you should be able to stay on schedule with your medication.

• Ask your doctor if it’s appropriate for you to be prescribed a 60- or 90-day supply of pills, which minimizes the risk of your running out of medication.

• Set an alarm on your watch, smartphone or computer to remind you when it’s time to take your pill. You could also try a medication reminder app. There are a number of free and highly-rated apps that can be easily found by a quick internet search. (A low-tech approach could be as simple as keeping a running list of the date and time each pill was taken.)

• Note the date you will need to refill your prescription (a few days before you run out of pills) and put a reminder wherever you are sure to see it.

• When you pick up a new supply of pills, check the label for the number of refills that remain on your prescription. If there are zero refills, call your doctor’s office to renew your prescription (or ask your pharmacy to do that for you).

• Sign up for any reminder services that your pharmacy offers. Many pharmacies will send you text messages and/or place automated calls when a refill or renewal is due.

• Consider using your insurance company’s mail service pharmacy. You can receive convenient home delivery if your specific medication is part of this service, often in supply amounts larger than 30 days.

A few words about pill sorters: Many people use a pill sorter (available for purchase at drug stores and online) to sort all or some of the pills they take. Before doing so, ask a member of your health care team if there is any concern with your cancer medication being taken out of its original bottle or packaging. Also ask if it poses any problems for your cancer medication to be stored in the same pill sorter as your other pills.

All cancer treatments can cause side effects. It’s important that you report any side effects you experience to your health care team so they can help you manage them. Report them right away—don’t wait for your next appointment. Early reporting can help improve your quality of life and allow you to stick with your treatment plan.

This section provides tips and guidance on how to manage certain common side effects should they occur.

Managing Digestive Tract Symptoms

Nausea and vomiting

• Eat small, frequent meals.

• Avoid food with strong odors, as well as overly sweet, greasy, fried or highly seasoned food.

• Having something in your stomach when you take medication may help ease nausea.

• Do not lie down within two hours after eating.

Diarrhea

• Drink plenty of water. Ask your doctor about using drinks such as Gatorade, which provide electrolytes. Electrolytes are body salts that must stay in balance for cells to work properly.

• Over-the-counter medicines such as loperamide (Imodium A-D and others) and prescription drugs are available for diarrhea but should be used only if necessary and with your health care team’s guidance. If the diarrhea is bad enough that you need medicine, contact a member of your health care team.

• Choose foods that contain soluble fiber, like whole grain products, oat cereals and flaxseed, and high-pectin foods such as peaches, apples, oranges, bananas and apricots.

• Avoid beans, as they can cause gas and worsen diarrhea.

• Avoid food high in refined sugar and those sweetened with sugar alcohols such as sorbitol and mannitol.

Loss of appetite

• Eating small meals throughout the day is an easy way to take in more protein and calories, which will help maintain your weight. Try to include protein in every meal. Nutrition shakes or protein drinks are a way to add calories to your daily diet.

• To keep from feeling full early, avoid liquids with meals or take only small sips (unless you need liquids to help swallow). Drink most of your liquids between meals.

• Keep high-calorie, high-protein snacks on hand such as hard-boiled eggs, peanut butter, cheese, ice cream, granola bars, liquid nutritional supplements, puddings, nuts, canned tuna and trail mix.

• If you are struggling to maintain your appetite or weight, talk to your health care team about a referral to a dietician or nutritionist who has specialist-level oncology knowledge. You can also ask your doctor whether appetite-building medication could be right for you.

Managing Pain

There are a number of options for pain relief, including prescription and over-the-counter medications. It’s important to talk to a member of your health care team before taking any over-the-counter medication to determine if it is safe and will not interfere with your treatment. Many pain medications can lead to constipation. Your doctor can recommend over-the-counter or prescription medications that help to avoid or manage constipation.

Physical therapy, acupuncture, progressive muscle relaxation exercises and massage may also be of help in managing your pain. Consult with a member of your health care team before beginning any of these activities.

Managing Fatigue

Fatigue (extreme tiredness not helped by sleep) is one of the most common side effects of cancer and many cancer treatments. If you are very fatigued while on treatment, your doctor may change the dose or schedule of the drug(s) you are taking, as long as that does not make the treatment less effective. If you are experiencing fatigue, talk to your doctor about whether a dose change is right for you.

There are a number of other tips for reducing fatigue:

• Take several short naps or breaks during the day.

• Take walks or do some light exercise, if possible.

• Try easier or shorter versions of the activities you enjoy.

• Ask your family or friends to help you with tasks you find difficult or tiring. There are also prescription medications that may help. Your health care team can provide guidance on whether medication is the right approach for your individual circumstances.

Frequently Asked Questions

Q: I have trouble swallowing pills. Do you have any advice for me?

A: Here are a few tips that might help if you have difficulty swallowing pills. One or more of these tips might work well for you. Check with a member of your health care team before trying any of these techniques. They may also have additional suggestions.

• As you prepare to take your pill, breathe deeply a few times to relax your throat muscles.

• If your difficulty swallowing pills is caused by a high gag reflex, try spraying the back of your throat with a numbing spray before you take your pill.

• Take a drink of water before placing the pill on your tongue.

• Think “food” rather than “pill” as you prepare to swallow. This might help keep your throat from tightening.

• Try taking your pill with a soft solid—like yogurt, pudding or applesauce—instead of water. The texture of these foods can make pills easier to swallow.

Q: What guidance do you have about travel?

A: Following is some general guidance related to travel. Ask a member of your health care team if they have any advice that is specific to your individual circumstances.

• Read the information that came with your prescription (or check with a member of your health care team) to determine the optimal temperature range of your medication. Ask your health care team if you should pack your pills in some specific way, such as in an insulated medication travel bag.

• Take extra pills with you in case your return is delayed.

• In case you experience a medical issue while away, it’s helpful to have a list of all your current medications with you, including over-the-counter medicines, vitamins and supplements. That list should include both the generic and brand names of your medications.

• If your trip involves air travel, keep your medication with you in your carry-on bag. Wherever possible, keep the pills in their original container with the prescription label attached.

• For short trips to a different time zone, take your medication according to your “body clock” (your home time zone). For trips of more than a day or two, switch over to the time zone of your destination.

Q: What is a treatment summary and why is important?

A: Keeping your own records up-to-date in the form of a treatment summary can be helpful, as it allows you and your family members to have instant access to the specifics of your cancer diagnosis and treatment. A treatment summary should include:

• Your name and date of birth
• Date of diagnosis
• Prescribed therapy/therapies, including dates started and stopped and dosages when appropriate
• Dates and types of baseline and post-diagnosis testing and the results of these tests
• Other medications and supplements you are taking
• Names, affiliations and contact information of all members of your health care team

Ask the members of your health care team what they suggest be included. Take your personal record with you when you visit any doctor, not just your oncologist.