Traveling with Chemotherapy
Lisa A. Thompson, PharmD BCOP
Clinical Pharmacy Specialist in Oncology
Kaiser Permanente Colorado
Lafayette, CO
Oral chemotherapy medications increasingly are used in the treatment of cancer, and many of these medications are taken on a continuous basis for extended durations.1 Pharmacists frequently receive questions about traveling with medications, and these issues are especially relevant to patients receiving oral chemotherapy.
General Considerations
Although pill organizers may be helpful to improve adherence, it is recommended that medications be stored in their original, pharmacy-labeled container when patients are traveling, in order to facilitate identification of these as prescription medications.2
If taking an oral chemotherapy medication that must be refrigerated, patients should use a cooler or cold packs, with the medication itself stored in a manner that protects it from exposure to water (such as placing the prescription bottle in a waterproof container). Many hotels can provide an in-room refrigerator if needed; however, patients should contact the hotel in advance to confirm availability.
Patients with travel plans frequently ask about dose timing when in different time zones. Patients traveling across multiple time zones may need to adjust the timing of their medication administration, taking into account the duration of their trip and their travel itinerary. For example, a patient traveling from Chicago to Berlin would need to account for a 7-hour time difference. If the patient typically takes his or her medication at 7 am and 7 pm in Chicago, he or she may choose to take the medication at 2 pm and 2 am in Berlin. Patients doing this may find it helpful to set a reminder alarm to prevent missed doses. Other patients may prefer to gradually adjust their dosage time before their trip. This is typically accomplished by taking the medication 1–2 hours earlier or later each day until the timing fits with their schedule in the destination city. Patients doing this should perform the gradual timing adjustment in reverse upon their return. Those taking oral chemotherapy medications should also travel with water and snacks if the medication should be taken with food, in order to prevent any delays in administration while traveling.
Another important consideration relates to medication supply. In general, it is recommended that patients travel with enough medication for their planned trip and with additional supply to account for possible delays in their return. Given the high cost of many oral chemotherapy medications and differences in regulatory approval between countries, patients should not assume that they will be able to purchase their oral chemotherapy medication at their destination. Therefore, patients should work with their oncologist and prescription insurance provider to obtain a sufficient supply before their trip.
Air Travel
Patients traveling by air should plan for some additional considerations, including location of their medication during travel and Transportation Security Administration (TSA) screening. Patients should pack their medications in their carry-on luggage to ensure that they have access to them in the event of lost checked baggage or flight delays. This also reduces the medication’s exposure to temperature extremes on the runway and in flight.
As with other carry-on items, medications must undergo TSA screening. Liquid or topical medications are exempt from the “3-1-1 Liquids” rule; however, travelers should separate these items and inform TSA officers of their presence before beginning screening.2 Travelers should present liquid medications in excess of 3.4 ounces to TSA officers separately for screening. Medications stored at refrigerated temperatures may be transported with cold packs as long as they are identified to the TSA officers during the screening process.
Although no harmful effects of consuming medications that have passed through X-ray security scanners are known,3 no information is available about the impact of these on medication integrity, and some passengers may prefer to have their medications screened using alternate screening procedures. This typically involves inspection by a TSA officer, which may be performed on request. Patients traveling with liquid medications or requesting alternate screening procedures should allow additional time for security screening.
Automobile Travel
Patients traveling by car should take extra care to ensure that their medication stays at an appropriate temperature. Medications that need refrigeration should be transported in a cooler. Patients also should use caution with medications that are stored at room temperature because the temperature in a parked automobile can fluctuate greatly in a short period of time. In general, patients should keep these medications on their person to prevent exposure to extreme heat or cold.
International Travel
Each country has unique requirements regarding traveling with medications and declaration of these upon entry. For instance, patients traveling to England may need to provide a signed letter from their prescribers listing their name, medications, and travel plans.4 Because of these variations, patients traveling internationally should research the requirements for their destination(s) well in advance of their planned travel. In general, it is recommended that patients travel with their medications in the original containers and obtain a recent prescription or provider’s note that includes the medication’s generic name and reason for use.5
Although international treaties do not allow for travelers taking narcotics or other controlled substances to travel with a supply for personal use,6 patients likely will need to complete some additional preparation prior to their travel. Depending on the laws and regulations of the destination country, patients may or may not need to present their controlled substances at border control, travel with prescriber documentation, or obtain a permit or certificate from their destination country.
With the increasing use of oral chemotherapy, more patients with cancer are traveling with these medications. Pharmacists play a crucial role in educating patients; facilitating communication between the patient, providers, and insurers; and optimizing adherence during travel.
References
1. Conti RM, Fein AJ, Bhatta SS. National trends in spending on and use of oral oncologics, first quarter 2006 through third quarter 2011. Health Aff (Millwood) 2014;33(10):1721-1727.
2. Transportation Security Administration. Special procedures: disabilities and medical conditions. Retrieved from www.tsa.gov/travel/special-procedures. Accessed September 2016.
3. U.S. Food and Drug Administration. Frequently asked questions on cabinet X-ray systems. Retrieved from www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/SecuritySystems/ucm116421.htm. Accessed September 2016.
4. Drug and Firearms Licensing Unit. Travelling with controlled drugs. Retrieved from www.gov.uk/travelling-controlled-drugs. Accessed August 2016.
5. U.S. Department of State Bureau of Diplomatic Security: Overseas Security Advisory Council. Traveling with medication. Retrieved from www.osac.gov/pages/ContentReportDetails.aspx?cid=17386. Accessed August 2016.
6. International Narcotics Control Board. International guidelines for national regulations concerning travellers under treatment with internationally controlled drugs. Retrieved from www.incb.org/incb/en/psychotropic-substances/travellers_guidelines.html. Accessed August 2016.