article · Journal of Oncology Pharmacy Practice
Swallowing difficulties frequently affect older cancer patients, complicating the safe administration of oral anticancer treatments. To manage these difficulties, tablets are often crushed or capsules opened. These manipulation practices can compromise medicine stability, bioavailability, pharmacokinetics, and clinical efficacy, creating significant risks because oral anticancer therapies typically have narrow therapeutic windows. Such handling also exposes healthcare workers, caregivers, and domestic environments to hazardous substances. There is currently an absence of standardised administration procedures, and clinical evidence guiding alternative delivery methods remains scarce across various oncology medications. Emerging pharmaceutical formulations, such as orodispersible tablets, dispersible systems, multiparticulate designs, mini-tablets, and three-dimensional printed medicines, present potential alternatives to reduce improper manipulation and enhance treatment acceptability. Addressing these issues requires patient-centred drug design, standardised clinical guidance, and multidisciplinary collaboration.
Cancer therapies often rely on precise dosing and carry toxic risks. When older patients cannot swallow solid tablets, informal modifications can alter drug effectiveness or endanger family members and carers through toxic exposure. Understanding these challenges highlights the need for safer clinical protocols and modern pharmaceutical formulations tailored to the physical needs of ageing populations.
The review highlights market and development opportunities for pharmaceutical manufacturers and formulation technologists developing geriatric-friendly oncology treatments. Relevant applications include dispersible or orodispersible tablets, multiparticulate formulations, mini-tablets, and three-dimensional printed medicines designed to avoid manual drug manipulation. Because the abstract discusses these formulation approaches as emerging concepts alongside gaps in standardised evidence, the technology is at an early to intermediate stage of pharmaceutical research and development.
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ObjectiveTo review the challenges associated with oral anticancer drug administration in older adults, focusing on dysphagia, dosage-form manipulation, medication-related risks, acceptability, and oncology-specific safety considerations.Data SourcesA narrative literature review was conducted using PubMed, Scopus and ScienceDirect. Publications from January 2000 to March 2026 were identified using keywords related to geriatric oncology, dysphagia, oral dosage forms, dosage-form manipulation, oral anticancer agents, medication safety, acceptability, and hazardous drugs. Review articles, original studies, professional recommendations and regulatory documents were included.Data SummarySwallowing disorders are common among older adults with cancer and may compromise oral anticancer therapy administration. Dosage-form manipulation practices, including tablet crushing and capsule opening, are frequently used despite their potential effects on drug stability, bioavailability, pharmacokinetics, and therapeutic efficacy. These concerns are amplified by the narrow therapeutic index of many oral anticancer agents and the risk of occupational, caregiver, and environmental exposure to hazardous drugs. Available evidence reveals gaps in standardized administration procedures and limited data supporting alternative administration strategies. A review of selected oral anticancer agents showed substantial variability in formulation constraints, manipulation practices, and supporting evidence. Emerging approaches, including dispersible and orodispersible formulations, multiparticulate systems, mini-tablets, and three-dimensional (3D) printed medicines, may improve treatment acceptability and reduce inappropriate dosage-form manipulation.ConclusionsDysphagia and dosage-form manipulation remain underrecognized challenges in geriatric oncology, with implications for treatment safety, efficacy, adherence, and hazardous-drug exposure. Addressing these issues requires multidisciplinary collaboration, standardized procedures, patient-centered formulation design, and further research to support evidence-based practice.
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DOI: 10.1177/10781552261486723
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