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Cancer
has a long history of troubling mankind as a disease itself. It often ends
one’s life within a very short period of time. Thus, it can be quite
debilitating for the patients and their loved ones. Therefore, it is crucial
that treatment options for different types of malignancies are explored. Due to
the complexity of cancer cells and their mechanism of action, treatment options
are very limited. Even today it’s an ongoing challenge to find a definite cure
for this disease. This further signifies the importance of continuing to
conduct research into this area of medicine. 

 

These
cancer cells have the ability to affect any part of the body and is characterized
by its uncontrollable and abnormal overgrowth pattern. It can rapidly create abnormal
cells that grow beyond their usual boundaries and then invade the adjoining
organs and distant parts as well (WHO, 2012). It begins to harm the body when
altered cells divide uncontrollably to form lumps or masses of tissue called
tumors that are malignant.

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It
is reported as a leading cause for morbidity and mortality worldwide. In 2013
there were 14.9 million cancer cases and 8.2 million deaths. It is the second
leading cause of death globally, and was responsible for 8.8 million deaths in
2015. Globally 1 in 6 deaths is due to cancer. Number of new cases are expected
to rise by about 70% over the next two decades. Africa, Asia, Central and South
America account for 60% of total new cancer cases and 70% of cancer deaths in
the world (WHO, 2012).

 

Fourteen
out of fifteen Asian countries consist of 3.6 million males and 4.0 million
females living with cancer (diagnosed within the past five years). Within the Asian
countries, colon and rectal cancers are most common among male cancer survivors
and breast cancer is the most prevalent among female survivors. Other most
common causes of death include lung, liver, stomach, breast, colorectal and esophageal
cancer (WHO, 2012).

 

It
is evident that cancer is a significant burden for many reasons. Not only it
have a great impact on the healthcare system, but it is also a financial
burden. Among the male population, prostate cancer has become more frequent
(1.4 million) while among the female population it’s breast cancer (1.8
million). Incidence rates have increased in most countries since 1990. This
trend is a particular threat to developing nations with health systems that are
ill-equipped to deal with complex and expensive treatments. Thus, effective
measures must be taken to reduce cancer morbidity and mortality (Oncol, 2015).

 

It
has shown that five leading behavioral and dietary risks including high body
mass index, low fruit and vegetable intake, lack of physical activity, tobacco
and alcohol use are responsible for around one third of cancer related deaths.
Most important risk factor among them is the tobacco use and it is accounted
for approximately 22% of deaths (WHO, 2012). The impact of one’s genetic makeup
along with exposure to carcinogens play a major role in this. There are other
risk factors such as age, hormones, infectious agents, radiation and sunlight which
also contribute to the development of this disease.

 

There are various
types of treatments available. The type of treatment depends on the type of
cancer and how advanced it is. Surgery, chemotherapy, radiation therapy, immunotherapy,
targeted therapy, hormone therapy and stem cell transplantation are the main
types of treatment. The main goals of treatment include definite cure,
prolongation of life and relief of suffering.

 

When
considering treatment options, priority is given for oral anti-cancer agents
(OACA) which is classified under chemotherapy. Oral chemotherapy is not
available for all types of cancers and it can be defined as any drug taken orally
to treat cancer by destruction of the malignant cells.  OACA are used as single agents or in
combinations and indicated for solid tumors and hematological malignancies
(Timmers et al, 2012). OACA have different modes of action and different
toxicity profiles.

 

Majority of
antineoplastic drugs act by interfering with cell growth. These drugs can be
used for cure, control or as palliative therapy. They have various mechanism of
actions. These include the interaction with the process of cell division of
cancer cells and DNA, RNA synthesis. Furthermore, they can also interfere with
various metabolic functions of cells disrupting normal cell function and altering
the hormonal environment of the cell.

 

OACA have
been used in multiple types of cancer such as lung cancer, colon cancer, along
with hematological and genitourinary cancers. Some commonly used oral
anti-cancer agents are Capecitabine, Cyclophosphamide, Vinorelbine, Temozolamide
and Mercaptopurine.

 

Oral
chemotherapy has many advantages like ease of administration and convenience
and the ability to reduce the need for invasive procedures. Oral therapy in
general is preferable in the patient population over parenteral therapy due to
its ease and comfort. In addition, it does not cause significant damage to
surrounding organs as radiotherapy. There are some challenges associated with
oral chemotherapy. For instance, adherence to medication, understanding complex
schedules and its different side effect profiles can be challenging. It can
also interact with food and other medications. 
There is always the risk of medication errors and the lack of safe
handling procedures (Mahay, 2009).

 

Since
cancerous cells grow more rapidly than other cells. The drug can target other normal
dividing cells as well. As a result, antineoplastic drugs will affect hair
follicles, gonad organs, lymph tissues and bone marrow. Some of the common side
effects of these drugs are nausea, vomiting, diarrhea, loss of appetite, hair
loss, mouth sores and skin changes. These side effects of OACA negatively affect
the level of adherence.

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