Colorectal cancer (CRC) stands as one of the most prevalent malignant tumors of the digestive system, ranking third in global incidence and second in mortality rates. According to the latest statistics from the International Agency for Research on Cancer (IARC) under the World Health Organization, the global burden of CRC reached 1,933,600 new cases in 2020 (1), with China alone reporting 517,100 new cases in 2022 (2). Over the past decades, significant advancements in treatment modalities have led to a steady improvement in survival rates (3, 4), particularly through the development of novel therapeutic agents and optimized chemotherapy regimens. The current standard of care for CRC involves a multidisciplinary approach, combining surgical intervention with adjuvant therapies including radiotherapy, chemotherapy, targeted therapy, and integrated traditional Chinese medicine. Clinical evidence demonstrates that patients undergoing chemotherapy achieve significantly higher 3- and 5-year overall survival (OS) and progression-free survival (PFS) rates compared to non-chemotherapy groups (5, 6)). However, the cytotoxic nature of chemotherapeutic agents not only targets malignant cells but also adversely affects healthy tissues, leading to a spectrum of treatment-related complications (7, 8). This is particularly concerning for home-based care, as studies indicate that over 50% of terminal cancer patients require hospital readmission due to acute complications arising during home treatment (9, 10).

The paradigm of cancer management has evolved with medical advancements, establishing take-home cancer drugs (THCDs) as an integral component of CRC treatment protocols. Modern pharmacotherapy for CRC has become increasingly sophisticated, encompassing not only antineoplastic agents but also comprehensive supportive care medications. While existing research in China has predominantly focused on clinical characteristics, healthcare utilization patterns, and intravenous chemotherapy regimens (11), there remains a notable gap in understanding the management of gastrointestinal complications during home-based treatment. Specifically, insufficient attention has been given to critical issues such as cancer-related pain, nutritional deficiencies, CINV, defecation disorder, and sleep disturbances. These unaddressed complications frequently necessitate hospital readmissions for symptom management, significantly compromising patients’ quality of life and treatment adherence.

Emerging evidence highlights the efficacy of medication therapy management (MTM) in optimizing patient outcomes (12). This approach, particularly when implemented through home-based pharmaceutical care programs, has demonstrated significant benefits in medication safety evaluation and adverse drug reaction management (13, 14). Notably, systematic management of THCDs has been associated with reduced 90-day readmission rates (15). Despite these advancements, there remains a global knowledge gap regarding the implementation of MTM services for CRC patients and the optimization of THCDs programs. Therefore, this study aims to investigate home-based medication strategies to effectively manage treatment-related complications, mitigate adverse drug reactions, enhance treatment compliance, and prevent unexpected clinical events through comprehensive drug therapy management services within the THCDs framework.

The implementation of Take-Home Cancer Drugs (THCDs) has become indispensable in the management of various malignancies (16). However, patients undergoing home-based treatment frequently encounter challenges due to insufficient medical support and limited understanding of their therapeutic regimens, potentially leading to medication errors or inappropriate drug use. Medication Therapy Management (MTM) interventions encompass a comprehensive approach, including the management of comorbidities, monitoring of additional medications, surveillance for adverse events, assessment of potential drug interactions, patient education, guidance provision, adherence evaluation, and management of treatment-related toxicities (17, 18). Pain represents a predominant symptom in the CRC population, with epidemiological studies indicating a prevalence exceeding 70% (19–21). Chemotherapy-induced peripheral neuropathy frequently manifests through characteristic symptoms such as seizures and neuropathic pain (22). The constipating effects of opioid analgesics are well-documented, with literature reporting constipation incidence rates ranging from 40% to 90% among chemotherapy patients (23, 24). These findings are consistent with our observational data, which revealed constipation rates of 42.37% in the control group versus 30% in the MTM intervention group. The pathophysiology is further complicated by reduced oral intake secondary to chemotherapy-induced anorexia, nausea, and vomiting.

The MTM intervention demonstrated significant clinical efficacy in symptom management. Pain severity was markedly reduced, with 51.67% of intervention group patients reporting improvement compared to 76.27% in controls. Sleep disturbances and bowel dysfunction showed notable improvement, with 30% fewer patients experiencing insomnia (versus 37.29% in controls) and 41.67% fewer patients reporting defecation disorders (compared to 67.8% in controls). The intervention group also demonstrated reduced consultation rates for surgical complications including anastomotic leakage, hemorrhage, wound infections, and pulmonary infections. Statistical analysis revealed significantly lower incidence rates of pain, sleep disturbances, weight loss, nausea/vomiting, and anxiety in the MTM group (p<0.05), accompanied by reduced unscheduled hospital admissions. Multivariate regression analysis identified significant correlations between unscheduled admissions and the presence of pain, insomnia, or defecation disorders (p<0.05). The intricate interplay between pain-induced insomnia and gastrointestinal symptoms creates a complex clinical syndrome that substantially impairs quality of life (25, 26). This cyclical relationship suggests that therapeutic strategies should prioritize the simultaneous management of these interconnected symptoms while minimizing treatment-related adverse effects (19).

Common challenges in home medication management include dosing errors, non-adherence (manifesting as under- or over-medication), severe toxicities, and postoperative complications (27, 28). Adverse drug reactions can be objectively assessed through laboratory parameters and clinical manifestations. For instance, leukopenia predisposes patients to infections, thrombocytopenia may cause hemorrhagic complications, hepatic dysfunction can lead to jaundice, and hypoalbuminemia may present as peripheral edema, while immunological disturbances can manifest as cutaneous pruritus. Alarmingly, medication non-adherence contributes to approximately 125,000 annual deaths (29), with cancer patients demonstrating particularly low adherence rates to oral therapies (46%) (30). However, targeted interventions have shown efficacy in improving medication adherence among high-risk populations (31, 32). Our findings indicate that structured medication management significantly reduced the incidence of hepatic dysfunction, leukopenia, peripheral edema, and fatigue in home-treated patients (p<0.05).

Patients with colorectal cancer received personalized education on disease management and medication protocols, tailored to their educational background and comprehension abilities. The educational program encompassed a comprehensive range of topics, including risk factors, clinical manifestations, treatment options, drug indications and dosages, optimal timing of medication administration, necessary precautions, management of adverse drug reactions, handling of overdoses or missed doses, lifestyle recommendations, and monitoring frequency for symptoms and signs during medication use (33). To assess the impact of the intervention, surveys were conducted using key performance indicators (KPA), which included 12 statements related to clinical presentation and risk factors, 5 statements evaluating participants’ confidence and behavior, and 5 statements assessing attitudes toward colorectal cancer screening. The results revealed statistically significant differences between the MTM intervention group and the control group in terms of knowledge and understanding of clinical presentation and therapy, as well as attitudes toward colorectal cancer screening practices. These findings suggest that MTM intervention enhances patients’ disease knowledge, boosts confidence in rehabilitation, and improves treatment cooperation, ultimately leading to better prognosis (p<0.05).

MTM is designed to provide individualized pharmaceutical care throughout the entire course of home drug therapy. It aims to promote health literacy and improve medication compliance by offering evidence-based recommendations combined with practical application (34). The services include a holistic evaluation of all medications used by the patient, rather than focusing solely on drugs for a single condition. Additionally, MTM provides health education, manages complications, monitors for adverse reactions in colorectal cancer patients, and addresses concurrent symptoms during treatment. These issues are prioritized because they are more urgent and directly impact patients’ quality of life (35). The results demonstrate that this pharmaceutical care model not only reduces the incidence of adverse reactions but also minimizes complication rates, while emphasizing patient-centered care through personalized services.

This study demonstrates that the application of MTM significantly reduces the incidence of THCDs-related complications such as CINV, abdominal pain, and insomnia, while also decreasing the rate of unscheduled hospital admissions. Furthermore, MTM enhances the KPA of colorectal cancer patients. However, the study has some limitations. First, the data were collected from a single center, this observation limits their applicability in a more heterogeneous international context, and future research should involve multi-center studies with larger populations to validate these findings. Additionally, due to the limited study duration, the relationship between complications and survival rates was not explored. Nevertheless, this study enrolled a substantial number of cases and included detailed follow-up parameters, enabling a comprehensive analysis. Therefore, the results and insights derived from this study remain valuable for advancing patient care in colorectal cancer management.