Preventing Occupational Exposures to Antineoplastic Drugs in Health Care Settings

Abstract

The toxicity of antineoplastic drugs has been well known since they were introduced in the 1940s. Because most antineoplastic drugs are nonselective in their mechanism of action, they affect noncancerous as well as cancerous cells, resulting in well-documented side effects. During the 1970s, evidence came to light indicating health care workers may be at risk of harmful effects from antineoplastic drugs as a result of occupational exposure. Since that time, reports from several countries have documented drug contamination of the workplace, identified drugs in the urine of health care workers, and measured genotoxic responses in workers. Evidence also exists of teratogenic and adverse reproductive outcomes and increased cancers in health care workers. During the past 30 years, professional organizations and government agencies have developed guidelines to protect health care workers from adverse effects from occupational exposure to antineoplastic drugs. Although many safety provisions were advanced to reduce worker exposure in the 1980s, recent studies have shown that workers continue to be exposed to these drugs despite safety policy improvements. In 2004, the National Institute for Occupational Safety and Health (NIOSH) published an alert reviewing the most recent information available and promoting a program of safe handling during their use. (CA Cancer J Clin 2006;56:354-365.)

Occupational exposures among nurses and risk of spontaneous abortion

“…29,30 However, since 1985, several exposure studies still report drug contamination on work surfaces in pharmacies and patient rooms. 31 NIOSH recently updated the recommendations for safe handling of antineoplastic drugs. 32 Our findings regarding exposure to sterilizing agents is consistent with our previously reported association of sterilizing agents with risk of preterm birth (RR=1.9, 95% CI = 1.1-3.4).…”

Antineoplastic drugs contamination of workplace surfaces in two Portuguese hospitals

“…Nevertheless, they can pose a serious threat to the healthcare workers involved in their preparation and administration (Shirato 1992;McDevitt et al 1993;Connor and McDiarmid 2006;Yoshida et al 2013), since most of them are classified by the International Agency for Research on Cancer as known or suspected human carcinogens (IARC 2012).…”

Relationship between Genotoxic Effects of Breast Cancer Treatments and Patient Basal DNA Integrity

“…1 The risk-benefit equation for a cancer patient often determines the appropriate use of treatment despite acknowledged side effects. 4 In addition, the difference between the amount of drug needed to induce successful tumoricidal action and the amount needed to induce toxicity in the host is small and depends on individual characteristics. 8 Because radiation and most of the drugs applied in breast cancer treatment affect DNA, DNA damage must be considered as a plausible therapy side effect.…”

“…Anti-tumor drugs generally do not selectively affect tumor-cell DNA. 4 Indeed, following in vivo exposure to antineoplastic drugs, diverse lesions in DNA are induced. 5 In fact, several studies have shown that…”