Salient features and outline of the joint Japanese guidelines for safe handling of cancer chemotherapy drugs

Abstract

The purpose of this paper is to introduce the outline and describe the salient features of the “Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs” (hereinafter, “Guideline”), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure.

Surface contamination of the outer and blister packages of oral anticancer drugs: A multicenter study

“…3 On the basis of this report, guidelines recommend that pharmacists should wear PPE even when touching the PTP strips of oral anticancer drugs. 8,9 There are several reasons why these drugs were not detected in this study, except in the case of methotrexate tablets supplied in bottles, not in blister packs. First, the sampling or testing methods were inappropriate.…”

“…In other countries, anticancer drugs were reported to adhere to the press-through-package (PTP) strips or external packaging, 3 thereby necessitating the need to wear PPE during dispensing of oral anticancer drugs. 8 While there were reports of surface contamination in other countries, little is known whether this occurs in Japan. Therefore, this study aims to clarify whether oral anticancer drugs are exposed during production or transportation in Japan.…”

Suggestions for Protecting Breast Cancer Patients Receiving Outpatient Chemotherapy and Their Families Against the Exposure Risk from Salivary Cyclophosphamide

“…In 2004, the US National Institute for Occupational Safety and Health (NIOSH) published an alert reviewing the most recent information available and promoting a program of safe handling of these drugs during their use [6]. Although countermeasures for hazardous drugs (HZ) exposure of medical personnel have been developed (JSCN/JSMO/JASPO Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs, 2015) [7], preventive measures for the families of patients visiting a hospital for treatment or hospitalization are insufficient. Cancer chemotherapy has shifted from inpatient to outpatient settings, and so exposure of medical staff and family members to HZ is a serious concern.…”