HAZARDOUS DRUG EXPOSURES IN HEALTHCARE
Antineoplastic Agents
Overview
The adverse health effects associated with antineoplastic agents (cancer chemotherapy drugs, cytotoxic drugs) in cancer patients and some non-cancer patients treated with these drugs are well documented. The very nature of antineoplastic agents make them harmful to healthy cells and tissues as well as the cancerous cells. For cancer patients with a life-threatening disease, there is certainly a great benefit to treatment with these agents. However, for the health care workers who are exposed to antineoplastic agents as part of their work practice, precautions should be taken to eliminate or reduce exposure as much as possible. Pharmacists who prepare these drugs or nurses who may prepare and/or administer them are the two occupational groups who have the highest potential exposure to antineoplastic agents. Additionally, physicians and operating room personnel may also be exposed through the treatment of patients. Hospital staff, such as shipping and receiving personnel, custodial workers, laundry workers and waste handlers, all have potential exposure to these drugs during the course of their work. The increased use of antineoplastic agents in veterinary oncology also puts these workers at risk for exposure to these drugs.
In addition to acute or short-term effects related to treatment with antineoplastic agents, there are a number of long-term or chronic effects that have been identified in patients. These include liver and kidney damage, damage to the bone marrow, damage to the lungs and heart, infertility (temporary and permanent), effects on reproduction and the developing fetus in pregnant women, hearing impairment and cancer. The International Agency for Research on Cancerexternal icon (IARC) in Lyon, France has identified a number of antineoplastic agents and two combination therapies as having an association with cancer in patients who are treated with them. These include both cancer and non-cancer patients. IARC currently lists eleven agents and two combined therapies as Group 1 (Human carcinogens), twelve as Group 2A (Probable human carcinogens) and eleven as Group 2B (Possible human carcinogens).
A number of studies have documented environmental and worker exposure to the antineoplastic agents. A variety of biological endpoints have been used to evaluate worker exposure. These include, urine mutagenicity, chromosomal damage, sister chromatid exchange, micronuclei induction, DNA damage, HPRT mutations, and thioether excretion.
Additionally, analytical methods have been used to document worker exposure to antineoplastic agents by measuring these drugs and/or their metabolites in the urine of health care workers.
Similar analytical methods are currently being employed to measure the level of environmental contamination in the workplace. Although the studies on air sampling are limited, there have been numerous studies published on environmental wipe sampling for these drugs.
In September, 2004, The National Institute for Occupational Safety and Health (NIOSH) published an Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings, 2004pdf icon (DHHS (NIOSH) Publication No. 2004-165). This topic page is an expanded bibliography of related publications drawn from the published literature related to the Alert. Additional information on this topic can also be found on the NIOSH Hazardous Drug Exposures in Health Care topic page.