The Antineoplastic Drug Exposure Monitoring Program is part of the Department of Occupational and Environmental Health at the UBC School of Population and Public Health in Vancouver, Canada.
What are Antineoplastic Drugs?
Antineoplastic drugs are used in treatment of cancer and other diseases in humans, and increasingly in companion pets. These drugs have huge benefits for to those suffering from disease. However, to healthcare workers (and to veterinary staff) who must handle the drugs every day, potentially for a lifetime, they present many occupational health hazard. Studies of exposures in healthcare workers have shown increasing rates of adverse reproductive effects, and cancer. Previous studies have documented antineoplastic drug residues on surfaces in pharmacy, nursing and patient-care areas.
Issue: There are no regulated exposure limits in Canada, or elsewhere. Variability of contaminants across surfaces is poorly understood making it difficult to develop sampling guidance. Nevertheless, monitoring contamination using surface wipe testing is now required by safe drug handling guidelines, such <USP 800>. Regular screening for contamination by AD will help to identify contamination levels, sources, pathways and determinants of exposure, with the ultimate goal to prevent of worker exposure.
Program: Currently, we have the capacity to simultaneously detect the following 11 antineoplastic drugs from surface wipe sampling in order to better characterize where and how contamination occurs in healthcare, veterinary, and research facilities:
- 5-Fluorouracil
- Bortezomib
- Cyclophosphamide
- Docetaxel
- Gemcitabine
- Ifosfamide
- Methotrexate
- Oxaliplatin
- Paclitaxel
- Vinblastine
- Vincristine
Drug information courtesy of the BC Cancer Drug Manual [Abiraterone. Revised 1 August 2017. In: BC Cancer Drug Manual®. Badry, Nadine (editor). BC Cancer. Vancouver, British Columbia. Available at http://www.bccancer.bc.ca/. (Accessed 14 February 2019).]
Health Hazards
The health risks of handling antineoplastic drugs (AD) are well established. Healthcare professionals such as pharmacists and nurses can be exposed while caring for cancer patients receiving AD therapies. In Canada, an estimated 75,000 workers are exposed to AD, including 22,900 pharmacy technicians (75% female), 20,500 nurses (90% female) and 20,000 pharmacists (60% female; CAREX, 2017). In the U.S. it is estimated that 5.5 million healthcare workers are engaged in cancer patient care, with the majority being nurses and pharmacists (Bureau of Labor Statistics, 2016).
AD exposures have been associated with adverse acute (National Institute for Occupational Safety and Health, 2004; McDiarmid & Egan, 1988), cardio-toxic (Lamberti et al., 2014), reproductive (Dranitsaris et al., 2005; Valanis et al., 1997; Valanis, Vollmer, & Steele, 1999) and genotoxic (McDiarmid et al., 2010; Testa et al., 2007) effects. Exposure sources are numerous, including drug delivery carriers, intravenous infusion bags, surfaces where contaminated bags are placed, floors in patient care and pharmacies (Graeve et al., 2017), and when proper removal procedures are not followed, contaminated gloves and gowns (Tomas et al., 2015). Studies conducted worldwide over the past two decades indicate widespread surface contamination (Connor et al., 2010). The majority of this research has been conducted outside North America (Connor, Zock, & Snow, 2016) and the potential health risks associated with low-level multi-agent exposure from contaminated surfaces remain poorly understood (Connor, Zock, & Snow, 2016). AD contamination is invisible and thus exposure may go undetected without purposeful investigation, typically through surface wipe or biomonitoring methods.
AD use is increasing globally as the number of cancer patients receiving treatment grows and as AD use in treating nonmalignant diseases expands. Healthcare workers’ exposures to these agents are thus likely to continue to increase as well (National Institute for Occupational Safety and Health, 2004). Occupational exposures likely affect a broader group of healthcare workers than previously thought; surface contamination is prevalent in multiple hospital departments (Hon, Barzan, & Astrakianakis, 2014) and AD residues were detected on healthcare workers’ hands that had no known direct AD contact. In fact, researchers reported that the highest proportion of samples came from individuals not involved in AD administration (e.g. volunteer, oncologist, ward aide, dietician) in that study (Hon, Barzan, & Astrakianakis, 2014).
