Work Related Exposures to Cancer Chemotherapy Agents

When it comes to the management of or cure for cancer, chemotherapeutic agents offer patients a broad spectrum of benefits. Also known as cytotoxic or antineoplastic agents, chemotherapies essentially fight cancer via a chemical destruction of cells—cancer and healthy cells alike. Because of the non-discriminatory way in which chemotherapeutic agents destroy cells, they are considered to be extremely toxic substances that must be handled with great care. Relevant to occupational risk, antineoplastic agents are of particular concern to those health care professionals who work with these hazardous chemicals every day.

While the oncology nurses who administer chemotherapies, as well as the pharmacists who prepare them, run the greatest risk of occupational exposures to these cancer-fighting agents, the list of others who must remain vigilant against such exposures is long. Surgeons and attendant personnel may become exposed to cytotoxic agents when operating on a patient who is undergoing chemotherapeutic treatments. Custodial workers who routinely handle medical waste must guard against accidental exposures—shipping and receiving clerks, laundry workers, and just about anyone else who spends their occupational time in a cancer treatment setting must avoid unintentional exposures to chemotherapeutic agents.

The Risks to Health are High

While cytotoxic drugs and substances are on the front line of defense against cancer, most people are aware of the very serious side-effects that are generally associated with chemotherapy treatments. These side-effects are the result of the damage or death (apoptosis) of cells such as those briefly noted below:

• Bone marrow cells: Antineoplastic agents can damage bone marrow cell production, which can lead to a severely compromised immune system and the possible onset of various opportunistic diseases.
• Digestive tract cells: Mucositis refers to the chemotherapeutic destruction of the cells that line the digestive tract. Mucositis is chiefly responsible for the nausea and vomiting that is so often associated with chemotherapies.
• Hair follicle cells: Alopecia areata or alopecia totalis refers to the cytotoxic destruction of hair follicle cells that result in the partial or total hair loss commonly seen in patients who are undergoing chemotherapy.

While some of the side-effects of cancer chemotherapy are short-lived, others such as myelosuppression can take some time to overcome. Additionally, cytotoxic agents have been identified with long-term an/or permanent damage to the heart, kidneys, liver, bone marrow, reproductive system, etc., Clearly, antineoplastic agents can pose substantial occupational risks to workers who handle these agents every day, and as a result, health professionals have identified a number of biological markers that are used to test workers for the presence of these substances in their system. These biological endpoints are: chromosomal damage; urine mutagenicity; DNA damage; thioether excretion; sister chromatid exchange; micronuclei induction, and HPRT mutations.

One of the most common ways to test workers for the presence of antineoplastic agents, is to test for these drugs and/or their metabolites in urine. Urine tests provide medical setting workers with a fast, simple, and non-invasive way to screen for cytotoxic agents, and when such tests are combined with the approved methods for the safe handling and disposal of these substances, occupational risks to health are effectively minimized.