Potential Health Effects of Cytotoxic Drugs Waste

Statistics shows that one in three people have a life-long risk of developing cancer. There is little scientific evidence currently available relating to whether working with cytotoxic drugs actually increases the risk of developing cancer or not. However, in the absence of such data, a strategy of prudent avoidance is recommended. Occupational exposure may occur where control measures fail or are not in place. Exposure may be through skin contact, skin absorption, inhalation of aerosols and drug particles, ingestion and needle stick injuries resulting from the following activities:

• Drug preparation

• Drug administration

• Handling patient waste

• Transport and waste disposal, or

• Spills

Personnel likely to be involved in these activities include:

• Nurses and medical officers

• Pharmacists

• Laboratory staff, and

• Cleaning, maintenance and waste disposal staff

Where control measures are not adequate, adverse health effects may result from occupational exposure. Health effects attributed to cytotoxic drugs exposure amongst people preparing and administering cytotoxic drugs include:

• Abnormal formation of cells and mutagenic activity

• Alterations to normal blood cell count

• Fetal loss in pregnant women and malformations in the offspring of pregnant women

• Abdominal pain, hair loss, nasal sores and vomiting

• Liver damage, and

• Contact dermatitis, local toxic or allergic reaction, which may result from direct contact with skin or mucous membranes

The greatest risk of exposure to cytotoxic drugs is during drug manufacture and preparation, because of the concentrations and quantities used. The first priority in protecting the health of individuals is to eliminate or reduce the risks to health so far as is practicable.

This may be implemented through:

• Effective planning and design of the workplace

• Use of “best practice” control measures and specialized equipment such as cytotoxic drug safety cabinets

• The implementation of stringent handling procedures

• Training and education of employees

• Wearing personal protective equipment

• An integrated health monitoring program that:

• Includes the assessment and counseling of prospective employees before they commence any work involving cytotoxic drugs and related waste; and

• Ensures employee confidentiality is maintained.

It is paramount in healthcare settings that patients are appropriately educated before treatment, so they understand and appreciate the health and safety requirements for healthcare employees.

Prior to looking at waste disposal there are a whole series of steps in the management of chemotherapy drugs: inventory management, preparation, storage, administration, waste segregation that result in minimizing the amount and type of material that needs special disposal. Most small quantities of waste cytotoxic drugs are either minimal amounts remaining in vials, in tubing and IV bags, or on gloves, gowns, gauze, syringes and the like. In these forms small quantities are hard to extract from the materials (and very dangerous), and no amount of water deactivates them. They are cytotoxic, and therefore by definition they kill cells very effectively. They need to be handled with special care.

Less frequently, larger quantities of waste may result from expired product. This is very expensive. Many of these agents can cost hundreds, if not thousands, of dollars per unit. Inventory control should be in place to avoid this. In the event this happens it is essential that work be engaged in contracts for ‘return to manufacturer’. Some agents may have a manufacturer specified deactivation agent that can be procured. There should, of course, be regulations on how such highly toxic wastes are disposed of and these should be followed.

Read more about Translational Medicine in Biopharmaceutical R&D – Enabling R&D Optimization And Early Detection Of Potential Failures