Chemotherapy is one of the most widely known forms of cancer treatment.
However, it is little known that medical practitioners, including nurses, pharmacists and doctors who are involved in preparing and administering anticancer drugs run the risk of exposing themselves to the toxicity of these drugs.
They may unknowingly inhale carcinogenic substances or absorb them through the skin. So let's look at this problem.
Chemotherapy drugs are effective in controlling cancer growth or, on some occasions, eradicating cancer cells. But normal cells, which actively grow and divide to produce new cells, are affected by the drugs in various parts of the body, including the bone marrow, digestive tracts and hair roots.
Cancer patients undergoing chemotherapy endure agonizing pain due to adverse reactions to the drugs. Nonetheless, chemotherapy is used because it is by far the most appropriate treatment for cancer patients.
Adverse reactions are associated with many other kinds of drugs. X-ray examinations may also cause a variety of side effects. However, the merits are greater than the drawbacks.
On the other hand, medical professionals in charge of treating cancer patients with chemotherapy may expose themselves to anticancer drugs - an occupational hazard that needs to be addressed to ensure workplace safety.
Research reports show:
- More cases of nurses who routinely handle anticancer drugs suffering damage to the DNA of their leukocytes, or white blood cells, than nurses who do not.
- Absorption of anticancer drugs in the first trimester of pregnancy increases the risk of miscarriage.
Nordic countries, such as Sweden and Norway, began tackling this issue as early as the 1980s. By the 1990s, US medical institutions had established a negative air pressure ventilation system, called a safety cabinet, to control the room environment during the preparation of anticancer drugs.
In some countries in the European Union, a more robust system called an "isolator" has been introduced to set up a physical barrier between medical professionals and the drug preparation process. Germany has adopted a system in which chemotherapy drugs are prepared outside hospitals and delivered to them. In the European Union, where many people move back and forth across the borders, an EU directive obliges all member states to implement measures to protect medical workers from exposure to anticancer drugs.
Meanwhile, the National Institute for Occupational Safety and Health (NIOSH), an agency of the US Labor Department, said in 2004: "Preparation, administration and disposal of hazardous drugs may expose pharmacists, nurses, physicians and other health care workers to potentially significant workplace levels of these chemicals." The NIOSH warned that the safety cabinet alone could not ensure the protection of medical workers and it called on pharmaceutical firms and medical institutions to take further measures.
Japan a late comer
Compared with the United States and the EU, Japanese society has not paid sufficient attention to the hazardous exposure of medical professionals to anticancer drugs in their working environment. Therefore, it cannot be said that Japan has taken adequate measures to prevent exposure to chemotherapy drugs.
In fact, at many medical institutions, especially small and medium-sized hospitals, anticancer drug preparation used to be routinely carried out in patients' wards. Only recently has Japan made a belated effort to enforce safety measures.
In 2005, one year after the NIOSH's warning, the Japanese Society of Hospital Pharmacists (JSHP) compiled guidelines on how to handle anticancer drugs. While it was in the process of compiling the guidelines, the World Health Organisation's International Agency for Research on Cancer (IARC) released a report warning that the chemotherapy drug Cyclophosphamide, used for the treatment of malignant lymphoma, leukemia, breast cancer and lung cancer, is as carcinogenic as asbestos.
Cyclophosphamide is made of fine powder that can be easily inhaled or absorbed by the skin by medical practitioners preparing the drug. Moreover, the powder may contaminate the surfaces of infusion bags. Therefore, extra care is required when delivering or administering the drug to patients and when disposing of the bags and infusion tubes.
Besides Cyclophosphamide, the IARC report listed various types of chemotherapy drugs as carcinogenic or suspected of being carcinogenic. Among them are azathioprine, an immunosuppressive drug; melphalan, used to treat multiple myeloma, a bone marrow tumour; cisplatin, a platinum-compound drug; doxorubicin, an anthracycline antibiotic; and etoposide, a chemotherapy drug derived from a type of plant alkaloid.
In Japan, too, JSHP-initiated inspections led to the disclosure that Cyclophosphamide had been detected on the walls, floors and preparation tables of hospitals as well as in the urine of hospital employees.