Perspectives on occupational exposure to antineoplastic drugs

This review has attempted to focus on the salient features of the potential risks of occupational exposure to the major antineoplastic agents that have broad utility in cancer chemotherapy, as well as in the treatment of a spectrum of refractory non-malignant conditions. An initial focus centered about the classes (primarily alkylating agents, antimitotics, antibiotics, and antimetabolites), types of action and their carcinogenicity, genotoxicity, and reproductive effects exhibited by many of these agents in animals and treated patients. Nurses, pharmacists, and oncologists are the principal individuals with a potential risk to these agents primarily during the preparation and administration of these agents. Although the number at potential risk are not known precisely, they are believed to be relatively small in the aggregate, perhaps numbering several thousand. The measurement of exposure has generally been attempted on a relatively small number of nurses and pharmacists by biological monitoring employing urinary mutagenicity assays and cytogenetic analysis with conflicting results. The levels of exposure currently found are low compared to the therapeutic doses employed and are probably much lower than that which may have occurred earlier before the employment of vertical laminar flow hoods and the more recent implementation of guidelines and/or recommendations. The long-term effects of exposure to occupational personnel at potential risk of exposure to chemotherapeutic agents and waste are not known. Although studies to date have failed to show conclusively that nurses and pharmacists are at risk to the carcinogenic, genotoxic and reproductive effects of these agents, prudence would dictate that every effort be taken to minimize their exposure during the handling and disposal of antineoplastic drugs.