Abstract

The DNA damaging effects of treatment with hazardous, anti-cancer drugs (HD) resulting in therapy- related leukaemia and other cancers have been recognised for more than thirty years. Health concerns for cancer caregivers handling these drugs has also been raised as scores of environmental monitoring studies documented drug contaminated work areas including some linking these results to drug levels in workers’ urine, documenting drug uptake. Biomarkers of cytogenetic effect have also been examined, including chromosomal damage and micronuclei frequency, both of which may be prognostic of an increased cancer risk, suggesting they are potentially meaningful markers of effect. Importantly, dose-related excesses in ‘signature’ chromosomal aberrations typically seen in patients treated with specific anti-cancer drug classes have recently been reported in workers, even while ‘using’ safe handling practices.

Beyond the cancer risk, acute effects such as skin disorders and respiratory compromise from allergic sensitisation have also long been described in workers, as has reproductive loss, reflecting the experience of treated patients and the drugs’ known mechanisms of action. Of the 184 drugs on the 2014 NIOSH HD list, about 80% are classified as harmful to reproduction. In the most recent large, epidemiology study on this topic, investigators found a statistically significant two-fold increased risk of spontaneous abortion in nurses reporting first-trimester HD exposure.

While safe drug handling practices have been promoted since the 1980s, concern has persisted that the risk has not been fully addressed. The findings above amplify that concern and suggest that biologically important exposure and health risks persist for oncology workers. This presentation will review the evidence documenting hazardous drug exposure and will argue the need to enforce safe handling as the standard of practice in clinical oncology.