Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe

Abstract

We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.

Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

“…Particularly, studies conducted in Asia showed the highest pooled ES compared with studies conducted in the Americas and even more in Europe. As suggested by Hon et al, different standard procedures, protocols, level of education, and legislations across the globe might influence the level of occupational risk, and consequently the conclusions drawn from one country might not be fully applicable to another [50]. Furthermore, in the cumulative analysis by year of publication, the results remained stable until 2008, while from 2009, they started to lose significance, with a large 95% CI.…”

Analytical strategies for assessing occupational exposure to antineoplastic drugs in healthcare workplaces

“…While the research on surface and biological monitoring for ADs has continued with enthusiasm, demonstrated by the number of recent publications reporting improved technology for wipe [23][24][25] and urine [26][27][28] sampling, only a limited number of the studies published consider both matrices [11,13,29].…”

Antineoplastic drug contamination in the urine of Canadian healthcare workers

“…Furthermore, dermal wipe samples do not account for other potential routes of occupational exposure such as inhalation or ingestion and, therefore, may not provide a complete measure of exposure. Given this, a number of occupational exposure studies have collected urine samples as a biomarker to estimate the dose of antineoplastic drug as evidenced in reviews conducted by Suspiro and Prista (2011) and Hon et al (2014a).…”