Levels and risks of antineoplastic drugs in households of oncology patients, hospices and retirement homes

Abstract

Background Contamination of the indoor environment by antineoplastic drugs (ADs) is known to pose health risks to the exposed staff in hospitals or pharmacies. ADs may also contaminate households of the patients receiving chemotherapy, but the exposure levels and potential risks to family members have not been studied. The objective was to provide an in-depth research of surface contamination by ADs inside homes focusing on the households of oncology patients, hospices, and retirement houses. Methods The study was carried out in 17 patient households, 2 hospices, and 3 retirement homes. Surfaces were sampled using a standardized approach and the wipe samples were analyzed by UPLC–MS for 11 organic ADs and by ICP-MS/MS for total Pt as a marker of Pt-based ADs. Results The main study included repeated samplings of surfaces (floors, desktops) in households of 17 ambulant oncology patients receiving different chemotherapies with cyclophosphamide (CP), platinum-based drugs (Pt), doxorubicin (DOX), 5-fluorouracil (FU) and others. Patients treated with chemotherapy were found to serve as a source of contamination for their households, representing thus a risk to sensitive family members such as children or elderly people. Carcinogenic CP was commonly found at relatively high concentrations, especially during the first 6 days after the chemotherapy (maximum 511 pg/cm2). Sweat seems to be a major medium for the spread of the contamination, and high and long-time persisting CP levels (traces still found after 6 months post-chemotherapy) were found on various desktops including kitchen dining tables. The pilot studies in hospices and retirement homes indicated rather lower exposure risks of the personnel but pointed to potential long-lasting contamination by Pt or some other persistent ADs such as ifosfamide (IF). Conclusions This is one of the first studies investigating the contamination by ADs in indoor environments outside of hospitals or pharmacies. Peak concentrations of the carcinogenic CP in households were comparable to those observed in hospitals, but the temporal exposures are likely to cause lower risks to family members and caregivers compared to the long-time occupationally exposed health care personnel. The information guidance flier with practical recommendations was prepared improving thus information as well as prevention of eventual risks for family members.

Proposals of guidance values for surface contamination by antineoplastic drugs based on long term monitoring in Czech and Slovak hospitals and pharmacies

“…The present study investigated surface contamination in 40 pharmacies ( N = 1,277 samples) and 43 hospitals ( N = 946). In addition to this data set, monitoring covered also 17 patient homes ( N = 133), three retirement houses ( N = 19), and 2 hospices ( N = 10) ( 9 ) but the data are not considered in the present paper.…”

“…In conclusion, long-life exposures of health care staff to ADs represent a major issue, and routine monitoring along with implementation of proper measures help to implement the “as low as reasonably achievable” principle (ALARA) ( 12 ) minimizing thus occupational risks. Challenging problems that require research attention are the take-home anticancer therapies ( 48 ), veterinary clinics or research facilities that might contribute to spread of AD contamination to other environments such as patient homes ( 9 ).…”

“…However, other processes in handling of ADs are often less controlled and may lead to serious occupational exposures of nurses as well as sanitary staff (cleaning of contaminated floors or desktops/tables, handling and washing of contaminated beddings). Recently, exposures to ADs in home care settings have also been documented ( 9 , 10 ).…”

“…For example, in the Czech Republic, about eight ADs are applied intra venously in large quantities including cyclophosphamide (CP), platinum-based drugs (Pt), 5-fluorouracil (FU), paclitaxel (PX), gemcitabine (GEM), irinotecan (IRI), ifosfamide (IF) and methotrexate (MET). These 8 ADs form 50% or more of the AD applications prepared in individual hospitals ( 9 , 10 ). In agreement with other studies, this shows high importance of few ADs, namely CP, FU and Pt-based drugs as representative markers of occupational exposures ( 3 , 15 , 23 – 25 ).…”