Review
The Dangers of Working with Antineoplastic Drugs
By: Sarah Liederman
Introduction
Radiation and chemotherapy may cure cancer in some and cause it in others. One danger that generally gets overlooked may be the use of personal protective equipment while preparing and dealing with drugs, or by being exposed to liquidized aerosols. Antineoplastic drugs are medications used to treat cancers, yet some are carcinogenic to those handling and administering them. Just in Canada alone, CAREX Canada said that around 75,000 Canadians are exposed to antineoplastic drugs in their work departments [1]. Therefore, it is interesting to learn about those who work in specific fields, like oncology, where medical professionals are constantly exposed to these hazardous drugs. Although protocols and procedures are available to those in these fields, the rules are not strictly followed and therefore hazardous concerns remain.
Exposure to Antineoplastic Drugs
In 2021 the estimated number of new cancer cases was 1.9 million, and the estimated cancer deaths were 608,570 [2]. Unfortunately most individuals have at least heard of someone with cancer and know that many cancers are currently still unable to be cured. Therefore, it is crucial that those in medical positions who are exposed to hazardous drugs that may cause cancers and other diseases are aware of the health hazards and are knowledgeable of the proper precautions they should take. There are many studies that show that those exposed to neoplastic drugs are more at risk to develop cancer [3]. A survey was done in the Netherlands to determine what nursing staff knows about antineoplastic drugs. 1,373 survey questionnaires were given to 10 different hospitals, and it was found that 68% of the nursing staff were working with patients being treated with antineoplastic drugs on a daily or weekly basis. They found that 94% of these nurses said that the protective measures were effective. 91% said they wore gloves when giving these drugs, and 3% used goggles,18% wore masks, and 21% wore gowns [4]. In another survey taken of 330 oncology nurses it was found that over 95% reported glove use, larger than what was found in earlier studies. Gown usage while administering drugs and handling human waste remained about the same. It was also found that the nurses who worked in private practices were not as likely to use the proper protection [5]. Overall, although glove use among oncology nurses is relatively high, gown usage and other proper personal protective equipment is lower than it should be in order to protect those medical personnel from health hazards.
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Genotoxic Effects of Antineoplastic Drugs
Several studies have been conducted regarding assessing the genotoxicity risk in those working with hazardous drugs. One study conducted was on chromosomal aberrations, sister chromatid exchanges and micronuclei in lymphocytes of those working in the oncology department and constantly dealing with antineoplastic drugs. In this specific study, 71 oncology nurses along with 10 drugstore workers who were all exposed were used as the experimental group. The control group consisted of 74 nurses similar in age and who did not have exposure to these hazardous drugs. The results found that the mean frequency of all the damages including chromatid and chromosome breaks along with the micronucleus assay, sister chromatid assay were higher in those individuals exposed to the antineoplastic drugs [6]. Once again, this study emphasized the fact that it is crucial that nurses receive the proper training and knowledge when it comes to administering and dealing with antineoplastic drugs.
Several more studies have been done in which there is a statistically significant difference in aberrant lymphocytes, micronuclei frequencies, and chromosomal aberrations and deletions. In order to assess the genotoxicity in the lymphocytes of oncology nurses, a study chose 38 professionals from the oncology department in Tanta Cancer Center. These individuals were separated by pharmacists and oncology nurses who were normally exposed to antineoplastic drugs. 30 nurses who were similar in age and gender with no smoking habits were chosen as the control group. Each individual gave a 5 mL blood donation and were coded and processed. The lymphocytes were then able to be washed and isolated. In order to analyze the genotoxicity, the micronucleus and chromosomal aberration tests were used. It was found that there were more chromosomal aberrations and abnormal lymphocytes in the subjects who were exposed. They also showed more deletions, fragments, and breaks in their chromosomes [7]. Another study which also displayed that there is a correlation between exposure to antineoplastic drugs and genotoxicity was a study done in a hospital in South India. This was done using the comet assay and the micronucleus assay. 60 nurses exposed to antineoplastic drugs were chosen, along with 60 nurses similar in age and gender who were not exposed. In order to mark any drug absorption, urinary cyclophosphamide was used. It was found that the damaged DNA was found to be higher in the lymphocytes of the nurses who were exposed to these hazardous drugs. There was also a significant increase of the micronuclei found in the lymphocytes and buccal cells of these exposed nurses [8]. This study yet again emphasizes the idea of the importance in prevention of exposure to these antineoplastic drugs. One more study made use of FISH, a lab technique to detect specific DNA sequences, which displayed increased damage in the exfoliated buccal cells of the exposed nurses [9]. Lastly, another study made use of the sister chromatid exchange assay as well, compared nurses not exposed, exposed with proper protection, and without proper protection. The group with the least protection has the highest SCE frequency, as expected [10].
On the contrary, a study was done which found a lack of genotoxicity among nurses in oncology, emphasizing the importance of protective equipment. In this study, the experimental group was made up of oncology nurses, while two control groups were present. One control group did not come into contact with neoplastic drugs but worked in the same areas as the exposed nurses, and the second control group worked separately altogether in different parts of the hospital. The sister chromatid exchange assay was used to detect for genotoxicity, and it was found that no statistically significant difference was found [11]. This must have been due to a good use of personal protective equipment along with proper training and supervision.
Conclusion
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This review reflects both sides of genotoxicity of nurses exposed to genotoxic drugs. Although there are studies which show negative results in terms of DNA damage, it is still extremely prevalent that with increased protective equipment and awareness these genotoxic risks have the ability to be decreased. Therefore, medical practices and hospitals should ensure proper personal protective equipment is always available, and should work to increase knowledge of the possible risks that come along with increased exposure.
References
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