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Ferreira AA, Freitas AS, Diniz JA, Cunha MDC, Magalhães VDS, Dewulf NDLS, Lopes AF. Professional profile in veterinary oncology: A Brazilian nationwide survey. J Oncol Pharm Pract 2024:10781552241269690. [PMID: 39106361 DOI: 10.1177/10781552241269690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services. METHODS A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data. RESULTS This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection. CONCLUSION The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents.
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Affiliation(s)
| | | | - Juliana Araújo Diniz
- Graduate Program in Pharmaceutical Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Nathalie de Lourdes Souza Dewulf
- Faculty of Pharmacy, Laboratory of Research in Teaching and Health Services (LaPESS), Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Angela Ferreira Lopes
- Faculty of Pharmacy, Laboratory of Research in Teaching and Health Services (LaPESS), Federal University of Goiás, Goiânia, Goiás, Brazil
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Pharmacokinetics of Carboplatin in Combination with Low-Dose Cyclophosphamide in Female Dogs with Mammary Carcinoma. Animals (Basel) 2022; 12:ani12223109. [PMID: 36428336 PMCID: PMC9686876 DOI: 10.3390/ani12223109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 11/12/2022] Open
Abstract
This prospective study aimed to evaluate the effect of metronomic cyclophosphamide on carboplatin’s tolerability, efficacy, and pharmacokinetics in dogs with mammary carcinoma. Sixteen female dogs with mammary carcinoma were divided into groups: 300 mg/m2 intravenous (i.v.) carboplatin therapy (G1 = 8) or 300 mg/m2 i.v. carboplatin which was associated with 12.5 mg/m2 oral cyclophosphamide in a metronomic regimen (G2 = 8). The investigated animals underwent a clinical evaluation, a mastectomy, a carboplatin chemotherapy, and serial blood sampling for the pharmacokinetic analysis. The adverse events and survival rates were monitored. A non-compartmental analysis was applied to calculate the pharmacokinetic parameters of carboplatin in the 2nd and 4th chemotherapy cycles. Carboplatin PK showed high interindividual variability with a 10-fold variation in the area under the plasma concentration−time curve (AUC) in G1. The systemic plasma exposure to carboplatin was equivalent in both of the treatments considering the AUC and maximum plasma concentration (Cmax) values. Although the red blood cells (p < 0.0001), platelets (p = 0.0005), total leukocytes (p = 0.0002), and segmented neutrophils (p = 0.0007) were reduced in G2, the survival rate increased (p = 0.0044) when it was compared to G1. In conclusion, adding low daily doses of cyclophosphamide to a carboplatin therapy showed promising outcomes in female dogs with mammary tumors.
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Fazel SS, Keefe A, Shareef A, Palmer AL, Brenner DR, Nakashima L, Koehoorn MW, McLeod CB, Hall AL, Peters CE. Barriers and facilitators for the safe handling of antineoplastic drugs. J Oncol Pharm Pract 2021; 28:1709-1721. [PMID: 34612752 DOI: 10.1177/10781552211040176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Antineoplastic drugs are widely used in the treatment of cancer. However, some are known carcinogens and reproductive toxins, and incidental low-level exposure to workers is a health concern. CAREX Canada estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in workplace settings. While policies and guidelines on safe handling of antineoplastic drugs are available, evidence suggests that compliance is low. In this paper, we identify barriers and facilitators for safe handling of antineoplastic drugs in workplace settings. METHODS We utilized a unique method to study public policy which involved compiling policy levers, developing a logic model, conducting a literature review, and contextualizing data through a deliberative process with stakeholders to explore in-depth contextual factors and experiences for the safe handling of antineoplastic drugs. RESULTS The most common barriers identified in the literature were: poor training (46%), poor safety culture (41%), and inconsistent policies (36%). The most common facilitators were: adequate safety training (41%), leadership support (23%), and consistent policies (21%). Several of these factors are intertwined and while this means one barrier can cause other barriers, it also allows healthcare employers to mitigate these barriers by implementing small but meaningful changes in the workplace. CONCLUSION The combination of barriers and facilitators identified in our review highlight the importance of creating work environments where safety is a priority for the safe handling of antineoplastic drugs. The results of this study will assist policy makers and managers in identifying gaps and enhancing strategies that reduce occupational exposure to antineoplastic drugs.
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Affiliation(s)
- Sajjad S Fazel
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Arshiya Shareef
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada
| | - Alison L Palmer
- CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Darren R Brenner
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mieke W Koehoorn
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Chris B McLeod
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Amy L Hall
- 142123Government of Canada, Charlottetown Prince Edward Island, Canada
| | - Cheryl E Peters
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Smith AN, Klahn S, Phillips B, Parshley L, Bennett P, Flory A, Calderon R. ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice. J Vet Intern Med 2018; 32:904-913. [PMID: 29603372 PMCID: PMC5980460 DOI: 10.1111/jvim.15077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this report is to offer a consensus opinion of ACVIM oncology diplomates and technicians on the safe use of cytotoxic chemotherapeutics in veterinary practice. The focus is on minimizing harm to the personnel exposed to the drugs: veterinary practitioners, veterinary technicians, veterinary staff, and pet owners. The safety of the patient receiving these drugs is also of paramount importance, but is not addressed in this statement. Much of the information presented is based on national recommendations by Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, United States Pharmacopeia, and other published regulations. These directives reflect an abundance of caution to minimize exposure to medical personnel, but large-scale studies about the consequences of long-term occupational exposure are not available in veterinary medicine. Challenges in the delivery of optimal treatment safely and economically to veterinary patients in general practice without access to a veterinary oncologist or other specialist, because of costs or proximity, remain.
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Affiliation(s)
- Annette N. Smith
- Department of Clinical SciencesAuburn University College of Veterinary MedicineAuburnAlabama
| | - Shawna Klahn
- Department of Small Animal Clinical SciencesVirginia–Maryland Regional College of Veterinary Medicine, Virginia TechBlacksburgVirginia
| | - Brenda Phillips
- Oncology Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
| | - Lisa Parshley
- Oncology Olympia Veterinary Cancer CenterOlympiaWashington
| | - Peter Bennett
- Oncology University Veterinary Teaching Hospital Sydney, University of SydneySydneyAustralia
| | - Andi Flory
- Oncology Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
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Alexander K, Northrup N, Clarke D, Lindell H, Laver T. Engineering controls in veterinary oncology: A survey of 148 ACVIM board-certified oncologists and environmental surveillance in 20 specialty hospitals. Vet Comp Oncol 2018; 16:385-391. [PMID: 29446222 DOI: 10.1111/vco.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Abstract
Engineering controls (EC, facility and equipment barriers between hazards and people) are used to avoid exposure to chemotherapy drugs. In this study, American College of Veterinary Internal Medicine board-certified veterinary oncologists were surveyed about their use of containment primary EC (C-PEC) and supplemental EC (closed system transfer devices, CSTD). The survey was completed by 148 (38%) of practicing diplomates. All used EC. Both C-PEC and CSTD were used at 92% of hospitals; however, US Pharmacopoeial Convention Chapter <800> (USP <800>) standards were met at only 19% of hospitals and oncologists did not know the type of C-PEC at 18% of hospitals. Next, surface contamination and EC use were assessed with environmental surveillance for carboplatin, cyclophosphamide, doxorubicin, and vincristine in 20 veterinary specialty hospitals using a commercially available kit. No contamination with carboplatin, doxorubicin, or vincristine was detected, however, there was contamination with cyclophosphamide at 4 hospitals. Based on this study, most veterinary oncologists use C-PEC and CSTD, but few meet USP <800> standards. Current measures appear effective for preventing contamination with IV drugs, but additional measures are needed for oral drugs.
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Affiliation(s)
- K Alexander
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - N Northrup
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - D Clarke
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - H Lindell
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - T Laver
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Hall AL, Demers PA, Astrakianakis G, Ge C, Peters CE. Estimating National-Level Exposure to Antineoplastic Agents in the Workplace: CAREX Canada Findings and Future Research Needs. Ann Work Expo Health 2017; 61:656-658. [PMID: 28595280 PMCID: PMC6824530 DOI: 10.1093/annweh/wxx042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/29/2017] [Accepted: 05/11/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Occupational exposure to antineoplastic agents occurs in various environments and is associated with increased cancer risk and adverse reproductive outcomes. National-level information describing the location and extent of occupational exposure to antineoplastic agents is unavailable in Canada and most other countries. CAREX Canada aimed to estimate the prevalence and relative levels of occupational exposures to antineoplastic agents across work setting, occupation, and sex. METHODS 'Exposure' was defined as any potential for worker contact with antineoplastic agents. Baseline numbers of licensed workers were obtained from their respective professional bodies. For unlicensed workers, Census data or data extrapolated from human resources reports (e.g., staffing ratios) were used. Prevalence was estimated by combining population estimates with exposure proportions from peer-reviewed and grey literature. Exposure levels (classified as low, moderate, and high) by occupation and work setting were estimated qualitatively by combining estimates of contact frequency and exposure control practices. RESULTS Approximately 75000 Canadians (0.42% of the total workforce) are estimated as occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is community pharmacy workers, with 30200 exposed. By work setting, 39000 workers (52% of all exposed) are located in non-hospital settings; the remaining 48% are exposed in hospitals. The majority (75%) of workers are in the moderate exposure category. CONCLUSIONS These estimates of the prevalence and location of occupational exposures to antineoplastic agents could be used to identify high-risk groups, estimate disease burden, and target new research and prevention activities. The limited secondary data available for developing these estimates highlights the need for increased quantitative measurement and documentation of antineoplastic agent contamination and exposure, particularly in work environments where use is emerging.
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Affiliation(s)
- Amy L. Hall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, B525 University Avenue, 3rd Floor, Toronto, Ontario M5G 2L3, Canada
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Calvin Ge
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Cheryl E. Peters
- Department of Health Sciences, Carleton University, 1125 Colonel By Dr., 5411 Herzberg Building, Ottawa, Ontario K1S 5B6, Canada
- CAREX Canada, Simon Fraser University, 105 - 515 W. Hastings St., Downtown Campus, Vancouver, British Columbia V6B 5K3, Canada
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