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Ali N, Carmo H, Robalo R, Rocha L, Fernandes C, Moreira F. A simple and inexpensive method to monitor and minimize exposure from manipulation of cytotoxic drugs. J Oncol Pharm Pract 2024; 30:257-262. [PMID: 37151079 PMCID: PMC10943622 DOI: 10.1177/10781552231173878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023]
Abstract
Pharmacy personnel that manipulate cytotoxic drugs are under continuous exposure risk. Therefore, training and strict adherence to recommended practices should always be promoted. The main objective of this study was to develop and apply a safe, effective and low-cost method for the training and assessment of the safe handling of cytotoxic drugs, using commercially available tonic water. To evaluate the potential of tonic water as a replacement marker for quinine hydrochloride, deliberate spills of 1 mL of four different tonic waters (one coloured and three non-coloured) were analysed under ultraviolet light (300-400 nm). The pigmented sample did not produce fluorescence under ultraviolet (UV) light. The three commercially available tonic waters that exhibited fluorescence were further analysed by UV/Vis spectrophotometry (300-500 nm). Afterwards, a protocol of simulated manipulation of cytotoxic drugs was developed and applied to 12 pharmacy technicians, that prepared 24 intravenous bags according to recommended routine procedures using tonic water. Participants responded to a brief questionnaire to evaluate the adequacy and applicability of the activity. Seven of the participants had spillages during manipulation, the majority of which recorded during manipulation with needles. All participants scored the tonic water manipulation simulation with 4 or 5 points for simplicity, efficiency and feasibility. The obtained results suggest that tonic water can be used to simulate the manipulation of cytotoxic drugs in training and assessment programs. By using this replacement marker for quinine hydrochloride, it is possible to perform a more cost-effective, yet equally effective, assessment.
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Affiliation(s)
- Nuro Ali
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Department of Biological Sciences, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
- UCIBIO/REQUIMTE, Department of Biological Sciences, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Helena Carmo
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Department of Biological Sciences, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
- UCIBIO/REQUIMTE, Department of Biological Sciences, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Raquel Robalo
- Serviço Farmacêutico do Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E., Vila Nova de Gaia, Portugal
| | - Luísa Rocha
- Serviço Farmacêutico do Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E., Vila Nova de Gaia, Portugal
| | - Cristina Fernandes
- Serviço Farmacêutico do Centro Hospitalar de Vila Nova de Gaia/Espinho, E.P.E., Vila Nova de Gaia, Portugal
| | - Fernando Moreira
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
- Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
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2
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Delafoy C, Benoist H, Vasseur M, Breuil C, Divanon F, Odou P, Simon N, Saint-Lorant G. Perception, knowledge, practices and training regarding the risk of exposure to antineoplastic drugs in three French compounding units. J Oncol Pharm Pract 2023; 29:1893-1906. [PMID: 36785934 DOI: 10.1177/10781552231156520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Healthcare workers are exposed to hazardous drugs such as antineoplastic drugs, which have potential carcinogenic, mutagenic and teratogenic effects. Protective measures must be taken after appropriate staff training to handle antineoplastic drugs in a safe way. The objective was to assess perception, knowledge, practices and training regarding the risk of exposure of healthcare workers in three French compounding units. METHODS This descriptive study was based on a questionnaire made of 33 questions divided into five sections related to the handling of antineoplastic drugs: perception of the risks, knowledge of the risks, protection practices, specific training and general questions. RESULTS Among the 39 participants, over half considered their overall risk of exposure to antineoplastic drugs not being very low. Inhalation was known to 69.2% of them as possible route of contamination. The breakroom was identified by 28.9% of them as a place of contamination. The procedure in case of accidental exposure to antineoplastic drugs was known by 69.2%, but only half could explain it. Only 38.5% said they changed their gloves every 30 min as recommended. Barely half said that they had been trained specifically for the handling of antineoplastic drugs during an initial training. Over half wished to be informed, trained and aware of the proper handling of antineoplastic drugs. CONCLUSION Although some of these results are encouraging, specifically when compared to the other settings where antineoplastic drugs are handled, there is still room for improvement. Efforts to build an adapted and impactful training program must pursue. CLINICAL TRIAL REGISTRATION Study CONTACT, ref. 19-504.
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Affiliation(s)
- Clémence Delafoy
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
| | - Hubert Benoist
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Cécile Breuil
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Fabienne Divanon
- Departement of Pharmacy, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - Pascal Odou
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Nicolas Simon
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Guillaume Saint-Lorant
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
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3
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Villa A, Geshkovska A, Bellagamba G, Baldi I, Molimard M, Verdun-Esquer C, Lehucher-Michel MP, Canal-Raffin M. Factors associated with internal contamination of nurses by antineoplastic drugs based on biomonitoring data from a previous study. Int J Hyg Environ Health 2023; 254:114264. [PMID: 37776759 DOI: 10.1016/j.ijheh.2023.114264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
Internal contamination of healthcare professionals by antineoplastic drugs (ADs) remains a current occupational health issue, particularly because these compounds are classified as dangerous to handle by the NIOSH. In order to improve preventive actions, a study of the factors associated with this internal contamination was conducted among nursing staff in health care institutions. This study is a statistical analysis of metadata from a cross-sectional observational study conducted among nurses in two French hospitals. The internal contamination of each nurse was assessed in a previous study and was defined by whether or not at least one studied AD was detected in at least one urine sample. Three urine samples and a self-questionnaire were collected for each participant. Analysis of five ADs (cyclophosphamide, ifosfamide, metabolite of 5-fluorouracil, methotrexate, doxorubicin) were performed by liquid chromatography coupled to tandem mass spectrometry. A multivariate stepwise descending regression model was used to determine factors associated with internal contamination by coupling data from a self-questionnaire with internal contamination data. A total of 74 nurses participated to the study and 68 were included for this work: 39 nurses with and 29 without detectable internal ADs contamination. Two protective factors of internal contamination could be identified: a high "glove wearing score" (OR: 0.957; 95%CI: 0.93-0.98; p < 0.01) and a high "total number of years handling ADs and/or caring for patients treated with ADs" (OR: 0.797; 95%CI: 0.67-0.91; p < 0.01). In addition, three factors contributing to internal contamination were identified, namely "feeling sufficiently informed about tasks exposing to ADs" (OR: 9.585; 95%CI: 2.23-57.05; p < 0.01), "disposal of a waste bin containing equipment used for administration of the ADs studied" (OR: 8.04; 95%CI: 1.87-46.08; p < 0.01) and "changing sheets and/or making bed of a patient treated by one of the ADs studied" (OR: 10.479; 95%CI: 1.43-133.30; p < 0.05). Thus, the use of gloves when handling ADs directly or indirectly and the contaminating nature of certain tasks should be taken into account when (1) implementing preventive actions in health care services and (2) training and informing exposed staff. Further studies would be desirable to confirm these results and extend them to other professional categories.
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Affiliation(s)
- Antoine Villa
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France; Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Arna Geshkovska
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France
| | - Gauthier Bellagamba
- Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Isabelle Baldi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France; Service Santé Travail Environnement, CHU de Bordeaux, 33076, Bordeaux, France
| | - Mathieu Molimard
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, AHEAD Team, UMR 1219, F-33000, Bordeaux, France
| | | | - Marie-Pascale Lehucher-Michel
- Centre régional de Consultations de Pathologies Professionnelles et Environnementales, APHM, Hôpital Timone, Marseille, 13005, Marseille, France
| | - Mireille Canal-Raffin
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076, Bordeaux, France; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000, Bordeaux, France.
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4
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Pajic J, Milovanovic APS. Biological response to the continuous occupational exposure to antineoplastic drugs and radionuclides. Int J Radiat Biol 2023; 99:1934-1947. [PMID: 37498230 DOI: 10.1080/09553002.2023.2241901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Antineoplastic drugs and radioiodine are recognized occupational risk factors affecting the genetic material of exposed persons. To assess cytogenetic damage and evaluate the presence of chromosomal instability during occupational exposure, a biomonitoring study was performed using a chromosomal aberration assay and a cytokinesis-block micronucleus (CBMN) test. MATERIALS AND METHODS Blood samples from 314 healthy donors divided into 3 groups (control, exposed to antineoplastic drugs and exposed to radioiodine) were collected and cytogenetically analyzed. RESULTS There was an increase in almost all analyzed parameters registered in the exposed persons. Chromatid breaks were higher in the subjects exposed to antineoplastic drugs, while dicentrics and premature centromere division (PCD) parameters were higher in nuclear medicine workers. The total number of micronuclei was higher in both groups of the exposed. The correlation analysis indicated the association of dicentrics, acentrics, chromosome and chromatid break with PCDs in both groups of the exposed, and micronuclei and nucleoplasmic bridges with PCDs in the subjects exposed to radioiodine. The discriminant analysis marked off PCD1-5 as the best predictor of exposure. Age, sex, sampling season and duration of exposure significantly influenced the analyzed parameters, while smoking habits did not show any influence. CONCLUSION Based on the observed results, premature centromere division can be considered a valuable parameter of genotoxic risk for individuals occupationally exposed to low doses of ionizing radiation.
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Affiliation(s)
- Jelena Pajic
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Belgrade, Serbia
| | - Aleksandar P S Milovanovic
- Occupational Health Department, Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia; Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Belgrade, Serbia
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5
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Guan Z, Liang Y, Zhu Z, Yang A, Li S, Guo J, Wang F, Yang H, Zhang N, Wang X, Wang J. Cytosine arabinoside exposure induced cytotoxic effects and neural tube defects in mice and embryo stem cells. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115141. [PMID: 37320917 DOI: 10.1016/j.ecoenv.2023.115141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/16/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
Cytosine arabinoside (Ara-C) is one of the most widely used chemotherapeutic agents for hematological malignancies. The residues of Ara-C have been detected in wastewater and river water with increased usage and discharge. As the ability to cross the placenta and the teratogenicity at low ng/L levels, the toxic effects on pregnant women and infants have been concerned. The toxicity of Ara-C exposure on early embryonic neurodevelopment has not been fully elucidated. In this study, pregnant C57BL/6 mice were injected with different doses of Ara-C on Gestation day (GD) 7.5 and assessed on GD11.5 and GD13.5 to explore the neural developmental effects of Ara-C. HE staining, immunofluorescence, western blot, EdU assay, and flow cytometry were utilized to determine the toxic effects of Ara-C in vivo and in vitro. Our results showed that Ara-C (15-22.5 mg/kg body weight) induced the occurrence of neural tube defects (NTDs). The expression of PH3 was markedly reduced in embryos with Ara-C-induced NTDs, compared to the control group (P < 0.05). In contrast, cell apoptosis was markedly increased. Increased expression levels of GFAP and decreased Nestin were observed in the embryonic brain tissues in Ara-C induced NTDs. The level of β-catenin was also decreased on both GD11.5 and GD13.5. These results were confirmed in vitro using mouse Sv129 embryonic stem cells (mESC). Ara-C at a dose comparable to the environment level (0.05 nM) had cytotoxicity. Impaired Wnt/β-catenin signaling pathway is involved in Ara-C exposure induced imbalance between cell proliferation, apoptosis, and differentiation, which might contribute to Ara-C-induced occurrence of NTDs. Our data indicated the environmental concentration of Ara-C had cytotoxicity and that maternal exposure to Ara-C induced NTDs. These results might provide more information to understand the environmental toxic impact of Ara-C on neurodevelopment.
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Affiliation(s)
- Zhen Guan
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yingchao Liang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Zhiqiang Zhu
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Aiyun Yang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Shen Li
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Jin Guo
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Fang Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Huimin Yang
- Growth and Development Department, Capital Institute of Pediatrics, Beijing 100020, China
| | - Na Zhang
- Key Laboratory of Environmental and Viral Oncology, College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
| | - Xiuwei Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China.
| | - Jianhua Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China.
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6
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Vanneste D, Verscheure E, Srinivasan AN, Godderis L, Ghosh M. Systematic review of genotoxicity induced by occupational exposure to antineoplastic drugs. Arch Toxicol 2023; 97:1453-1517. [PMID: 37099053 DOI: 10.1007/s00204-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 04/27/2023]
Abstract
With increasing numbers of cancer cases, the use of antineoplastic agents is expected to rise. This will be accompanied by an increase in occupational exposure, which can cause unwanted health effects in workers. Our aim was to give an overview of genotoxic and epigenetic effects after occupational exposure to antineoplastic agents and to assess the concentration-effect relation. Four databases were searched for papers investigating genotoxic and/or epigenetic effects of occupational exposure to antineoplastic agents. Out of the 245 retrieved papers, 62 were included in this review. In this systematic literature review, we confirmed that exposure of healthcare workers to antineoplastic agents can lead to genotoxic damage. However, we observed a lack of data on exposure as well as genotoxic and epigenetic effects in workers other than healthcare workers. Furthermore, gaps in the current knowledge regarding the potential epigenetic effects caused by antineoplastic drug exposure and regarding the link between internal antineoplastic drug concentration and genotoxic and epigenetic effects after occupational exposure to antineoplastic agents were identified, offering a first step for future research.
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Affiliation(s)
- Dorian Vanneste
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Eline Verscheure
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Adhithya Narayanan Srinivasan
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Lode Godderis
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Manosij Ghosh
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium.
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7
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Kennedy K, Vu K, Coakley N, Daley-Morris J, Forbes L, Hartzell R, Lessels D. Safe handling of hazardous drugs. J Oncol Pharm Pract 2023; 29:401-412. [PMID: 36373754 PMCID: PMC9900183 DOI: 10.1177/10781552221135121] [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] [Indexed: 11/16/2022]
Abstract
Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.
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Affiliation(s)
- Kardi Kennedy
- Cancer Services, Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Kathy Vu
- Safety Initiatives Systemic Treatment Program, Ontario Health,
Cancer Care Ontario, Toronto, Ontario, Canada,Teaching Stream, Leslie Dan Faculty of Pharmacy, University of
Toronto, Toronto, Ontario, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
| | - Nadia Coakley
- Department of Oncology, McMaster University, Hamilton, Ontario,
Canada,Ontario Health's Cancer Care Ontario's Program in Evidence-Based
Care, McMaster University, Hamilton, Ontario, Canada,Nadia Coakley, Department of Oncology,
McMaster University, Hamilton, ON, Canada; Ontario Health's Cancer Care
Ontario's Program in Evidence-based care, McMaster University, Juravinski Site
G-227, 1280 Main St W, Hamilton, Ontario, Canada L8N 3Z5.
| | - Jennifer Daley-Morris
- Oncology Pharmacy & Systemic Therapy Suite, Southlake Regional Health
Centre, Newmarket, Ontario Canada
| | - Leta Forbes
- Systemic Treatment Program Ontario Health, Cancer Care Ontario,
Durham Regional Cancer Center, Oshawa, Ontario, Canada
| | - Renee Hartzell
- Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Darrilyn Lessels
- Lakeridge Health, Durham Regional Cancer Center, Oshawa, Ontario,
Canada
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Brycht M, Poltorak L, Baluchová S, Sipa K, Borgul P, Rudnicki K, Skrzypek S. Electrochemistry as a Powerful Tool for Investigations of Antineoplastic Agents: A Comprehensive Review. Crit Rev Anal Chem 2022:1-92. [PMID: 35968923 DOI: 10.1080/10408347.2022.2106117] [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: 10/15/2022]
Abstract
Cancer is most frequently treated with antineoplastic agents (ANAs) that are hazardous to patients undergoing chemotherapy and the healthcare workers who handle ANAs in the course of their duties. All aspects related to hazardous oncological drugs illustrate that the monitoring of ANAs is essential to minimize the risks associated with these drugs. Among all analytical techniques used to test ANAs, electrochemistry holds an important position. This review, for the first time, comprehensively describes the progress done in electrochemistry of ANAs by means of a variety of bare or modified (bio)sensors over the last four decades (in the period of 1982-2021). Attention is paid not only to the development of electrochemical sensing protocols of ANAs in various biological, environmental, and pharmaceutical matrices but also to achievements of electrochemical techniques in the examination of the interactions of ANAs with deoxyribonucleic acid (DNA), carcinogenic cells, biomimetic membranes, peptides, and enzymes. Other aspects, including the enantiopurity studies, differentiation between single-stranded and double-stranded DNA without using any label or tag, studies on ANAs degradation, and their pharmacokinetics, by means of electrochemical techniques are also commented. Finally, concluding remarks that underline the existence of a significant niche for the basic electrochemical research that should be filled in the future are presented.
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Affiliation(s)
- Mariola Brycht
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
| | - Lukasz Poltorak
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
| | - Simona Baluchová
- Faculty of Science, Department of Analytical Chemistry, UNESCO Laboratory of Environmental Electrochemistry, Charles University, Prague 2, Czechia
- Department of Precision and Microsystems Engineering, Delft University of Technology, Delft, The Netherlands
| | - Karolina Sipa
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
| | - Paulina Borgul
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
| | - Konrad Rudnicki
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
| | - Sławomira Skrzypek
- Faculty of Chemistry, Department of Inorganic and Analytical Chemistry, University of Lodz, Lodz, Poland
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9
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Benoist H, Busson A, Faveyrial A, Bouhier-Leporrier K, Divanon F, Breuil C, Roger-Leenaert S, Palix A, Odou P, Simon N, Saint-Lorant G. Perception, knowledge, and handling practice regarding the risk of exposure to antineoplastic drugs in oncology day hospitalization units and compounding unit staff. J Oncol Pharm Pract 2022:10781552221103803. [PMID: 35635230 DOI: 10.1177/10781552221103803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Antineoplastic drug exposure is a major problem in regard to caregivers' health. The aim of the present study was to assess the perception, knowledge, and handling practices of all occupation level categories of two oncology day hospitalization units and two compounding units regarding the risk of exposure to antineoplastic drugs. METHODS This descriptive study, performed through face-to-face interviews, concurrently assessed the perception, knowledge, and handling practices of antineoplastic drugs in five different job categories in four different settings. This work was part of a larger comprehensive project examining surface and blood contamination. Different scores were assigned to evaluate responses to a questionnaire about the perception, knowledge, and handling practices of healthcare workers, a risk global score including a risk perception score, and education/knowledge and handling practices scores. RESULTS In the survey, continuous training was associated with the global risk score (p = 0.03), particularly with the handling practices risk score (p = 0.01). Job category was also significantly associated with the global risk score (p < 0.001), particularly with the handling practices risk score (p < 0.001) and the education/knowledge score (p < 0.001). Pharmacy technicians had the highest score regarding risk perception (71.4%), indicating a higher perception of risk, and had a lower score regarding handling practices (25.0%) as well as a lower score (15.7%) regarding risk knowledge. Nurses and physicians had a high score (50%) regarding the risk of handling practices and a score of 57.1% regarding risk perception, indicating an increased perception of safety. Auxiliary caregivers had the highest global score (43.5%) and a score of 30.0% regarding handling practices. CONCLUSIONS This study identified significant differences among healthcare workers depending on job categories in the antineoplastic drug handling practices and in the knowledge of the risks associated with occupational exposure to antineoplastic drugs. These differences were particularly important between trained and untrained participants, revealing the importance of implementing a continuous training program.
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Affiliation(s)
- Hubert Benoist
- 357634Normandie Univ., ABTE, centre de lutte contre le cancer François Baclesse, Caen, France
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
| | - Amandine Busson
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Université de Caen Normandie, Caen, France
- Centre de lutte contre le cancer François Baclesse, Caen, France
| | - Audrey Faveyrial
- Service d'hospitalisation de jour de cancérologie, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Karine Bouhier-Leporrier
- Service d'hospitalisation de jour de gastro-entérologie, centre hospitalier universitaire de Caen, Caen, France
| | - Fabienne Divanon
- Service de pharmacie, 55072centre de lutte contre le cancer François Baclesse, Caen, France
| | - Cécile Breuil
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
| | - Sophie Roger-Leenaert
- Service de médecine du travail, centre hospitalier universitaire de Caen, Caen, France
| | - Agnès Palix
- Service de médecine du travail, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Pascal Odou
- 27023Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Nicolas Simon
- 27023Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Guillaume Saint-Lorant
- 357634Normandie Univ., ABTE, centre de lutte contre le cancer François Baclesse, Caen, France
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
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10
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Kirsanov KI, Sycheva LP, Lesovaya EA, Zhidkova EM, Vlasova OA, Osipova AV, Lylova ES, Grigorieva DD, Kulakova EM, Solenova LG, Belitsky GA, Mikhaylova IN, Yakubovskaya MG. Buccal Micronucleus Cytome Assay for the Evaluation of Cytogenetic Status of Healthcare Professionals Contacting with Anti-Cancer Drugs. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422050052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Berges-Gimeno MP, Pueyo López C, Barra-Castro A, Solano Solares E, de la Hoz Caballer B. Safe Handling of Antineoplastic Drugs During Allergy Diagnostic Workup and Desensitization: A Single Experience of the Allergy Department in a Tertiary Hospital. FRONTIERS IN ALLERGY 2022; 2:787537. [PMID: 35387052 PMCID: PMC8974773 DOI: 10.3389/falgy.2021.787537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 12/30/2022] Open
Abstract
The increased use of antineoplastic drugs has been associated with a rising number of hypersensitivity reactions to these drugs, which has led to a growth in the demand for assistance from allergy services. The involvement of an allergist is essential to ensure that these patients with hypersensitivity reactions continue to be able to receive appropriate first-line treatment. Chemotherapy and biological agents have specific handling requirements and all the allergy departments involved in the diagnosis and therapeutic management of patients reacting to these drugs should find the means to guarantee safety. There are currently several guidelines on the safe handling of hazardous drugs for healthcare workers. However, specific recommendations are lacking for reducing occupational exposure in staff working in the allergy departments and managing these drugs for the diagnosis and management of hypersensitivity reactions. This review article focuses on the safe handling strategy of the allergy department in the Ramón y Cajal University Hospital and provides details of its implementation and experience over 10 years. This protocol could improve the knowledge of safe handling of antineoplastic drugs in allergy procedures.
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Affiliation(s)
- María Pilar Berges-Gimeno
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria—IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
- Red de Asma, Reacciones Adversas a Fármacos y Alergia, ARADyAL, Madrid, Spain
- *Correspondence: María Pilar Berges-Gimeno
| | - Cristina Pueyo López
- Instituto Ramón y Cajal de Investigación Sanitaria—IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
- Pharmacy Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Alicia Barra-Castro
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria—IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
| | - Emilio Solano Solares
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria—IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
| | - Belén de la Hoz Caballer
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria—IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
- Red de Asma, Reacciones Adversas a Fármacos y Alergia, ARADyAL, Madrid, Spain
- School of Medicine, Alcalá University, Madrid, Spain
- Belén de la Hoz Caballer
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12
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Expanding Antineoplastic Drugs Surface Monitoring Profiles: Enhancing of Zwitterionic Hydrophilic Interaction Methods. SEPARATIONS 2022. [DOI: 10.3390/separations9020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antineoplastic drugs are a wide and heterogeneous group of substances that, as universally known, can cause highly severe toxic effects to whoever is exposed. From an occupational safety point of view, surface contaminations inside preparation and administration units are a growing issue and therefore require the development and implementation of sensible and fast monitoring methods. The unlikelihood of a unique all-embracing chromatography, able to correctly retain and separate each analyte led to the need to create an orthogonal normal phase analysis, which might be able to fill the gaps in the more common reversed-phase ones. An existing hydrophilic interaction method has thus been expanded to 6 other drugs and applied to real samples after an evaluation of its performances. The experimental data were then used to evaluate the possibility of estimating reliable relationships between the chromatographic retention and the chemical-structural features of the drugs under analysis.
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13
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Huang X, Gao C, Cai W, Tao Y, Zhong X, Liu H, Hong X, Ding X, Lu H, Lai W, Yi X, Gu Y. Effect of occupational exposure to antineoplastic drugs on DNA damage in nurses: a cross-sectional study. Occup Environ Med 2021; 79:253-258. [PMID: 34969777 DOI: 10.1136/oemed-2021-107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although the therapeutic effect of antineoplastic drugs is incontestable, these agents can also potentially act as carcinogens, mutagens and/or teratogens in people. The aim of this study was to assess the effect of occupational exposure to antineoplastic drugs on DNA damage, assessed by the comet assay and cytokinesis-block micronucleus (CBMN) assay, in nurses. METHODS The cross-sectional study enrolled 305 nursing staff members from 7 public hospitals in Shenzhen who handled antineoplastic drugs, and 150 healthy nursing staff members who were not exposed to antineoplastic drugs as the control group. DNA damage was assessed by the comet and CBMN assay. Multiple linear regressions and logistic regressions models were used to analyse the effect of occupational exposure to antineoplastic drugs on DNA damage. RESULTS After adjustment for confounding factors, compared with non-exposure to antineoplastic drugs, exposure to antineoplastic drugs was positively related to tail moment, olive moment, tail length and tail DNA per cent, and adjusted β or OR (95% CI) was 0.17 (0.08 to 0.26), 0.18 (0.10 to 0.27), 1.03 (0.47 to 1.60) and 1.16 (1.04 to 1.29) (all p<0.05). Moreover, similar significant relationships were observed for the biomarkers of the CBMN assay. Additionally, other than age, there was no interaction between antineoplastic drug exposure and other variables for the levels of biomarkers of the CBMN assay and the comet assay. CONCLUSIONS The present results showed that exposure to antineoplastic drugs was positively related to the risk of DNA damage in nurses. The results imply that occupational exposure to antineoplastic agents is an important global public health problem that requires urgent attention.
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Affiliation(s)
- Xiaohong Huang
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Chaoxian Gao
- Department of Pathology & Toxicology, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Yanling Tao
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Xiao Zhong
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Haiying Liu
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Xiaodan Hong
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Xiaorong Ding
- Department of Nursing, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hong Lu
- Department of Nursing, Cancer Hospital Chinese Academy of Medical Sciences, Chaoyang District, Beijing, China
| | - Wenjuan Lai
- Department of Nursing, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoqing Yi
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yeqing Gu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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14
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Batista KC, Sousa KHJF, Ruas CADS, Zeitoune RCG. Knowledge about antineoplastic drugs: implications for the health of nursing workers in a general hospital. Rev Bras Enferm 2021; 75:e20210025. [PMID: 34669829 DOI: 10.1590/0034-7167-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to understand, from a worker's health perspective, the knowledge of nursing professionals about the use of antineoplastic drugs in a general hospital. METHODS a descriptive and exploratory study with a qualitative approach. It was conducted at a university hospital, between April and August 2018, with 35 nursing professionals who responded to a semi-structured interview. Thematic analysis was used for data treatment. RESULTS from the data, three thematic categories emerged, related to the nursing professionals' knowledge about antineoplastic drugs and their effects on workers' health; situations in which exposure to these drugs occurs; and protection mechanisms for the patient, the environment, and the worker. FINAL CONSIDERATIONS the nursing professionals had little knowledge about antineoplastic drugs. The practices related to handling and the necessary protective measures to deal with these drugs were empirically determined and relatively subsidized the knowledge acquired by the professionals.
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Affiliation(s)
- Kely Cristine Batista
- Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil.,Universidade Federal do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Characterization and Separation of Platinum-Based Antineoplastic Drugs by Zwitterionic Hydrophilic Interaction Liquid Chromatography (HILIC)–Tandem Mass Spectrometry, and Its Application in Surface Wipe Sampling. SEPARATIONS 2021. [DOI: 10.3390/separations8050069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Platinum-based antineoplastic drugs (PtADs) are among the most important and used families of chemotherapy drugs, which, even showing severe side effects and being hindered by drug resistance, are not likely to be replaced clinically any time soon. The growing interest in the occupational health community in antineoplastic drug (AD) surface contamination requires the development of increasingly fast and easy high-throughput monitoring methods, even considering the lack of harmonized legally binding regulation criteria. Thus, a wipe sampling method together with zwitterionic hydrophilic interaction liquid chromatography (HILIC-Z)–tandem mass spectrometry (MS/MS) analysis was developed for the simultaneous evaluation of oxaliplatin, cisplatin, and carboplatin surface contaminations. A design of experiments approach was used to optimize the chromatographic conditions. Limits of quantification ranging from 2 to 5 ng/mL were obtained from interday and intraday repetitions for oxaliplatin and carboplatin, and between 170 and 240 ng/mL for cisplatin. The wipe desorption procedure is equivalent to other AD sampling methods, enabling a fast sample preparation, with an LC-MS/MS analysis time of less than 7 min.
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16
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Pajic J, Rovcanin B, Rakic B. Evaluation of Genetic Damage in Persons Occupationally Exposed to Antineoplastic Drugs in Serbian Hospitals. Ann Work Expo Health 2021; 65:307-318. [PMID: 33886965 DOI: 10.1093/annweh/wxaa100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Although useful in the treatment of malignant cells, antineoplastic drugs (ANPDs) as chemical genotoxic agents, can interfere with normal cell physiology causing genetic damage and unfavourable health effects, especially in occupationally exposed persons. The Cytokinesis-block Micronucleus (CBMN) Cytome assay has been widely used in human biomonitoring studies as a reliable biomarker of chemical genotoxic exposure. OBJECTIVES Our comprehensive research was conducted in order to evaluate micronuclei as a marker for preventive medical screening purposes for persons occupationally exposed to ANPDs. METHODS Using the CBMN Cytome test, peripheral blood lymphocytes of 201 control and 222 exposed subjects were screened for genetic damage. RESULTS Age and gender influenced micronucleus (MN) frequency, but smoking habit did not. The mean micronuclei frequencies and other parameters of the CBMN Cytome test [numbers of binuclear lymphocytes with one (MN1) or two (MN2) micronuclei] were significantly higher in the group of exposed persons. Positive correlation between duration of occupational exposure and MN frequency was revealed. CONCLUSIONS The results of our study performed on a large sample confirmed the capacity of the CBMN Cytome assay to serve as a reliable biomarker of long-term ANPD exposure.
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Affiliation(s)
- Jelena Pajic
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Radiation protection department, Deligradska 29,Belgrade, Serbia
| | - Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Koste Todorovica 8, Belgrade, Serbia
| | - Boban Rakic
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Radiation protection department, Deligradska 29,Belgrade, Serbia
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17
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do Nascimento MLLB, Dos Reis AC, Santos JVO, Negreiros HA, da Silva FCC, Ferreira PMP, Gonçalves JCR, Dittz D, Braz DC, Nunes AMV, Cunha RLOR, Melo-Cavalcante AAC, de Castro E Sousa JM. Antiproliferative and Genotoxic Action of an Underexploited Organoteluran Derivative on Sarcoma 180 Cells. Anticancer Agents Med Chem 2021; 21:1019-1026. [PMID: 32951579 DOI: 10.2174/1871520620666200918110152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The search for novel metallic chemical compounds with toxicogenic effects has been of great importance for more efficient cancer treatment. OBJECTIVE The study evaluated the cytotoxic, genotoxic and mutagenic activity of organoteluran RF07 in the S-180 cell line. METHODS The bioassays used were cell viability with 3-(4,5-dimethyl-2-thiazole)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) test, evaluation of apoptosis and necrosis using fluorescence and flow cytometry, cytokinesisblock micronucleus test and comet assay. The compound was tested at 1; 2.5 and 5μM. RESULTS The results showed the cytotoxicity of RF07 at concentrations of 2.5, 5, 10 and 20μM when compared to the negative control. For genotoxicity tests, RF07 showed effects in all concentrations assessed by increased index and frequencies of damage and mutagenic alterations. The compound was also cytotoxic due to the significant decrease in the nuclear division index, with significant values of apoptosis and necrosis. The results of fluorescence and flow cytometry showed apoptosis as the main type of cell death caused by RF07 at 5μM, which is thought to avoid an aggressive immune response of the organism. CONCLUSION In addition to cytotoxic and genotoxic effects, RF07 creates good perspectives for future antitumor formulations.
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Affiliation(s)
- Maria L L Barreto do Nascimento
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | - Antonielly Campinho Dos Reis
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | - José V O Santos
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | - Helber A Negreiros
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | | | - Paulo M P Ferreira
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | - Juan C R Gonçalves
- Department of Pharmaceutical Sciences, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Dalton Dittz
- Department of Biochemistry and Pharmacology, Federal University of Piaui, Teresina, Brazil
| | - Débora C Braz
- Department of Pharmacy, University of Piaui, Teresina, Brazil
| | - Adriana M V Nunes
- Department of Biophysics and Physiology, Laboratory of Experimental Cancerology, Federal University of Piaui, Teresina, Brazil
| | - Rodrigo L O R Cunha
- Center for Natural and Human Sciences, Laboratory of Chemical Biology, Federal University of ABC, Santo Andre, Brazil
| | - Ana A C Melo-Cavalcante
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
| | - João Marcelo de Castro E Sousa
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Toxicological Genetics, Federal University of Piaui, Teresina, Brazil
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18
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Ness SLR, Mascarenhas MÁ, Arbo MD, Tonietto BD, Cestonaro LV, Dos Santos NG, Garcia SC, Ferreira CF, Capp E. Occupational exposure assessment in professionals who manipulate and administer antineoplastic drugs in a university hospital in Southern Brazil. J Oncol Pharm Pract 2021; 27:1205-1213. [PMID: 33736555 DOI: 10.1177/10781552211003638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Our goal was to demonstrate the effects of occupational exposure to antineoplastic drugs on oxidative stress parameters and DNA damage in health professionals who manipulate and administer antineoplastic drugs in a University Hospital in Southern Brazil. METHODS The case-control study with a longitudinal design, involved 64 individuals, 29 of them pharmacists, pharmacy technicians and nurses who were occupationally exposed to antineoplastic drugs and 35 professionals who were not exposed. Gene mutations were determined by micronucleus from salivary fluid; DNA damage by comet assay and oxidative stress parameters in whole blood were also evaluated. RESULTS All workers exposed to antineoplastic drugs used personal protective equipment (PPE). It was demonstrated that the total nonprotein thiol and thiobarbituric acid reactive substances levels showed interaction between group and time, with higher levels one week after handling/administration of antineoplastic drugs in the exposed group (GEE, p ≤ 0.0001 and p = 0,013, respectively). Additionally, there was a group effect on the activities of the catalase and glutathione peroxidase antioxidant enzymes (GEE, p = 0.027 and p ≤ 0.0001, respectively), and workers occupationally exposed to antineoplastic drugs had higher enzyme activities compared to those not exposed. No genotoxic damage was demonstrated through the evaluated parameters. CONCLUSIONS Despite the correct use of PPE, professionals occupationally exposed to antineoplastic drugs were more susceptible to oxidative stress than those not exposed. The evaluation of the studied parameters is especially important for the definition of conducts and practices in the area, always in search of guaranteeing the establishment of a rational policy to protect workers' health.
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Affiliation(s)
- Sandro Luis R Ness
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Central de Misturas Intravenosas, Serviço de Farmácia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcello Á Mascarenhas
- Programa de Pós-Graduação Strict Sensu em Biociências e Reabilitação, Curso de Farmácia do Centro Universitário Metodista-IPA, Porto Alegre, Brazil
| | - Marcelo D Arbo
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bruna D Tonietto
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Larissa V Cestonaro
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Nícolas G Dos Santos
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Solange Cristina Garcia
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Charles F Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Grupo de Pesquisa: Climatério, e Menopausa. Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Edison Capp
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduação na Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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19
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Chabut C, Tanguay C, Gagné S, Caron N, Bussières JF. Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program. J Oncol Pharm Pract 2021; 28:343-352. [PMID: 33567975 DOI: 10.1177/1078155221992103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Healthcare workers exposure to antineoplastic drugs can lead to adverse health effects. Guidelines promote the safe handling of antineoplastic drugs, but no safe exposure limit was determined. Regular surface sampling contributes to ensuring workers safety. METHODS A cross-sectional monitoring is conducted once a year with voluntary Canadian centers, since 2010. Twelve standardized sampling sites were sampled. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng/cm2) were: 0.001 for cyclophosphamide and gemcitabine; 0.3 for docetaxel and ifosfamide; 0.04 for 5-fluorouracil and paclitaxel; 0.003 for irinotecan; 0.002 for methotrexate; 0.01 for vinorelbine. RESULTS The surfaces from 109 centers were sampled between 01/01/2020-18/06/2020. Twenty-six centers delayed their participation because of the COVID-19 pandemic. 1217 samples were analyzed. Surfaces were frequently contaminated with cyclophosphamide (34% positive, 75th percentile 0.00165 ng/cm2) and gemcitabine (16% and <0.001 ng/cm2). The armrest of patient treatment chairs (84% to at least one drug), the front grille inside the biological safety cabinet (BSC) (73%) and the floor in front of the BSC (55%) were frequently contaminated. Centers that prepared ≥5000 antineoplastic drugs annually had higher concentration of cyclophosphamide on their surfaces (p < 0.0001). Contamination measured on the surfaces was reduced from 2010 to 2020. CONCLUSIONS This large-scale study showed reproducible long term follow up of the contamination of standardized sites of Canadian centers and a reduction in surface contamination from 2010 to 2020. Periodic surface sampling help centers meet their continuous improvements goals to reduce exposure as much as possible. The COVID-19 pandemic had a limited impact on the program.
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Affiliation(s)
- Claire Chabut
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montreal, Canada
| | - Cynthia Tanguay
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montreal, Canada
| | - Sébastien Gagné
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Quebec, Canada
| | - Nicolas Caron
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Quebec, Canada
| | - Jean-François Bussières
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
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20
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Simon N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Chemical Decontamination of Hazardous Drugs: A Comparison of Solution Performances. Ann Work Expo Health 2021; 64:114-124. [PMID: 31848570 DOI: 10.1093/annweh/wxz093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/15/2019] [Accepted: 11/29/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Over the past 40 years, numerous actions have been undertaken to decrease the contamination of hospital facilities by intravenous conventional antineoplastic drugs (ICADs) such as centralizing compounding in pharmacies, using personal protective equipment, specific compounding, or infusion devices. As recently proposed in the <USP800> monograph, an additional specific decontamination step must be envisaged. A recent literature review analysed and discussed the different solutions tested in terms of decontamination efficacy. This article aims to discuss the performance of these solutions in the framework of aseptic compounding. METHODS The same dataset used in the previous literature review was reanalysed according to other parameters so as to select decontamination solutions: overall decontamination efficiency (EffQ), tested contaminants, and the risks of use in daily practice. RESULTS Using an EffQ threshold of 90% resulted in discarding 26 out of the 59 solutions. Solutions were tested differently: 8 on 1 contaminant, 11 on 2 contaminants, and 14 solutions on between 3 and 11 contaminants. Three risks were identified to help make choices in routine practice: the mutagenicity of degradation products, the safety of operators and facilities, and respect for the aseptic environment. CONCLUSIONS From the results, performance is discussed according to specific situations: a one-time incident or the basic chemical contamination due to daily practice. Accordingly, the decontamination solution selected then required a risk analysis and an evaluation before implementing it in the daily practice of a compounding unit.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Simon N, Guichard N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Efficiency of four solutions in removing 23 conventional antineoplastic drugs from contaminated surfaces. PLoS One 2020; 15:e0235131. [PMID: 32569333 PMCID: PMC7307753 DOI: 10.1371/journal.pone.0235131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Residual contamination by intravenous conventional antineoplastic drugs (ICAD) is still a daily issue in hospital facilities. This study aimed to compare the efficiency (EffQ) of 4 different solutions to remove 23 widely used ICADs from surfaces. METHOD AND FINDINGS A solution containing 23 ICADs (4 alkylating agents, 8 antimetabolites, 2 topo-I inhibitors, 6 topo-II inhibitors and 3 spindle poisons) was spread over 100 cm2 stainless steel. After drying, decontamination was carried out using 10×10 cm wipes moistened with 300 μL of one of the following solutions: 70% isopropanol (S1); ethanol-hydrogen peroxide 91.6-50.0 mg/g (S2); 10-2 M sodium dodecyl sulphate/isopropanol 80/20 (S3) or 0.5% sodium hypochlorite (S4). Six tests were performed for each decontamination solution. Two modalities were tested: a single wipe motion from top to bottom or vigorous wiping (n = 6 for each modality). Residual contamination was measured with a validated liquid chromatography with tandem mass spectrometry detection method. Solution efficiency (in %) was computed as follows: EffQ = 1-(quantity after decontamination/quantity before decontamination), as median (min-max) for the 23 ICADs. The overall decontamination efficiency (EffQ) of the 4 solutions was compared by a Kruskall-Wallis test. Decontamination modalities were compared for each solution and per ICAD with a Mann-Whitney test (p<0.05). EffQ were significantly different from one solution to the next for single wipe motion decontamination: 79.9% (69.3-100), 86.5% (13.0-100), 85.4% (56.5-100) and 100% (52.9-100) for S1, S2, S3 and S4 (p<0.0001), respectively. Differences were also significant for vigorous decontamination: EffQ of 84.3% (66.0-100), 92.3% (68.7-100), 99.6% (84.8-100) and 100% (82.9-100) for S1, S2, S3 and S4, respectively (p<0.0001). Generally, vigorous decontamination increased EffQ for all tested solutions and more significantly for the surfactant. CONCLUSION Decontamination efficiency depended on the solution used but also on the application modality. An SDS admixture seems to be a good alternative to sodium hypochlorite, notably after vigorous chemical decontamination with no hazard either to materials or workers.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Nicolas Guichard
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Polovich M. USP General Chapter <800>: Considerations for Oncology Nursing Practice. Semin Oncol Nurs 2020; 36:151022. [PMID: 32404243 DOI: 10.1016/j.soncn.2020.151022] [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: 11/26/2022]
Abstract
OBJECTIVES To describe the nurse leader's role in implementing the hazardous drug safe-handling standards from USP General Chapter <800> that are most relevant to oncology nursing practice, and to provide strategies for reducing nurses' exposure to hazardous drugs. DATA SOURCES Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION Nurse leaders are essential to promoting a safe environment for nurses handling hazardous cancer drugs. IMPLICATIONS FOR NURSING PRACTICE Several barriers and challenges to handling hazardous drugs exist and must be overcome before oncology nurses' exposure can be reduced.
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Affiliation(s)
- Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA.
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Soteriades ES, Economidou SC, Tsivitanidou A, Polyviou P, Lorimer A, Katodritis N, Theophanous-Kitiri S. Environmental assessment of cytotoxic drugs in the Oncology Center of Cyprus. PLoS One 2020; 15:e0216098. [PMID: 32134912 PMCID: PMC7058296 DOI: 10.1371/journal.pone.0216098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background Cytotoxic drugs constitute an important workplace hazard in the hospital environment. Our aim was to conduct an environmental assessment of hazardous drugs in the Oncology Center of Cyprus. Methods Wipe samples were obtained from 42 workplace areas of the Oncology Center including two pairs of gloves in an initial assessment, while 10 samples were obtained at follow-up 3 years later. Potential contamination with cyclophosphamide (CP), ifosphamide (IF) and 5-fluorouracil (5-FU) and other cytotoxic medications was examined using the GC-MSMS system (CP, IF) and the HPLC system with UV detection (5-FU) method, respectively. Results Wipe sample contamination was detected at 11.9% and 15% in the initial and follow-up assessment, respectively. Both pairs of gloves assessed were free from contamination. The results showed contamination with cyclophosphamide on the work space inside the isolator, on a day-care office phone and on the central pharmacy bench. Ifosphamide was only detected on the floor of a patient’s room. Contamination with 5-fluorouracil was found only on the surface of a prepared IV infusion bag. The levels of contamination in the positive samples ranged from 0.05 to 10.12 ng/cm2. Conclusions The overall percentage of sample contamination at the Oncology Center was very low compared to other centers around the world. In addition, the detected levels of contamination with cytotoxic drugs were relatively low with the exception of the workspace inside the biological safety cabinet. These results in both assessments may reflect the implementation of comprehensive control measures including employee training, technological equipment and effective cleaning procedures.
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Affiliation(s)
- Elpidoforos S. Soteriades
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, UAE
- Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | | | | | - Petros Polyviou
- Department of Radiology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - Amanda Lorimer
- Department of Nursing, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - Nikos Katodritis
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
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Gianfredi V, Nucci D, Fatigoni C, Salvatori T, Villarini M, Moretti M. Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E523. [PMID: 31947621 PMCID: PMC7013773 DOI: 10.3390/ijerph17020523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Antineoplastic drugs (ANDs) are a broad group of chemicals showing, at the same time, carcinogenic effects. The potential, albeit true, risk of side effects cannot be accepted, especially if resulting from occupational exposure. The aim of this study was to evaluate the association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/Medline, Web of Science, and Scopus were used to perform the literature search. The databases were examined in July 2019. Sub-group, moderator, and cumulative analyses were conducted. The trim and fill method was used in the case of potential publication bias. RESULTS Twenty studies were included in the qualitative analysis, and 19 in quantitative evaluation. The pooled effect size was 1.27 [(95% confidence interval (CI) = 0.66-1.88), p = 0.000] based on 1569 subjects. The moderator analysis by duration of exposure showed a positive association between duration of exposure and primary DNA damage. CONCLUSIONS This systematic review clearly shows a significant association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Considering these results, health professionals should be warned against this potential occupational risk.
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Affiliation(s)
- Vincenza Gianfredi
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Piazzale Gambuli, 06122 Perugia, Italy
| | - Daniele Nucci
- Digestive Endoscopy Unit, IRCCS Istituto Oncologico Veneto, Via Gattamelata 64, 35128 Padova, Italy;
| | - Cristina Fatigoni
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Tania Salvatori
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Milena Villarini
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Massimo Moretti
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
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Aristizabal-Pachon AF, Castillo WO. Genotoxic evaluation of occupational exposure to antineoplastic drugs. Toxicol Res 2019; 36:29-36. [PMID: 31998624 DOI: 10.1007/s43188-019-00003-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 12/19/2022] Open
Abstract
During the last years, several reports have provided evidence about adverse health effects on personal involved in Antineoplastic Drugs (ANPD) handling. ANPD has the ability to bind DNA, thus produce genotoxic damage. In this way, XRCC1 and XRCC3 proteins are necessary for efficient DNA repair and polymorphisms in this genes can be associated with an individual response to ANPD exposure. Therefore, the aim of this study was to evaluate genetic damage of occupational exposure to antineoplastic drugs and the possible effect of XRCC1 and XRCC3 polymorphisms in oncology employees from Bogotá, Colombia. Peripheral blood samples were obtained from 80 individuals, among exposed workers and healthy controls. The comet assay and Cytokinesis-block micronucleus cytome assay was performed to determinate genetic damage. From every sample DNA was isolated and genotyping for XRCC1 (Arg194Trp, Arg280His and Arg399Gln) and XRCC3 (Thr241Met) SNPs by PCR-RFLP. The exposed group showed a significant increase of comet assay results and micronucleus frequency, compared with unexposed group. It was observed a gender, exposure time and workplace effect on comet assay results. Our results showed no significant associations of comet assay results and micronucleus frequency with either genotype, allele, nor haplotype of XRCC1 and XRCC3 SNPs. The results suggest that occupational exposure to ANPD may lead to genotoxic damage and even be a risk to human health. To our knowledge, this is the first study to assess the genotoxic damage of occupational exposure to APND in South America.
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Affiliation(s)
- Andres Felipe Aristizabal-Pachon
- 1Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Carrera 7 # 43-82, Bogota, D.C. Colombia
| | - Willian Orlando Castillo
- 2Department of Biology, Faculty of Natural Sciences, Exact and Education, University of Cauca, Popayán, Colombia
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26
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Dong J, Wang JQ, Qian Q, Li GC, Yang DQ, Jiang C. Micronucleus assay for monitoring the genotoxic effects of arsenic in human populations: A systematic review of the literature and meta-analysis. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2019; 780:1-10. [DOI: 10.1016/j.mrrev.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 01/22/2023]
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27
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Simon N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Efficiency of degradation or desorption methods in antineoplastic drug decontamination: A critical review. J Oncol Pharm Pract 2019; 25:929-946. [DOI: 10.1177/1078155219831427] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although considerable efforts have been made over the last 40 years, occupational exposure to antineoplastic drugs is still a daily concern, since eradicating such contamination from workplaces seems unattainable. Considerable data are currently available on the risks associated with their use at work. Hospital facilities are often cleaned with marketed antimicrobials whose chemical decontamination efficacy certainly differs but remains unknown. To keep compounding facilities sterile, alcohol-based solutions are frequently used but with very limited efficiency. It would be particularly useful if a decontamination method could be added to the means already available so that all conventional antineoplastic drug contamination could be removed. Several degradation methods or desorption methods have previously been experimented, with varying success. They have never been compared or discussed in terms either of efficiency or usability. This review aims to analyse and discuss the results of each degradation or decontamination procedure and to compare them. This should facilitate selection of the method to be implemented in daily practice.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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28
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Chauchat L, Tanguay C, Therrien R, Dufour A, Gagné S, Caron NJ, Bussières JF. Biological Monitoring of 4 Antineoplastic Drugs in Health Care Workers from 2 Adult Hospitals: A Pilot Study. Can J Hosp Pharm 2019; 72:56-59. [PMID: 30828096 PMCID: PMC6391236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Laure Chauchat
- Department of Pharmacy and Pharmacy Practice Research Unit, Centre hospitalier universitaire Sainte-Justine, DPharm candidate with Université de Lorraine, Nancy, France
| | - Cynthia Tanguay
- Department of Pharmacy and Pharmacy Practice Research Unit, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec
| | | | - Annick Dufour
- Department of Pharmacy, CISSS de la Montérégie-Centre, Greenfield Park, Quebec
| | - Sébastien Gagné
- Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Quebec
| | - Nicolas J Caron
- Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Quebec
| | - Jean-François Bussières
- Department of Pharmacy and Pharmacy Practice Research Unit, Centre hospitalier universitaire Sainte-Justine, Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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29
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Power LA, Coyne JW. ASHP Guidelines on Handling Hazardous Drugs. Am J Health Syst Pharm 2018; 75:1996-2031. [DOI: 10.2146/ajhp180564] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Kirsch-Volders M, Fenech M, Bolognesi C. Validity of the Lymphocyte Cytokinesis-Block Micronucleus Assay (L-CBMN) as biomarker for human exposure to chemicals with different modes of action: A synthesis of systematic reviews. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2018; 836:47-52. [DOI: 10.1016/j.mrgentox.2018.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/06/2018] [Accepted: 05/07/2018] [Indexed: 10/17/2022]
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García SV, Clérigues NV, Ferrer VF, Briz EL, Andrés JLP. Use and handling safety of Mini-Spike 2 ® chemo and puresite for safe chemotherapy compounding in a hospital pharmacy. Regul Toxicol Pharmacol 2018; 100:1-6. [PMID: 30296468 DOI: 10.1016/j.yrtph.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022]
Abstract
We wanted to evaluate the impact of Mini-Spike 2® Chemo + Puresite (MSCP) use on contamination surface levels, professionals' satisfaction and compounding time at pharmacy compared with Phaseal™. Presence of cyclophosphamide (CYP) and 5-fluorouracil (5FU) was evaluated at three sampling times: baseline; after a decontamination procedure and six months after MSCP use for CYP and 5FU compounding. Testing was carried out using an independent laboratory and wipe testing kit. To test compounding time, four different nurses followed the same compounding protocol with each device. We also developed a questionnaire to obtain feedback from the nurses. We did not find statistically significant differences in the median contamination surface levels between basal and final sampling time, CYP (0.140; 95% CI -1.135, 1.601), 5FU (-0.506; 95% CI -1.756, 0.287). We observed a difference of 10 s on compounding times between the two devices tested (p < 0.001) favoring MSCP. Finally, eight nurses answered the survey, with the best valued aspect as the aspiration/injection flow and resistance, and the worst value the comfort using Puresite and valve connection. MSCP maintains low surface contamination levels in our setting assuring compounding time standards. Satisfaction survey let us know which were the major advantages and disadvantages of the device.
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Affiliation(s)
- Silvia Valero García
- Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7(a) planta, 46026, Valencia, Spain.
| | | | - Victoria Fornés Ferrer
- Data Science, Biostatistics and Bioinformatics Platform, Instituto de Investicación Sanitaria La Fe, Valencia, Spain
| | - Eduardo López Briz
- Pharmacy Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Russo C, Isidori M, Deaver JA, Poynton HC. Toxicogenomic responses of low level anticancer drug exposures in Daphnia magna. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2018; 203:40-50. [PMID: 30075441 DOI: 10.1016/j.aquatox.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
The use of anticancer drugs in chemotherapy is increasing, leading to growing environmental concentrations of imatinib mesylate (IMA), cisplatinum (CDDP), and etoposide (ETP) in aquatic systems. Previous studies have shown that these anticancer drugs cause DNA damage in the crustacean Daphnia magna at low, environmentally relevant concentrations. To explore the mechanism of action of these compounds and the downstream effects of DNA damage on D. magna growth and development at a sensitive life stage, we exposed neonates to low level concentrations equivalent to those that elicit DNA damage (IMA: 2000 ng/L, ETP: 300 ng/L, CDDP: 10 ng/L) and performed transcriptomic analysis using an RNA-seq approach. RNA sequencing generated 14 million reads per sample, which were aligned to the D. magna genome and assembled, producing approximately 23,000 transcripts per sample. Over 90% of the transcripts showed homology to proteins in GenBank, revealing a high quality transcriptome assembly, although functional annotation was much lower. RT-qPCR was used to identify robust biomarkers and confirmed the downregulation of an angiotensin converting enzyme-like gene (ance) involved in neuropeptide regulation across all three anticancer drugs and the down-regulation of DNA topoisomerase II by ETP. RNA-seq analysis also allowed for an in depth exploration of the differential splicing of transcripts revealing that regulation of different gene isoforms predicts potential impacts on translation and protein expression, providing a more meaningful assessment of transcriptomic data. Enrichment analysis and investigation of affected biological processes suggested that the DNA damage caused by ETP and IMA influences cell cycle regulation and GPCR signaling. This dysregulation is likely responsible for effects to neurological system processes and development, and overall growth and development. Our transcriptomic approach provided insight into the mechanisms that respond to DNA damage caused by anticancer drug exposure and generated novel hypotheses on how these chemicals may impact the growth and survival of this ecologically important zooplankton species.
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Affiliation(s)
- Chiara Russo
- Dipartimento di Scienze e Tecnologie Ambientali, Biologiche e Farmaceutiche, Università della Campania L. Vanvitelli, Via Vivaldi 43, I-81100, Caserta, Italy
| | - Marina Isidori
- Dipartimento di Scienze e Tecnologie Ambientali, Biologiche e Farmaceutiche, Università della Campania L. Vanvitelli, Via Vivaldi 43, I-81100, Caserta, Italy
| | - Jessica A Deaver
- School for the Environment, University of Massachusetts, 100 Morrissey Blvd., Boston, MA, 02125-3393, United States
| | - Helen C Poynton
- School for the Environment, University of Massachusetts, 100 Morrissey Blvd., Boston, MA, 02125-3393, United States.
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Alehashem M, Baniasadi S. Important exposure controls for protection against antineoplastic agents: Highlights for oncology health care workers. Work 2018; 59:165-172. [PMID: 29439374 DOI: 10.3233/wor-172656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A great number of antineoplastic drugs (ANPDs) are used globally in cancer treatment. Due to their adverse health effects, occupational exposure to ANPDs is considered a potential health risk to health care workers. OBJECTIVE The current study aimed to evaluate safe-handling practices of ANPDs, exposure controls, and adverse health implications for health care providers exposed to ANDPs. METHODS Prevention measures, including engineering, administrative, and work practice controls, as well as personal protective equipment (PPE), were recorded daily through a questionnaire for six weeks. Acute adverse health effects experienced by health care workers were also documented. RESULTS The implemented exposure controls for preparation, administration, cleaning, and waste disposal were not in accordance with the safe handling guidelines. Central nervous system disorders (26.33%) were the most frequent acute adverse effects reported by health care workers. A significant correlation was found between the number of experienced adverse effects and handling characteristics, including the number of preparations (r = 0.38, p < 0.05), dose, and the number of prepared drugs (r = 0.46, p < 0.01 and 0.39, p < 0.05), and working hours in different locations of oncology setting for six weeks (preparation room: r = 0.38, P < 0.05, treatment room: r = 0.46, P < 0.01, patient room: r = 0.63, P < 0.01, and station: r = 0.68, P < 0.01). CONCLUSIONS Due to inadequate control measures, oncology health care workers were in danger of exposure to ANPDs and experienced acute adverse health effects. Implementation of appropriate exposure controls is required to prevent occupational exposure to ANPDs.
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Affiliation(s)
- Maryam Alehashem
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ndaw S, Hanser O, Kenepekian V, Vidal M, Melczer M, Remy A, Robert A, Bakrin N. Occupational exposure to platinum drugs during intraperitoneal chemotherapy. Biomonitoring and surface contamination. Toxicol Lett 2018; 298:171-176. [PMID: 29852276 DOI: 10.1016/j.toxlet.2018.05.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) has been introduced over the last decade for the treatment of peritoneal carcinomatosis. In this procedure, heated cytotoxic drugs are administered directly into the abdominal cavity, ensuring cancer cells to be exposed while reducing systemic toxicity. More recently, pressurized intraperitoneal aerosol chemotherapy (PIPAC), where the chemotherapeutic drug is injected into the peritoneal cavity as an aerosol under pressure, has been proposed to patients in palliative situation, as a new approach. The amount of drug used is up to 10 fold lower than in HIPEC. The use of cytotoxic drugs poses an occupational risk for the operating room personnel. This study investigated the potential exposure of the medical staff by biomonitoring and surface contamination measurements, during a HIPEC procedure and a PIPAC procedure. METHOD Wipe samples were collected from various locations in operating rooms including gloves, hands, devices and floor. Urines samples were collected from 10 volunteers of the medical staff and from a control group. The platinum analysis was performed by inductively coupled plasma mass spectrometry. RESULTS Significant contaminations were observed on the floor, gloves, shoes and devices. However, urinary platinum was below the limit of quantification (<10 ng/L) for more than 50% of samples from the healthcare workers performing HIPEC and PIPAC. Concentrations did not differ significantly from those reported for the control group. CONCLUSION There appears to be little risk of exposure to platinum drugs during HIPEC and PIPAC providing the adequate safety measures are implemented.
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Affiliation(s)
- S Ndaw
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France.
| | - O Hanser
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - V Kenepekian
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - M Vidal
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - M Melczer
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - A Remy
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - A Robert
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - N Bakrin
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Chauchat L, Tanguay C, Caron NJ, Gagné S, Labrèche F, Bussières JF. Surface contamination with ten antineoplastic drugs in 83 Canadian centers. J Oncol Pharm Pract 2018; 25:1089-1098. [PMID: 29726786 DOI: 10.1177/1078155218773862] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to monitor environmental contamination by 10 antineoplastic drugs in Canadian oncology pharmacy and patient care areas. The secondary objective was to explore the impact of factors that may explain contamination. METHODS Twelve standardized sites were sampled in each center (six in the pharmacy and six in patient care areas). Each sample was prepared to allow quantification of seven antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, cytarabine, gemcitabine, 5-fluorouracil, irinotecan) by UPLC-MS-MS. Docetaxel, paclitaxel and vinorelbine were also detected, but not quantified due to sensibility limitations. The impact of some factors was evaluated compared with a Kolmogorov-Smirnov test for independent samples. RESULTS Eighty-three Canadian centers were recruited in 2017. A total of 953 surfaces were sampled, 495 in pharmacy and 458 in patient care areas. Cyclophosphamide was most often found on surfaces (36% of samples positive, 75th percentile 0.0040 ng/cm2). The arm rest (81.7% of samples positive for at least one antineoplastic drug), the front grille inside the hood (78.3%) and the floor in front of the hood (61.4%) were more frequently contaminated. Centers who prepared more antineoplastic drugs per year had higher concentration on different surfaces ( p < 0.0001). CONCLUSION Despite growing awareness and implementation of new safe handling guidelines, healthcare centers' surfaces remain contaminated with traces of many antineoplastic drugs. The use of personal protective equipment remains indisputable. Performing an annual monitoring remains a good indicator to monitor trends over time and to compare with similar centers.
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Affiliation(s)
- L Chauchat
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada
| | - C Tanguay
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada
| | - N J Caron
- 2 Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
| | - S Gagné
- 2 Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
| | - F Labrèche
- 3 Institut de recherche Robert-Sauvé en santé et sécurité du travail, Montréal, Canada.,4 Département de santé environnementale et au travail, École de santé publique, Université de Montréal, Montréal, Canada
| | - J F Bussières
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada.,5 Faculté de pharmacie, Université de Montréal, Montréal, Canada
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Valero S, López-Briz E, Vila N, Solana A, Melero M, Poveda JL. Pre and post intervention study of antiblastic drugs contamination surface levels at a Pharmacy Department Compounding Area using a closed system drug transfer device and a decontamination process. Regul Toxicol Pharmacol 2018; 95:1-7. [PMID: 29510165 DOI: 10.1016/j.yrtph.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/13/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
Assuring healthcare workers security on Hazardous Drugs (HD) compounding is critical in healthcare settings. Our study aims to demonstrate that the use of a Close System drug Transfer Device (CSTD) PhaSeal™ added to a decontamination process reduces antiblastic surface contamination levels in the Compounding Area (CA) of our Pharmacy Department (PD). We selected cyclophosphamide, 5-fluorouracil and iphosphamide to be evaluated. Testing was carried out with a wipe kit and quantified by an independent laboratory. We defined four sampling times: baseline; just after a decontamination procedure, which was repeated weekly during the study; four months after introduction of CSTD PhaSeal™ for cyclophosphamide and 5-fluorouracil compounding; and after eight months using CSTD PhaSeal™ for cyclophosphamide and 5-fluorouracil and one month for iphosphamide compounding. There was a decrease at the number of positive samples at the beginning/end of the study for all the drugs tested: 28/15 for cyclophosphide, 29/23 for iphosphamide and 7/1 for 5-fluorouracile. Comparing to the baseline, median cyclophosphamide levels significantly decreased (p-value <0.001) at 4 and 8 months sampling time (baseline: 1.01 ng/cm2 to 0.06 ng/cm2 and 0.01 ng/cm2), and median iphosphamide levels significantly decreased (p < 0.001) at 8 months sampling time (baseline: 3.02 ng/cm2 to 0.06 ng/cm2). 5-Fluorouracil did not show significant differences between the sampling times (baseline: 0.09 ng/cm2 to 0.09 ng/cm2). We saw a significant increase at iphosphamide levels at 4 months sampling point, contrary to cyclophosphamide, which levels had decreased. The use of CSTD PhaSeal™ for iphosphamide compounding the last month was implemented for ethical reasons after this intermediate results review. Our study suggests that the use of CSTD PhaSeal™, adding to decontaminating procedures, significantly reduces antiblastic drug surface levels at the CA of our PD.
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Affiliation(s)
- Silvia Valero
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | | | - Nieves Vila
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Solana
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Mar Melero
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Gajski G, Ladeira C, Gerić M, Garaj-Vrhovac V, Viegas S. Genotoxicity assessment of a selected cytostatic drug mixture in human lymphocytes: A study based on concentrations relevant for occupational exposure. ENVIRONMENTAL RESEARCH 2018; 161:26-34. [PMID: 29100207 DOI: 10.1016/j.envres.2017.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
Cytostatic drugs are highly cytotoxic agents used in cancer treatment and although their benefit is unquestionable, they have been recognized as hazardous to healthcare professionals in occupational settings. In a working environment, simultaneous exposure to cytostatics may occur creating a higher risk than that of a single substance. Hence, the present study evaluated the combined cyto/genotoxicity of a mixture of selected cytostatics with different mechanisms of action (MoA; 5-fluorouracil, cyclophosphamide and paclitaxel) towards human lymphocytes in vitro at a concentration range relevant for occupational as well as environmental exposure. The results suggest that the selected cytostatic drug mixture is potentially cyto/genotoxic and that it can induce cell and genome damage even at low concentrations. This indicates not only that such mixture may pose a risk to cell and genome integrity, but also that single compound toxicity data are not sufficient for the prediction of toxicity in a complex working environment. The presence of drugs in different amounts and with different MoA suggests the need to study the relationship between the presence of genotoxic components in the mixture and the resulting effects, taking into account the MoA of each component by itself. Therefore, this study provides new data sets necessary for scientifically-based risk assessments of cytostatic drug mixtures in occupational as well as environmental settings.
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Affiliation(s)
- Goran Gajski
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Carina Ladeira
- Grupo de Investigação em Ambiente e Saúde, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal; Grupo de Investigação em Genética e Metabolismo, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal.
| | - Marko Gerić
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Vera Garaj-Vrhovac
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Susana Viegas
- Grupo de Investigação em Ambiente e Saúde, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
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Verdun-Esquer C, Atge B, Videau N, Delva F, Leclerc I, Goujon Y, Canal-Raffin M. Exposition du personnel des établissements de soin aux médicaments anticancéreux : de l’évaluation à la prévention. ARCH MAL PROF ENVIRO 2017. [DOI: 10.1016/j.admp.2017.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Willaert W, Sessink P, Ceelen W. Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC). Pleura Peritoneum 2017; 2:121-128. [PMID: 30911641 PMCID: PMC6328076 DOI: 10.1515/pp-2017-0018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/23/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel method to treat extensive, small volume peritoneal metastases. The clinical use of chemotherapy containing aerosols represents a potential occupational health hazard. We report the results of toxicological analysis during the first two clinical PIPAC procedures performed at Ghent University Hospital. METHODS After extensive preparation and in vitro testing, two patients were treated with PIPAC: the first using doxorubicin (2.86 mg in 51.43 mL) and cisplatin (14.28 mg in 164.3 mL), the second using oxaliplatin (182.10 mg in 186.42 mL). A standardized safety checklist was developed and used. Aerosol delivery was combined with electrostatic precipitation (ePIPAC). The following samples were obtained at several time points and locations: environmental air, floor surface wipes, surgeon's gloves, surgeon's hand wipes, circuit filters, and fluid from the water seal collection chamber container placed along the closed aerosol waste evacuating line. Platinum concentration was measured in these samples using voltammetry. Sample collection and analysis were performed by an independent external laboratory. RESULTS Platinum was not detected on the four floor locations after both procedures (detection limit 0.02 ng/cm2). Similarly, no platinum was detected in environmental air during both PIPACs at the surgeon's or anesthesiologist's position (detection limit 4.0-27 ng/m3). No platinum contamination was detected on the hands, outer pair of gloves, or inner pair of gloves of the surgeon (detection limit 70 and 50 ng respectively). Platinum was not detected on the filters and in the air-seal container liquid. CONCLUSIONS With adequate preparation and precautions, a clinical PIPAC program can be established without measurable chemotherapy exposure to the operating room environment or healthcare workers.
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Affiliation(s)
- Wouter Willaert
- Department of GI Surgery, Ghent University Hospital, route 1275, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Sessink
- Exposure Control Sweden AB, Bohus-Björkö, Sweden
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, route 1275, De Pintelaan 185, 9000, Ghent, Belgium
- Cancer research institute Ghent (CRIG), Ghent, Belgium
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Roussel C, Witt KL, Shaw PB, Connor TH. Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 781:207-217. [PMID: 31416576 DOI: 10.1016/j.mrrev.2017.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/15/2022]
Abstract
Many antineoplastic drugs used to treat cancer, particularly alkylating agents and topoisomerase inhibitors, are known to induce genetic damage in patients. Elevated levels of chromosomal aberrations, micronuclei, and DNA damage have been documented in cancer patients. Elevations in these same biomarkers of genetic damage have been reported in numerous studies of healthcare workers, such as nurses and pharmacists, who routinely handle these drugs, but results vary across studies. To obtain an overall assessment of the exposure effect, we performed a meta-analysis on data obtained from peer-reviewed publications reporting chromosomal aberration levels in healthcare workers exposed to antineoplastic drugs. A literature search identified 39 studies reporting on occupational exposure to antineoplastic drugs and measurement of chromosomal aberrations in healthcare workers. After applying strict inclusion criteria for data quality and presentation, data from 17 studies included in 16 publications underwent meta-analysis using Hedges' bias-corrected g and a random-effects model. Results showed the level of chromosomal aberrations in healthcare workers exposed to antineoplastic drugs was significantly higher than in controls. The standardized mean differences (difference of means divided by within sd) from all studies were pooled, yielding a value 1.006 (unitless) with p<0.001. Thus, in addition to the documented genotoxic effects of antineoplastic drugs in cancer patients, this meta-analysis confirmed a significant association between occupational exposure to antineoplastics during the course of a normal work day and increases in chromosomal aberrations in healthcare workers. Based on the studies reviewed, we were unable to accurately assess whether appropriate use of protective measures might reduce the incidence of genetic damage in healthcare workers. However, given the potential for increased cancer risk linked to increases in chromosomal aberrations, the results of this study support the need to limit occupational exposure of healthcare workers to antineoplastic drugs as much as possible.
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Affiliation(s)
- Christine Roussel
- Doylestown Hospital, 595 West State Street, Doylestown, PA, 18901, United States.
| | - Kristine L Witt
- Biomolecular Screening Branch, National Institute of Environmental Health Sciences/Division of the National Toxicology Program, Research Triangle Park, NC, 27709, United States.
| | - Peter B Shaw
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
| | - Thomas H Connor
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
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Assessment of the genotoxicity of the tyrosine kinase inhibitor imatinib mesylate in cultured fish and human cells. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 814:14-21. [DOI: 10.1016/j.mrgentox.2016.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
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Gajski G, Gerić M, Domijan AM, Garaj-Vrhovac V. Combined cyto/genotoxic activity of a selected antineoplastic drug mixture in human circulating blood cells. CHEMOSPHERE 2016; 165:529-538. [PMID: 27681109 DOI: 10.1016/j.chemosphere.2016.09.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
Antineoplastic drugs are highly cytotoxic chemotherapeutic agents that can often interfere directly or indirectly with the cell's genome. In an environmental or medical setting simultaneous exposure may occur. Such multiple exposures may pose a higher risk than it could be assumed from the studies evaluating the effect of a single substance. Therefore, in the present study we tested the combined cyto/genotoxicity of a mixture of selected antineoplastic drugs with different mechanisms of action (5-fluorouracil, etoposide, and imatinib mesylate) towards human lymphocytes in vitro. The results suggest that the selected antineoplastic drug mixture is potentially cyto/genotoxic and that it can induce cell and genome damage even at low concentrations. Moreover, the changes in the measured oxidative stress parameters suggest the participation of reactive oxygen species in the cyto/genotoxicity of the selected mixture. The obtained results indicate not only that such mixtures may pose a risk to cell and genome integrity, but also that single compound toxicity data are not sufficient for the predicting toxicity in a complex environment. Altogether, the results emphasise the need for further toxicological screening of antineoplastic drug mixtures, especially at low environmentally relevant concentrations, as to avoid any possible adverse effects on the environment and human health.
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Affiliation(s)
- Goran Gajski
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
| | - Marko Gerić
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
| | - Ana-Marija Domijan
- University of Zagreb, Faculty of Pharmacy and Biochemistry, A. Kovačića 1, 10000 Zagreb, Croatia.
| | - Vera Garaj-Vrhovac
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
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