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Garnier A, Bonnabry P, Bouchoud L. Using simulation to improve pharmacy operators' handling of cytotoxic spills. J Oncol Pharm Pract 2024:10781552241237441. [PMID: 38444168 DOI: 10.1177/10781552241237441] [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: 03/07/2024]
Abstract
INTRODUCTION International Society of Oncology Pharmacy Practitioners guidelines recommend having standard operating procedures (SOPs) and initial and yearly retraining programs on cytotoxic spill handling for pharmacy operators (POs). This study aimed to create a simulation-based training (SBT) program on this subject and evaluate its impact on POs' real-life performance. METHODS Randomly formed pairs of POs underwent a 2.5-hour training program, including two simulation exercises (a broken cytotoxic vial on the floor and a leaking cytotoxic bag) in a simulated pharmacy production unit. Each participant applied the cytotoxic spill handling SOPs. The PO and trainer-pharmacist did a debriefing after each exercise. Satisfaction was recorded on a 0-to-100% scale. A 20-item questionnaire assessed general knowledge about cytotoxic spill handling before and after the training. One month before and one month after the training, the POs underwent a real-life test when the trainer broke a fake cytotoxic vial in the cytotoxic storage area. Their performance in applying the SOPs was assessed on a 20-point checklist, and the time to handle the spill was recorded. RESULTS Twelve POs participated. Mean satisfaction score was 98.9%. Mean knowledge score improved from 10.8/20 (SD = 2.0) before training to 14.5/20 (SD = 1.6) after training (p < 0.05). Mean real-life SOP performance improved from 78.6% (SD = 7.4%) to 97.1% (SD = 5.2%) (p < 0.05). Mean time to handle cytotoxic spills decreased from 17.3 minutes (SD = 3.6 minutes) to 11.9 minutes (SD = 1.5 minutes) (p < 0.05). CONCLUSION POs improved their knowledge and real-life competencies for handling cytotoxic spills. This training will be included in POs' initial and continuing training programs.
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Affiliation(s)
- Alexandra Garnier
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Lucie Bouchoud
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
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Caron G, Vasseur M, Courtin J, Masse M, Décaudin B, Genay S, Odou P, Simon N. Evaluation of cancer drug infusion devices prior to the implementation of a compounding robot. J Oncol Pharm Pract 2024; 30:251-256. [PMID: 37203170 DOI: 10.1177/10781552231170792] [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: 05/20/2023]
Abstract
INTRODUCTION Compounding robots are increasingly being implemented in hospital pharmacies. In our hospital, the recent acquisition of a robot (RIVATM, ARxIUM) for intravenous cancer drug compounding obliged us to replace the previously used infusion devices. The objective of the present study was to assess and qualify the new intravenous sets prior to their use in our hospital and prior to the implementation of the compounding robot. MATERIALS AND METHODS The ChemoLockTM (ICU Medical) was compared with the devices used previously for compounding (BD PhaSealTM, Becton-Dickinson) and infusion (Connect-ZTM, Codan Medical). The connection/disconnection of infusion devices to/from 50 mL infusion bags was tested with a dynamometer (Multitest-i, Mecmesin). Leakage contamination was visualized by a methylene blue assay and was quantified in simulated pump infusions with 20 mg/mL quinine sulfate (N = 36/group); after the analytical assay had been validated, quinine was detected by UV-spectrophotometry at 280 and 330 nm. Groups were compared using chi-squared or Mann-Whitney U tests. RESULTS The connection/disconnection test showed that although all the devices complied with the current standard, there was a statistically significant difference in the mean ± standard deviation compression force (51.5 ± 11.6 for the Connect-ZTM vs. 60.3 ± 11.7 for the ChemoLockTM; p = 0.0005). Leaks were detected in 32 (29.1%) of the 110 tests of the ChemoLockTM. The contamination rates were also significantly different: 13.9% for the BD PhaSealTM versus 75.0% for the ChemoLockTM; p < 0.0001). DISCUSSION/CONCLUSION Our results showed that the new infusion device complied with current standards. However, the presence of contamination emphasizes the need for operators to use the recommended personal protective equipment. Further studies of contamination with cancer drugs are required.
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Affiliation(s)
| | - Michèle Vasseur
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | - Morgane Masse
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Décaudin
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Stéphanie Genay
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Odou
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Nicolas Simon
- Institut de Pharmacie, CHU Lille, Lille, France
- Université de Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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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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Murphy KD, O' Mahony C, McCarthy M, Saab MM, Barbosa TM, Fleming A, Cotter P, Noonan B, Breen E, Carroll G, De Frein A, Heckmann P, Triggs M, Sahm L. Quality assurance standards and their use in the preparation of parenteral systemic anticancer therapy products in healthcare establishments: a scoping review. Eur J Hosp Pharm 2024; 31:88-93. [PMID: 37879730 PMCID: PMC10895183 DOI: 10.1136/ejhpharm-2023-003922] [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: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES The use of parenteral systemic anticancer therapy (SACT) has led to improved cancer survival. A quality assurance (QA) system of the aseptic compounding process is necessary to ensure safe and consistent production of parenteral SACT. This scoping review identifies international evidence and practice relating to QA standards in the preparation of parenteral SACT in healthcare establishments. METHODS Standards relating to aseptic compounding in hospital pharmacies and literature exploring the aseptic compounding of parenteral SACT were included. Literature relating to the non-aseptic compounding of medicines and records specific to sterile manufacturing in industrial settings were excluded. A search of several electronic databases, trial registries, the grey literature and websites of key European hospital pharmacy groups and accreditation bodies was conducted on 16 March 2022. A narrative discussion was performed by country, and content analysis of articles was conducted. RESULTS Thirty-seven records were included. Standards reviewed covered the work environment, the preparation process and the safety of the workers who are potentially exposed to hazardous chemicals. It was a common practice to include frequent audits to ensure adherence to standards. Some standards also recommended external inspections to allow for further learnings. Periodic reviews are encouraged to ensure standards maintain relevance. National standards of the countries reviewed were based on international standards, with minor adaptations for local conditions. CONCLUSIONS The main limitation of this review is that it is limited to countries with a high human development index. The review shows that the use of an internationally recognised standard as a basis for national standards is best practice, and will allow for relevance into the future.
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Affiliation(s)
- Kevin D Murphy
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Cian O' Mahony
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Megan McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Aoife Fleming
- School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Patrick Cotter
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brendan Noonan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elizabeth Breen
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Grant Carroll
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - AnneMarie De Frein
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Patricia Heckmann
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Margaret Triggs
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Laura Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
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Yuan Z, Li Q, Tang T, Zhang M, Liu Y, Liu L. Studies on the optimization of decontamination protocol for surfaces contaminated with cytotoxic drugs in PIVAS. J Oncol Pharm Pract 2023; 29:1565-1573. [PMID: 36544379 DOI: 10.1177/10781552221138331] [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: 10/28/2023]
Abstract
PURPOSE The goal of this study was to create a cleaning procedure by comparing the performance of six different cleaning methods on the surfaces in pharmacy intravenous admixture service (PIVAS) work area. METHOD A stainless steel plate was simulating contaminated by gemcitabine, cyclophosphamide, epirubicin, etoposide, and paclitaxel, which was then dried and cleaned by per current cleaning protocols. The residues were collected and quantified by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Based on the most appropriate cleaning protocol, three cleaning variables were optimized: (1) use of dry gauze after cleaning agent application; (2) cleaning paths (inside-out vs. outside-in); (3) cleaning times (once or twice). Best conditions were tested with real samples from a hospital PIVAS. RESULTS This 10-2 M sodium dodecyl sulfate (SDS) and dry gauze cleaning protocol increases cleaning efficiency as well as saves time. Different from the traditional cleaning manner, we found that cleaning from outside to inside can not only improve the cleaning efficiency but also overcome the uneven distribution of drug residues caused by cleaning action. When simulating contamination at a high dose (4 mg/mL) level, it was found that the decontamination efficacy increased with repeating one more time. CONCLUSION The 10-2 M SDS and dry gauze cleaning protocol could obtain the best cleaning effect. The success of cytotoxic drug decontamination is determined not only by the cleaning solution, but also by the cleaning route and frequency. Compared with the traditional cleaning manner, there was a significant reduction in the contamination levels in the PIVAS work area after the cleaning protocol with 10-2 M SDS and dry gauze.
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Affiliation(s)
- Zhongzhen Yuan
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Qiaoqiao Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Tiantian Tang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Min Zhang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu Liu
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling Liu
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
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Miyazawa M, Yamashita R, Ichinohe Y, Kohzai Y, Kishimoto K. Cyclophosphamide exposure via sweat of patients receiving CHOP therapy. J Oncol Pharm Pract 2023; 29:1646-1651. [PMID: 36514300 DOI: 10.1177/10781552221145507] [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: 12/15/2022]
Abstract
INTRODUCTION "Secondary exposure to anticancer drugs" refers to exposure to anticancer drugs after chemotherapy via the patient's urine and other excretions. The necessity of countermeasures against secondary exposure to anticancer drugs has been recently highlighted. Although anticancer drugs are also excreted through sweat, few studies have reported exposure to drug residues via this route. We investigated the amount of cyclophosphamide (CPA) excreted in the sweat of patients receiving CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). METHODS The study population included eight patients with malignant lymphoma who received CHOP therapy between May and December 2021. The amount of CPA in their underwear (namely, cotton short-sleeved shirts) worn from the start of the CHOP therapy until 24 h after the end of CPA administration was measured, using liquid chromatography-mass spectrometry (LC-MS/MS). RESULTS CPA was detected in the underwear of all the patients, with levels ranging between 7.38 and 160.77 ng/cm2. No subjective changes were observed in the sweating status of any patients during the study period. CONCLUSIONS These results suggested that patients' sweat, as well as urine, is a potential route for exposure to anticancer drugs. Whether visibly contaminated or not, the clothing and linen worn directly by patients should be handled as a source of sweat-mediated exposure to anticancer drugs both in medical facilities and at home.
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Affiliation(s)
- Maho Miyazawa
- Showa University Graduate School of Pharmacy, Tokyo, Japan
- Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Rina Yamashita
- Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yui Ichinohe
- Department of Nursing, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasuji Kohzai
- Department of Hematology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Bláhová L, Bláha L, Doležalová L, Kuta J, Hojdarová T. Proposals of guidance values for surface contamination by antineoplastic drugs based on long term monitoring in Czech and Slovak hospitals and pharmacies. Front Public Health 2023; 11:1235496. [PMID: 37780438 PMCID: PMC10537921 DOI: 10.3389/fpubh.2023.1235496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction The exposures to hazardous antineoplastic drugs (AD) represent serious risks for health care personnel but the exposure limits are not commonly established because of the no-threshold effects (genotoxic action, carcinogenicity) of many ADs. In this study, we discussed and derived practically applicable technical guidance values (TGV) suitable for management of AD risks. Methods The long-term monitoring of surface contamination by eight ADs was performed in pharmacies and hospitals in the Czech Republic and Slovak Republic in 2008-2021; in total 2,223 unique samples were collected repeatedly in 48 facilities. AD contamination was studied by LC-MS/MS for cyclophosphamide, ifosfamide, methotrexate, irinotecan, paclitaxel, 5-fluorouracil and gemcitabine and by ICP-MS for total Pt as a marker of platinum-based ADs. Results The study highlighted importance of exposure biomarkers like 5-fluorouracil and especially carcinogenic and persistent cyclophosphamide, which should be by default included in monitoring along with other ADs. Highly contaminated spots like interiors of laminar biological safety cabinets represent a specific issue, where monitoring of contamination does not bring much added value, and prevention of staff and separated cleaning procedures should be priority. Rooms and surfaces in health care facilities that should be virtually free of ADs (e.g., offices, kitchenettes, daily rooms) were contaminated with lower frequency and concentrations but any contamination in these areas should be carefully examined. Discussion and conclusions For all other working places, i.e., majority of areas in pharmacies and hospitals, where ADs are being prepared, packaged, stored, transported, or administered to patients, the study proposes a generic TGV of 100 pg/cm2. The analysis of long-term monitoring data of multiple ADs showed that the exceedance of one TGV can serve as an indicator and trigger for improvement of working practices contributing thus to minimizing of unintended exposures and creating a safe work environment.
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Affiliation(s)
- Lucie Bláhová
- RECETOX, Faculty of Science, Masaryk University, Brno, Czechia
| | - Luěek Bláha
- RECETOX, Faculty of Science, Masaryk University, Brno, Czechia
| | | | - Jan Kuta
- RECETOX, Faculty of Science, Masaryk University, Brno, Czechia
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Puisset F, Le Louedec F, Dalenc F, Verguet L, De Maio E, Lacaze JL, Montastruc M, Ung M, Vinson C, Perriat S, Pacher S, Chatelut E, Koning MW. Investigating the clinical impact of dose-banding for weekly paclitaxel in patients with breast cancer: A retrospective and monocentric study. Br J Clin Pharmacol 2023; 89:2283-2294. [PMID: 36854898 DOI: 10.1111/bcp.15702] [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: 12/22/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
AIMS Dose-banding (DB) consists in approximating the theoretical dose of anticancer drugs calculated according to the body surface area (Dose-BSA) of patients. This concept is supported by pharmacokinetic but not by clinical data. The aim of this study was to assess the clinical outcome of DB defined as dose-fitting up to ±10%. METHODS This was a retrospective study conducted in patients receiving weekly paclitaxel in neoadjuvant (NAT) and metastatic (M+) settings. Three groups of patients were considered according to type of paclitaxel dosing: Dose-BSA, DB approximated down (DB-Low) and DB approximated up (DB-High). Efficacy was evaluated by the rate of pathological complete response for patients in NAT setting and by the median of progression-free survival plus overall survival for those in M+ setting. Toxicity and efficacy were compared in the 3 groups. RESULTS A total of 224 and 209 patients were assessable in the M+ and NAT settings, respectively. A toxic event was observed for 31.7 and 27.3% in M+ and NAT, respectively. The rate of pathological complete response was 41.6% in NAT. The median progression-free survival was 5.2 (4.1-5.8) months and overall survival was 16.3 (14.6-18.4) months for patients in M+. Efficacy and toxicity were not different in DB-Low and DB-High groups compared to Dose-BSA group. CONCLUSION DB with approximated doses up to ±10% does not seem to influence clinical outcome of patients treated with weekly paclitaxel. This is the first study to include clinical observations, which lends support to DB as a safe and effective dosing method.
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Affiliation(s)
- Florent Puisset
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse, France
- Pharmacy Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Félicien Le Louedec
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse, France
| | - Florence Dalenc
- Medical Oncology Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Lorène Verguet
- Pharmacy Department IUCT (Institut Universitaire du Cancer) Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Eleonora De Maio
- Medical Oncology Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Jean Louis Lacaze
- Medical Oncology Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Marion Montastruc
- Medical Oncology Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Mony Ung
- Medical Oncology Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Camille Vinson
- Pharmacy Department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Sophie Perriat
- Pharmacy Department IUCT (Institut Universitaire du Cancer) Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Sandrine Pacher
- Pharmacy Department IUCT (Institut Universitaire du Cancer) Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Etienne Chatelut
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse, France
| | - Mélanie White Koning
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse, France
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Gagaille MP, Leclerc V, Allard J, Marty F, Treguier B, Bonnet M, Pons-Kerjean N. Qualification and impact of a video-assisted control system in a chemotherapy compounding unit. Eur J Hosp Pharm 2023:ejhpharm-2023-003692. [PMID: 37076270 DOI: 10.1136/ejhpharm-2023-003692] [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: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Anticancer drug preparation control is essential to ensure quality and patient safety. Drugcam (Eurekam Company) is a digital video-assisted control system based on artificial intelligence methods to identify vials used and volumes withdrawn. As for any control system, qualification is required before use in a chemotherapy compounding unit (CCU). METHODS We conducted an operational qualification (sensitivity, specificity and accuracy assessment of vials and volumes recognition and quantitative analysis of measured volumes) and a performance qualification (comparison with visual control) of Drugcam in our CCU, as well as an impact study on compounding time and compound supply time. RESULTS Sensitivity, specificity and accuracy of vials (94%, 98% and 96%, respectively) and volumes (86%, 96% and 91%, respectively) recognition are satisfactory. It depends on both the object presented and the camera tested. False positives, which could lead to release of non-compliant preparation, were detected. Volume reading errors may exceed the tolerance threshold of ±5% for small volumes. Drugcam did not significantly lengthen compounding time and compound supply time. CONCLUSIONS No recommendations for a qualification method of this new type of control equipment exist. However, a qualification process is essential to understand tool limitations and integrate them into the CCU risk management system. Drugcam enables anticancer drug preparation to be secure and is also useful for initial and continuous staff training.
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Saint-Lorant G, Vasseur M, Allorge D, Beauval N, Simon N, Odou P. Four-year follow-up of surface contamination by antineoplastic drugs in a compounding unit. Occup Environ Med 2023; 80:146-153. [PMID: 36717254 DOI: 10.1136/oemed-2022-108623] [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: 08/24/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to monitor the contamination by antineoplastic drugs on work surfaces in a compounding unit 4 years after its implementation. METHODS This descriptive study was done in a unit performing on average 45 000 preparations per year. Surface sampling points (N=23) were monitored monthly in the frame of routine activity from the opening of an anticancer drug compounding unit. Contamination with nine antineoplastic drugs (cyclophosphamide, ifosfamide, dacarbazine, 5-fluorouracil, methotrexate, gemcitabine, cytarabine, irinotecan and doxorubicin) was assessed on wipes with a local liquid chromatography coupled with a tandem mass spectrometer analysis. The contamination rate (CR, %) was prospectively monitored every month during the entire study period. The occurrence of critical incidents was also registered. The effect of each safety measure implemented during this period was also analysed. RESULTS Based on the 1104 samples collected between March 2016 and March 2020, the CR was 18.5%. If three different critical incidents among a vial breakage that occurred were individually considered, this CR was slightly lower than that in the literature. Eight months after opening and taking different corrective actions, the overall CR dropped from 42.39% to 11.52% (p<0.001). Contamination was limited to the area that includes the compounding room and, more precisely, the welder and the QC-Prep+ sampling points. CONCLUSIONS From the beginning of the study and from month to month, surface contamination was limited to the nearest sampling points to the compounding unit. This 4-year monitoring study allowed us to determine the intravenous conventional antineoplastic drugs and sampling points to be focused on.
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Affiliation(s)
- Guillaume Saint-Lorant
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France .,Pharmacy, CHU Caen, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
| | - Delphine Allorge
- ULR-4483-IMPECS-IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France.,CHRU, Lille, France
| | | | - Nicolas Simon
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
| | - Pascal Odou
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
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11
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O'Connor S, Matthews H, Hornby C. VicTAG chemotherapy audit toolkit: Improving chemotherapy quality and safety. J Oncol Pharm Pract 2023; 29:416-421. [PMID: 36567674 DOI: 10.1177/10781552221148118] [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: 12/27/2022]
Abstract
OBJECTIVE Off-protocol prescribing of systemic anti-cancer therapy (SACT) can lead to concerns about effectiveness of patient care. To identify variations in practice, a toolkit was developed for health services to address patient safety and the risk of sub-optimal outcomes for patients. DATA SOURCES Following significant incidents with SACT in South Australia and New South Wales, the Department of Health and Human Services, Victoria (the department) conducted an assessment of Victorian public health services to understand current practice regarding SACT protocol governance. A literature review examining SACT auditing was also undertaken to guide improvements. A department supported Chemotherapy Audit Toolkit (CAT) was created for implementation at public hospitals in Victoria. A post-implementation survey was done on uptake and issue identification. DATA SUMMARY An initial assessment showed that 27% of Victorian public health services were undertaking retrospective review of SACT dosing, which was targeted for improvement. The literature review identified little guidance, however an audit of current sector practices found several audit methodologies. A process that involved audits by health services assessing their own practice was adopted. The toolkit was developed and piloted with health services. A post-implementation survey showed that 20% of services were using the toolkit, 35% were implementing the toolkit and 45% did not use the toolkit. CONCLUSIONS The VicTAG CAT has been adopted by more than half of Victorian public health services and is being used to influence prescribing. Implementation of the toolkit has been affected by resource reallocation due to the COVID-19 pandemic. The CAT is available online.
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Affiliation(s)
- Shaun O'Connor
- Department of Health, Commissioning and System Improvement, Melbourne, Australia.,60078St Vincent's Public Hospital, Melbourne, Australia
| | - Helen Matthews
- Victorian Therapeutic Advisory Group, Melbourne, Australia
| | - Colin Hornby
- Department of Health, Commissioning and System Improvement, Melbourne, Australia
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12
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Kato G, Mitome H, Teshima K, Tawa K, Hakuba Y, Tanabe T, Funahashi T, Hatae N, Koike Y, Hasebe M, Hidaka N, Tanaka M, Akira K. Study on the Use of Ozone Water as a Chemical Decontamination Agent for Antineoplastic Drugs in Clinical Settings. Ann Work Expo Health 2023; 67:241-251. [PMID: 36416483 DOI: 10.1093/annweh/wxac075] [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: 06/25/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
The exposure of healthcare workers to antineoplastic drugs in hospitals has been recognized to be harmful. To minimize the risk of exposure, the removal of these drugs from work environments, such as compounding facilities, has been recommended. In our previous paper, the degradation and inactivation efficacy of ozone water, which is being introduced into Japanese hospitals as a chemical decontamination agent, was reported for its effects on typical antineoplastic drugs (gemcitabine, irinotecan, paclitaxel). This article aims to further investigate the efficacy of ozone water for eight antineoplastic drugs to clarify its application limitations. A small amount (medicinal ingredient: typically ca. 1.5 μmol) of formulation containing 5-fluorouracil, pemetrexed, cisplatin, oxaliplatin, cyclophosphamide, ifosfamide, doxorubicin, or docetaxel was mixed with 50 mL of ozone water (~8 mg/L), and the resulting solutions were analyzed by high-performance liquid chromatography over time to observe the degradation. Consequently, the ozonation was overall effective for the degradation of the drugs, however this varied depending on the chemical structures of the drugs and additives in their formulations. In addition, after the parent drugs were completely degraded by the ozonation, the degradation mixtures were subjected to 1H nuclear magnetic resonance spectroscopy and evaluated for mutagenicity against Salmonella typhimurium strains and cytotoxicity against human cancer cells. The degradation mixtures of cisplatin and ifosfamide were mutagenic while those of the other drugs were non-mutagenic. Further, the ozonation resulted in clear decreases of cytotoxicity for 5-fluorouracil, oxaliplatin, and doxorubicin, but increases of cytotoxicity for pemetrexed, cisplatin, cyclophosphamide, and ifosfamide. These results suggest that the ozone water should be restrictedly used according to the situation of contamination in clinical settings because the ozonation enhances toxicity depending on the drug even if degradation is achieved.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Kenichiro Teshima
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Kanako Tawa
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Yui Hakuba
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Tomotaka Tanabe
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Tatsuya Funahashi
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Noriyuki Hatae
- Faculty of Pharmaceutical Sciences, Yokohama University of Pharmacy, 601 Matano, Totsuka-ku, Yokohama, Kanagawa 245-0066, Japan
| | - Yasumasa Koike
- Division of Pharmacy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Masafumi Hasebe
- Division of Pharmacy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
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13
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Müller-Ramírez C, Almashat S, Gaitens J, McDiarmid M. Carcinogenic drug exposure among health-sector workers: the need for exposure assessment and surveillance. Rev Panam Salud Publica 2023; 47:e11. [PMID: 36909803 PMCID: PMC9976270 DOI: 10.26633/rpsp.2023.11] [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: 05/13/2022] [Accepted: 09/29/2022] [Indexed: 03/06/2023] Open
Abstract
Antineoplastic drugs (ANDs) used for chemotherapy can cause secondary cancers in treated patients and can pose carcinogenic risks to health-sector workers anywhere along these drugs' life cycle in a facility, from production to patient administration. Several PAHO/WHO Collaborating Centers (CCs) have experience addressing these hazards in the health sector. The objectives of this report are four-fold: 1) Provide an overview of longstanding research and prevention efforts, led by PAHO/WHO and its Occupational Health CCs, aimed at reducing the burden of occupational cancer in the Americas; 2) Discuss how robust AND exposure assessment and educational/outreach work by PAHO CCs can form the basis of exposure mitigation efforts among health-sector workers; 3) Through the presentation of original AND exposure assessment data from a pharmaceutical compounding facility in Chile, highlight relatively inexpensive methods by which such data can be generated; and 4) Discuss how effective, periodic environmental surveillance in healthcare facilities results in the identification of AND contamination in the work environment and enables the implementation of low-cost, high-impact interventions to reduce the risk of occupational cancer in health-sector workers, including in limited-resource settings. The risk of health-sector worker exposure to ANDs and other hazardous drugs is an important issue for inclusion within PAHO/WHO's broader efforts at reducing the impact of occupational cancer in the Americas. This report demonstrates that a wide range of accessible AND-exposure mitigation strategies are feasible at both a facility and a national policy level across the hemisphere.
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Affiliation(s)
| | - Sammy Almashat
- University of Maryland Baltimore United States of America University of Maryland, Baltimore, United States of America
| | - Joanna Gaitens
- University of Maryland Baltimore United States of America University of Maryland, Baltimore, United States of America
| | - Melissa McDiarmid
- University of Maryland Baltimore United States of America University of Maryland, Baltimore, United States of America
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14
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Perego G, Longobardo G, Baldisserotto A, Feliciani M, Fazio M. Automated chemotherapy compounding: Process optimization for the preparation of admixture containing high-dose of cyclophosphamide. J Oncol Pharm Pract 2023; 29:208-210. [PMID: 36172633 DOI: 10.1177/10781552221130012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Maria Fazio
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
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15
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Eisenberg S. Closed safety system for administration (CSSA): proposal for a new cytotoxic chemotherapy acronym. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S32. [PMID: 35648666 DOI: 10.12968/bjon.2022.31.10.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exposure to cytotoxic chemotherapy can result in acute and chronic conditions including nausea, headaches, rashes, miscarriages, infertility and genetic aberrations. Surface contamination can occur during drug administration, and can subsequently spread throughout the healthcare environment. Dermal contact with contaminated surfaces can lead to drug absorption. Closed system drug-transfer devices (CSTDs) were initially developed to protect pharmacists during compounding. Components include a vial adapter to prevent pressurisation leakage and a syringe connector for transferring the drug to the intravenous infusion bag. Membrane-based CSTDs require a Luer adapter for drug administration whereas Luer system-based products do not. Most European nurses are familiar with needleless connectors. Unfortunately, these devices do not provide protection from chemotherapy exposure. To decrease confusion, CytoPrevent, a multi-national, primarily European organisation has proposed the term 'closed safety system for administration' (CSSA) for Luer based CSTDs. Along with education, the new term can help promote safety for nurses administering cytotoxic chemotherapy.
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Affiliation(s)
- Seth Eisenberg
- Professional Practice Coordinator, Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington USA
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