Chemo Drugs Toxic to Nurses and Pharmacists
By Charlotte Gerson
There appeared a report in JAMA (Journal of the American Medical Association) dated January 1, 1982 (!), under the heading "Medical News" regarding tests done on hospital personnel who handle ‘anti-cancer drugs’ that may cause them ‘cancer risks’.
The article starts by saying "Although many antineoplastic (chemotherapy) drugs also are documented carcinogens, their therapeutic benefits usually far outweigh the potential risks to patients with cancer. But a recent study demonstrates that an unjustified hazard exists for another population exposed to chemotherapeutic agents—the hospital personnel who prepare them."
There follows a technical description of the specific urine tests done and the effects of the drugs on the handlers’ urine. Nine pharmacists worked six consecutive days preparing (reconstituting) chemotherapy doses in horizontal laminar flow hoods which blow filtered air across the work surfaces and toward those persons working in them. The drugs included doxorubicin and cyclophosphamide and others. After day one, the urine samples collected showed an increasingly elevated mutation rate that became significant (twice the spontaneous rate) on days 4 to 7. "Our conclusions from this study are that we should be concerned about the potential for mutation caused by exposure to these drugs.
"In another phase of the study, the pharmacists donned masks approved by the Occupational Safety and Health Administration for use with aerosolized compounds to alleviate exposure to drugs during preparation, but with little success. Protecting the pharmacists hands with disposable gloves also did not decrease the mutation rates induced, according to the urine samples. (Emphasis ours)
Only after pharmacists reconstituted the drugs in flow hoods did the mutation rates return to background levels. In response to these findings, M.D. Anderson Hospital acquired several flow hoods and began to segregate unused chemotherapeutic drugs, syringes, needles and intravenous tubing as hazardous wastes to be incinerated."
"Interest in performing these studies arose from several previous investigations that had suggested that workers exposed to anti-cancer drugs may suffer untold effects. Two cytological studies of Scandinavian nurses who handled cytotoxic drugs found an increased frequency of ‘sister chromatic exchanges’. In another study, a chemotherapy nurse reported dizziness, lightheadedness, nausea, headache, hair loss and cough in nurses who reconstituted the drugs in a small unventilated closet. (Natl. IV Ther Assoc. 1980;3.77)"
Maj. James Wilson of the hematology-oncology service at Walter Reed Army Medical Center in Washington, D.C. warned that "we stress aseptic technique in the manipulation of these drugs. Touch contamination is definitely the most important thing to consider. I can’t stress enough — don’t come into physical contact with the drugs. I’ve seen doctors, nurses and pharmacists slop the drugs all over themselves."
Adriamycin [doxorubicin] binds to proteins on the skin and can’t be washed off," Wilson continued. "It also fluoresces so that under an ultraviolet light you can see that it is still present." Wilson added that he ordered vertical hoods two years ago, which should arrive soon.
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This page last updated 5-Oct-1997 (hds)