Addressing Safety Issues of Health Care Personnel, Family Members, and the Environment

Abstract

TO THE EDITOR: We are writing in response to the article by Jacobson et al entitled “American Society of Clinical Oncology/ Oncology Nursing Society Chemotherapy Administration Safety Standards.” Although these published safety standards do much to ensure that patients are properly protected during treatments, we are concerned that these guidelines fail to adequately address the issue of protecting the general public and the health care personnel entrusted to administer the various antineoplastic agents. In the introductory text, the authors state that these medications pose a potential hazard to patients. It is also important to point out that these medications similarly present a potential serious harm for the pharmacists, nurses, and physicians whose task it is to administer these drugs on a daily basis. In addition, these agents pose risks to the environment and to the general population. There have been reports of the presence of anthracyclines in hospital effluence, cyclophosphamide in sewage water, and fluorouracil in river waters. Recently, these issues have become even more critical since an increasing number of antineoplastic agents are being formulated as tablets to be self-administered at home. In view of the fact that these medications are not given by professionals familiar with standards of safe handling and safe disposal of surplus drugs, the risk of exposure to the general population, primarily caregivers, and family members, becomes far greater. In this setting, disposal of self-administered antineoplastic drugs through the general household waste system becomes a real threat to the environment. Formal guidelines regarding the issue of safe antineoplastic drug administration are incomplete unless the safety of the personnel involved in preparation and administration of these drugs is addressed. Such guidelines should also include instructions for safe use at home by laymen. Importantly, instructions about the safe disposal of antineoplastic drugs and contaminated equipment should be part of these safety standards. Jessica Livneh The Sheba Medical Center Institute of Oncology, Tel-Hashemer, Israel