Secom Science and Technology Foundation
Research Grant Report－Summary	  	  	  	  	  	  	  	  	  	  	  	  	  	  Title
Establishing a regional security system to prevent environmental exposure to cancer
treatment agents used for cancer patients who receive chemotherapy at home	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	 	  	  	  	  	  	  	  	 Michiko	  Yuki
Professor,	  Fukushima	  Medical	  University

1Summary
It is becoming more common for cancer patients to be treated as outpatients instead ofinpatients. Exposure to anticancer agents can pose a danger to public safety, as theseagents have been linked to acute allergies, genotoxicity, spontaneous abortion, andcongenital abnormalities, among other effects. Anticancer agents can harm bothnormal and tumor cells. A significant proportion of still active anticancer agents canbe released in urine, feces, and the breath.
Anticancer drugs are classified as hazardous drugs because of their cellular toxicity. To
guarantee safety, their handling is subject to internationally recognized guidelines.
These guidelines cover the safe handling of these agents during their administration, andalso provide recommended procedures for handling patients’ excretory products for up
to 48 hours after administration. However, the excretion periods for hazardous drugsdiffer. Thus, it is important to take into account the period for which they maintain theirpharmacological activity. Previous research has identified the risks involved forpharmacists, nurses, and other staff members who handle contaminated products
associated with anticancer agents in medical institutions and exposure to contamination
in medical centers. To ensure safety, there are strict procedures to be followed in theseenvironments.
However, procedures to guard against exposure at homes or work places,
where outpatients spend most of their time, are not sufficient. Although guidelines
state that anyone who handles the excretory products of patients at home must use
masks, gowns, and disposable gloves in accordance with the practices used in medicalinstitutions, these guidelines are not adhered to.
Preliminary results from our research show this is not only the case in Japan,
but is an important issue elsewhere. Therefore, the aim of this study was to develop abetter understanding of the exact nature of contamination from anticancer agents inmedical institutions, and to gather evidence on exposure to anticancer agents amongfamily members of cancer patients in the home. Specifically, our research had thefollowing objectives.
1)

Monitor the degree of contamination in outpatient wards where chemotherapy isadministered.
2)

Monitor the exposure to anticancer drugs for a physician over a three day

working period using biological monitoring

23)

Evaluate the exposure of patients and their family members for 48 hours after

treatment, and evaluate the degree of contamination at the patients’ home at 48 hours
after treatment.
4)

Evaluate the degree of exposure by family members for seven days using

biological monitoring after treatment,

For the first objective, we considered that it was important to understand not only theexposure risk for health care workers, but also for patients who are receiving treatments
in outpatient departments. To this end, we observed the behaviors and movements ofpatients and the staff as they went about their normal workplace activities. A wipe
survey found that the degree of contamination on chairs, beds, doorknobs, and otherplaces used or touched by patients was high. Contamination by anticancer agents
appeared not only to be associated with their direct handling, but also resulted fromdrugs adhering to surfaces and after patients used the toilet.
Medical practices were chosen for the second objective. Exposure to anticancer
drugs was high for all physicians investigated. During the investigation period, noneof the physician directly handled anticancer drugs and they did not directly touch theexcretory products of their patients. Results from this investigation certainly point to aneed to strengthen safety standards to prevent exposures to these agents.
The results of our third objective showed that a total of 35 and 16 urine
samples were collected from the three patients and their family members, respectively.
The drugs were detected in all samples. The results also confirmed that all family
members had been exposed to anticancer drugs. At 48 hours after treatment, the areasurrounding the toilet was where most contamination occurred. This again confirmed
the need for safety standards to prevent exposures to patients and those who are close tothem.
Results for the fourth objective, longer term exposure after treatment, showedthat 64% of family members were still exposed to anticancer agents during seven days
after treatment. Of special note, in two cases where the family comprised two people,
both members were exposed in one case and neither member was exposed in the othercase.
The harmful effects of long-term exposure to low levels of anticancer agentsare unknown. The regular, repetitive nature of chemotherapy treatments required forcancer patients indicates that there is a need for safety protocols to guard against3

exposure among family members and other people who interact with these patients.
Recommendations for reducing exposure to hazardous drugs post administration
・Although information is not available for all drugs, two days (48 hours) has been
recommended as a time frame for use of the precaution when handling body fluid
because the majority of drugs are excreted within this time (ASHP, OSHA).
・Home linens can be handled the same as other household laundry (ONS) .
・Family members or caregivers should don chemotherapy gowns and double gloves ifthey are handling contamination linens (ONS) .
・Contaminated linens in the home should be double washed with hot water anddetergent separately from other household laundry (ONS) .
・Double flushing with a lid at home may be useful after use (ONS)・When family members handle patients’contaminated excreta, they should wear
gloves and mask (ONS) .

ASHP：American society of health-system pharmacists
OSHA：Occupational safety and health administration
ONS：Oncology nursing society4