Allison Field, James Henderson, Ann Hogan, Emma Thoms, Nyasha Manomano, Sue Renn, Alison Simons, Samantha Toland

Abstract:

This document provides guidance on the handling of cytotoxic chemotherapy and its focus is on traditional small molecule chemotherapy although there are references to biological therapies including monoclonal antibodies which are being used in increasing numbers.

Many cytotoxic drugs are known to be mutagenic, carcinogenic and teratogenic due to their activity at the cellular level with the potential to cause damage to genetic material which can be an important part of their activity. Staff exposure to these agents therefore carries a degree of risk, as with other mutagenic, carcinogenic substances therefore exposures should be kept to a minimum. The principles described below apply to all environments and all staff handling cytotoxic drug but the document and its recommendations are aimed primarily at nursing staff handling these agents in clinical areas.

The recent Cochrane review of closed systems use for cytotoxic chemotherapy1 concluded that there is currently no evidence to support or refute the routine use of closed-system drug transfer devices in addition to safe handling of infusional hazardous drugs, as there is no evidence of differences in exposure or financial benefits between CSTD plus safe handling versus safe handling alone (very low-quality evidence). None of the studies report health benefits.

However, the authors of this document feel that actions need to be taken in the short term to reduce exposure risks for nursing staff. It is hoped that a controlled study will be carried out in order to more fully assess the risks associated with cytotoxic chemotherapy, in the meantime the simple measures suggested within this document should be adopted in order to better control staff exposure to these agents.

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