Medical surveillance for antineoplastic-drug handlers

Elements of a medical surveillance program are described, with emphasis on a program for antineoplastic-drug handlers in a hospital setting. There are four data-gathering elements in any medical surveillance program: the history (medical and occupational), the physical examination, laboratory studies, and biological monitoring. Of these, the most useful and cost-effective is the history. The physical examination and laboratory tests should focus on the target organs of the hazardous agent in question. When results of biological monitoring are available for an unexposed control population, results for a group of exposed workers may be interpreted as greater than, similar to, or less than what was expected; thus, groups of unacceptably exposed workers may be identified. For antineoplastic-drug handling, the most important controls are use of a biological-safety cabinet and a worker education program. Estimating the average number of hours of drug handling per shift may serve as a surrogate measure of the potential exposure dose. Health-care professionals examining and testing workers who handle antineoplastic agents should give special emphasis to the skin and the hematopoietic, hepatic, renal, and urinary systems. Because of problems with assay sensitivity, cost, and interpretation of results, biological monitoring is not considered necessary in every medical surveillance program for antineoplastic drug handlers. The Occupational Safety and Health Administration currently recommends that a permanent registry be maintained of all employees who routinely handle antineoplastic agents. Because of their opportunity for exposure to potentially hazardous drugs, pharmacy professionals should take a leading role in establishing surveillance programs that complement existing drug-handling practices and worker education programs.