Public health policy activity on the safe handling of hazardous anti-cancer drugs in the healthcare workplace

Melissa A. McDiarmid

Research output: Contribution to journalArticlepeer-review


The foundation of modern cancer chemotherapy, antineoplastic agents comprise several drug classes which achieve their therapeutic action largely through binding to cellular macromolecules, including DNA, and interrupting DNA or protein synthesis, resulting in cell death. Many of these drugs are well-characterized genotoxic and carcinogenic agents, comprising 12 of the 80-odd Group 1 IARC carcinogens. Toxic side effects of chronic treatment with these drugs have resulted in "therapy-related", "second" malignancies in some patients. Theoretical risks to healthcare workers (HCWs) handling these drugs were first postulated based on their genotoxic characterization and toxic side effects observed in treated patients. More recently, evidence of reproductive toxicity in animals, treated patients and in epidemiologic studies of exposed HCWs has fueled concern regarding drug handling. In the last twenty years, the chain of evidence of worker exposure has been unambiguously completed with the documentation of pharmacy and clinic area drug contamination, recovery of drugs in the urine of HCWs handling them, and a large group of studies reporting excesses in various measures of mutagenicity in exposed HCWs. While safe handling guidance has been issued by many governments world wide, very recent environmental monitoring studies of cancer pharmacies and clinics have shown widespread drug contamination. These observations have renewed interest in the safe handling question in healthcare work settings and have raised critical public health policy considerations which are being re-visited now in scientific and government regulatory forums worldwide. This paper reviews the chain of evidence suggesting the need for occupational public health intervention and describes the application of the hierarchy of control technologies as an effective approach to minimize exposure.

Original languageEnglish (US)
Pages (from-to)81-86
Number of pages6
JournalEuropean Journal of Oncology
Issue number2
StatePublished - Oct 2004
Externally publishedYes


  • Carcinogenic effects
  • Chemotherapy
  • Genotoxic effects

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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