Cytotoxic drugs (also referred to as cytostatic or antineoplastic drugs) describe a group of medicines designed to destroy cells that grow in a rapid and uncontrolled manner, preventing their replication or growth. Worldwide, these medicines are increasingly being used in a variety of healthcare settings, prominently in the treatment of cancer. They also play an important role in haematology and rheumatology and are used to treat non-cancerous diseases such as multiple sclerosis, psoriasis and systemic lupus erythematosus, leading to a growing use of these drugs.
The cytotoxic drugs available for current use are generally non-selective, meaning that they do not differentiate between malignant cells and normal healthy tissue and are therefore likely to damage normal (non-tumour) cells, resulting in adverse health effects.
Sold in powder or as a concentrated solution, a form where a drug is more stable, cytotoxic drugs require individual manipulation for each patient prior to being administered as infusions or bolus injections. This may lead to errors, spillages, needle stick injuries and (spread of) contamination, which pose clear health risks to healthcare workers. Moreover, cytotoxic drugs may evaporate and form a gas during normal handling which may result in inhalation of the drugs.
Surveys, conducted primarily with nurses, have associated workplace exposures to cytotoxic drugs with acute health effects and/or chronic effects. Indeed, increased genetic damage has been demonstrated in nurses, particularly in day hospital nurses, the group handling the highest amount of drugs during the administration process.
Importantly, the effects of exposure may be subclinical and not be evident for years or generations of continuous exposure. For example, as cancer often takes decades to emerge, a case of leukaemia diagnosed in a nurse or in a pharmacist today might be the product of workplace exposures in the 1970s or the 1980s. Unfortunately, in many instances, the connection between work and disease is never made.
While patients receive concentrated doses of a limited number of cytotoxic drugs for a defined period of time, healthcare workers may be exposed to small doses of a broad range of with cytotoxic drugs over decades, with some workers being exposed every workday, year after year.
In order to provide workers with the highest protection, Member States must implement necessary administrative and engineering controls and ensure that workers use appropriate and validated procedures for handling hazardous drugs and proper protective equipment. Indeed, the use of safe handling practices and specialised drug handling equipment has proven to greatly reduce the potential exposure of healthcare workers to these drugs.
The policy recommendations provided, if consistently implemented, should help ensure a high level of protection for the exposed healthcare workers concerned.