ASSESSMENT OF OCCUPATIONAL EXPOSURE TO CYTOTOXIC DRUGS WITH PLATINUM
The past 20 years have been an explosion in the introduction of effective cytostatic drugs (C.D.) for treating malignant diseases. Not only has the number of agents increased, so has the frequency with which they are used (Pilger et al., Citation2000).
Workers handling C.D., such as nurses, pharmacy technicians and pharmacists, involved in their preparation and administration, and workers employed in the synthesis and production of these products, may face health risks.
Several C.D. have been shown to be mutagenic, teratogenic, and carcinogenic in experimental systems (De Meo et al., Citation1995). The effects of continuous low-level exposures to C.D. in working environments are still controversial.
A study was conducted to investigate whether oncology nurses are occupationally contaminated by antineoplastic drugs by measuring their urinary concentration by inductively coupled plasma mass spectroscopy (ICP-MS). Platinum, included in a lot of C.D., is used as marker for drug handling. The exposed group consisted of nurses, pharmacy technicians, and pharmacists employed by hospitals of Champagne County in France and handling C.D. Each person was interviewed and a questionnaire was filled in. The questions covered a detailed occupational, medical, and family history. Thirty-three nurses, pharmacy technicians, and pharmacists of seven different departments participated in this study. During occupational activities, such as preparation and administration of these drugs, acute toxic effects had not been observed.
An elevated level of urinary platinum was found in one nurse (0.15 μg/L or 0.63 μg/g creatinine) in comparison with the nonexposed control group. It seems that the elevation of urinary platinum in urine was related to occupational exposure to platinum-containing C.D. The same result was found in another study including 13 hospital pharmacists and pharmacy technicians (Ensllin et al., Citation1997). It can be concluded that the concentration of 0.15 μg/L found in only 1 sample (i.e., 3% of exposed workers) is above the background signal and is much higher than the upper concentrations found in subjects exposed to gold dental restorations.
In fact, biological monitoring by ICP-MS using specific antineoplastic tracers assesses the exposure to the specific chemical substance under investigation. It seems to be sufficiently sensitive to detect people exposed to low levels of chemicals, and yields more information on potential health risk than information obtained by ambient monitoring. But the results of the study including 33 exposed subjects with 1 positive case imply that one should carry out research in this field with the same methodological aspects. Health care workers preparing C.D. must receive initial and annual training, and should be provided with laminar air-flow hoods and personal protective devices. In all cases, the employers should offer workers all necessary information to achieve a safe working situation.
REFERENCES
- De Meo M. P., Merano S., De Baille A. D., Botta A., Laget M., Guirau D. H., Dumenil G. Monitoring exposure of hospital personnel handling cytostatic drugs and contaminated materials. Int. Arch. Occup. Environ. Health 1995; 66: 363–368
- Ensslin A. S., Huber R., Pethkan A., Rommelt M., Schierl R., Kulka U., Fruhmann G. Biological monitoring of hospital pharmacy personnel occupationally exposed to cytostatic drugs: Urinary excretion and cytogenetics studies. Int. Arch. Occup. Environ. Health 1997; 70: 205–208
- Pilger A., Köhler I., Stettener H., Mader R. M., Rizovski B., Terkola R., Diem E., Franz-Hainzl E., Konnaris C., Valic E., Rudiger H. W. Long-term monitoring of sister chromatid exchanges and micronucleus frequencies in pharmacy personnel occupationally exposed to cytostatic drugs. Int. Arch. Occup. Environ. Health 2000; 73: 442–448