Cisplatin
Full Profile
General Information
Cisplatin is a platinum-based chemotherapy drug that exists as a yellow crystalline powder.[2] It may also be referred to by its common trade name Neoplatin, or by its chemical name cis-diaminedichloroplatinum (CDDP).[3] There are numerous other synonyms and product names; see HSDB for more information.[3]
Cisplatin has been classified by IARC as Group 2A, probably carcinogenic to humans.[4] In experimental animal studies, cisplatin exposure was associated with leukemia and liver cancer, as well as benign lung tumours (adenoma), skin tumours (papilloma) and kidney tumours (adenoma) in mice and rats.[2,4] In humans, several case-control studies identified increased risks of leukemia with cisplatin treatment in cancer patients.[2] However, the study subjects in most epidemiological studies were exposed to other carcinogenic agents such as radiation and other antineoplastic drugs.[2] Other health effects experienced by patients taking cisplatin may include gastrointestinal problems, kidney damage, neurotoxicity and reproductive problems after long-term use.[3]
Cisplatin has been ranked by CAREX Canada as a Group A (immediate high priority) for occupational settings, targeting people who may be exposed to the drug at work (i.e. nurses and pharmacists), rather than those who are prescribed the drug for therapeutic use. Prioritization for pharmaceuticals was based on the carcinogenicity of the substance – only IARC Group 1 and 2A drugs were considered – and whether the drug is registered for use in Canada.
Regulations and Guidelines
Occupational Exposure Limits (OEL)
No occupational exposure limits for Canada or any other international bodies were located.
Canadian Agencies/Organizations
| Agency | Designation/Position | Year |
|---|---|---|
| Health Canada | Not included; due for screening | 2004[5] |
Cisplatin was not included in other Canadian government chemical listings reviewed.[6]
Main Uses
Cisplatin is a chemotherapeutic drug used to treat various cancers.[2]
Occupational Exposures
Occupational exposure to cisplatin may occur via inhalation, dermal exposure, or ingestion.
Probable exposure scenarios in BC are in hospitals and limited to handling in wholesale pharmacies, patient handling, sanitary and similar services, research, and education.[8]
Nurses
In 2006, CIHI (the Canadian Institute for Health Information) estimated that 68 Licensed Practical Nurses (LPNs) and 2,975 Registered Nurses (RNs) worked in the oncology areas of Canadian hospitals[8] and thus may have been exposed to chemotherapeutic drugs (including cisplatin). The number of nurses potentially exposed to cisplatin by province is shown in the table below.
| Nursing Oncology Workforce by Province/Territory 2006[8] | ||
|---|---|---|
| RN | LPN | |
| Canada | 2,975 | 68 |
| NL | 63 | 0 |
| PE | ** | * |
| NS | 206 | ** |
| NB | 128 | 12 |
| QC | 1,345 | 0 |
| ON | 0 | 0 |
| MB | 139 | 0 |
| SK | 174 | 18 |
| AB | 511 | 8 |
| BC | 396 | 15 |
| YT | * | 0 |
| NT | 0 | 0 |
| NU | ^ | .. |
Pharmacists and Pharmacy Technicians
Pharmacists and pharmacy technicians are potentially exposed to chemotherapeutics when they prepare the drugs for patient use.
A report by Eli Lilly on hospital pharmacies in Canada (for 2005/06) reports the number of hospitals with in-house pharmacies performing hematology and oncology functions for the whole country.[9] This data is presented in the table below. There were 94 pharmacists working in outpatient pharmacies with hematology/oncology, and 91 in inpatient pharmacies.
Inpatients are patients who are admitted to hospital. Outpatients visit the hospital for treatment, but are not admitted. There could be minor differences in the types of drugs prepared by workers in these different pharmacies (i.e. IV drugs are likely used more for inpatients), therefore we differentiate this information in the table.
| Number of Hematology/Oncology Clinical Pharmacy Services 2005/6[9] | ||||||
|---|---|---|---|---|---|---|
| All | BC | Pr. | ON | QC | Atl. | |
| Hospitals (total n) | 142 | 20 | 20 | 45 | 42 | 15 |
| Outpatient pharmacy (n) | 118 | 17 | 14 | 32 | 40 | 15 |
| Inpatient pharmacy (n) | 116 | 16 | 15 | 34 | 39 | 12 |
Pharmacy technicians compose approximately 47% of the average hospital pharmacy staff (pharmacists compose 40%).[9] The number of pharmacy technicians exposed to chemotherapeutic drugs can therefore be estimated as being slightly higher than the number of pharmacists.
Sources
- Wikimedia Commons Photo: Cisplatin
- NTP 12th Report on Carcinogens for Cisplatin (PDF)
- Hazardous Substances Databank entry for Cisplatin (Search term: ‘cisplatin’)
- IARC monograph summary, Volume 26 Supplement 7 (1987) (PDF)
- CEPA List of Toxic Substances (1999)
- Health Canada Drug Product Database (Search term: ‘cisplatin as active ingredient’)
- Ward et al. 2007. Mortality and Cancer Incidence in a cohort of Registered Nurses From British Columbia, Canada. American Journal of Industrial Medicine. 50:892–900.
- CIHI, 2006. 2006 Workforce Trends Health Human Resources Database
- Eli Lilly Canada. 2007. 2005/06 Hospital Pharmacy in Canada Report. (PDF)
