Antineoplastic Agents Occupational Exposures

Antineoplastic Agents Occupational Exposures

Overview

Occupational exposure to antineoplastic agents may occur directly via dermal contact, inhalation, ingestion, accidental injection, or indirectly via contact with contaminated surfaces and objects.[1] This can occur in hospitals, where antineoplastic agents are handled in shipping and receiving areas, prepared in pharmacies, administered in wards, and contacted through sanitary services such as laundry, cleaning, and waste handling.[2] Exposure can also occur outside of hospitals in workplaces such as community pharmacies, veterinary care facilities, and home care settings.[3]

READ MORE...

CAREX Canada estimates that approximately 75,000 Canadians are exposed to antineoplastic agents at work; most exposures occur in the moderate category. In addition, over 75% of exposed workers are female.

Exposure to antineoplastic agents was not estimated by industry per se, but by setting. The largest number of workers exposed were in non-hospital settings, with a substantial proportion working in hospitals.

Occupations at risk of exposure to antineoplastic agents are community pharmacy workers (including pharmacists, technicians, and assistants), hospital nurses (including nurses and licensed nurse practitioners), and hospital pharmacy workers (including pharmacists, technicians, and assistants).

Prevalence Estimate

Results show that approximately 75,000 Canadians are occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is pharmacy staff (pharmacists, technicians, and assistants), with 42,900 workers exposed. Of these, 30,200 workers are based in community settings.

When examining exposure further by work setting, 38,200 workers (51% of all exposed) are located in non-hospital settings; the remaining 36,800 are exposed in hospitals.

Level of exposure

In total, approximately 75,000 Canadians are exposed to antineoplastic agents in their workplaces. Exposure levels were developed differently across occupations and are shown here as a simplified summary. The majority of workers exposed to antineoplastic agents are in the moderate exposure category.

Level of Exposure by Occupation

Identifying occupations with: 1) workers exposed to high levels of antineoplastic agents, 2) a larger number of workers exposed to antineoplastic agents, or 3) workers who may not be adequately covered by exposure controls is important in guiding cancer prevention efforts to prioritize exposed groups and target resources most effectively.

The table below shows the number of workers exposed by occupation and relative level of exposure to antineoplastic agents. The majority of workers exposed to antineoplastic agents are in the moderate exposure category.

These results highlight occupations with the greatest number of workers exposed, as well as varying levels of exposure frequency and exposure controls within and between occupations and work settings.

Depending on the goals of a prevention campaign, exposure reduction in the largest occupational group might be a useful strategy, or reducing exposure to those at highest risk of exposure could be seen as a priority.

Methods and Data

Our Occupational Approach page outlines the general approach used to calculate prevalence and exposure level estimates for workplace exposures.

Data Sources

Data used to develop the occupational estimates for antineoplastic agents were collected from several sources:

  1. Peer-reviewed publications that addressed exposure to antineoplastic agents in Canada, the United States and the European Union;
  2. Canadian Census data that provided the number of workers for specific occupations;
  3. Human Resources databases that outlined occupation-specific demographics and practice areas;
  4. Reports from professional bodies that included the number of workers for specific occupations;
  5. Grey literature including technical reports from governments and international bodies; and

Prevalence Estimate Method

CAREX defined exposure to antineoplastic agents as the potential for worker contact with antineoplastic agents, either by working with the drugs directly or via contact with contaminated surfaces, patients, or bodily fluids. This included contact via different exposure pathways, and via different drug formulations.

To determine the number of workers potentially exposed to antineoplastic agents at work, CAREX occupational exposure experts combined baseline worker numbers with an estimate of exposure prevalence. The estimate of exposure prevalence was selected for exposure scenarios that were similar to those described in the peer reviewed or grey literature.

Exposure Level Method

CAREX used tailored methods to create relative exposure level categories by occupation and work location*. For antineoplastic agents, these categories are:

Category 1: Low Exposure

A group of workers (people in the same job category and industry) is put in this exposure category for the following reasons:

  1. Frequency of exposure is low, AND
  2. Control of exposure is high

Category 2: Moderate Exposure

A group of workers is put in this exposure category for one of these two groups of reasons:

  1. Frequency of exposure is low, AND
  2. Control of exposure is low

OR

  1. Frequency of exposure is high, AND
  2. Control of exposure is high

Category 3: High Exposure

A group of workers is put in this exposure category for the following reasons:

  1. Frequency of exposure is high, AND
  2. Control of exposure is low

 

*Definitions

A. Frequency of Exposure

High Daily to weekly
Low Monthly to yearly

B. Control of Exposure

High 2 or more of the following are observed:
  • Industry awareness of health hazard
  • Exposure controls, e.g. handling protocols, protective clothing
  • Environmental/medical monitoring of workplaces/workers
Low 1 or fewer of the following are observed:
  Control of Exposure
Low High
Frequency of Exposure Low MODERATE EXPOSURE LOW EXPOSURE
High HIGH EXPOSURE MODERATE EXPOSURE
Sources

1. National Institute for Occupational Safety and Health (NIOSH). NIOSH Workplace Safety and Health Topic: Occupational Exposure to Antineoplastic Agents (2015)
2. Hon C-Y, Teschke K, Chu W, Demers P, Venners S. “Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals.” Journ of Occup and Environ Hygiene 2013;10(7):374–83.
3. Meijster T, Fransman W, Veldhof R, Kromhout H. “Exposure to antineoplastic drugs outside the hospital environment.” Ann Occup Hyg 2006;50(7): 657–64.

Subscribe to our newsletters

The CAREX Canada team offers two regular newsletters: the biannual e-Bulletin summarizing information on upcoming webinars, new publications, and updates to estimates and tools; and the monthly Carcinogens in the News, a digest of media articles, government reports, and academic literature related to the carcinogens we’ve classified as important for surveillance in Canada. Sign up for one or both of these newsletters below.

CAREX Canada

Faculty of Health Sciences

Simon Fraser University
Harbour Centre Campus
2602 - 515 West Hastings St
Vancouver, BC  V6B 5K3
CANADA

© 2019 CAREX Canada