Adverse health effects among nurses and clinical pharmacists handling antineoplastic drugs: Adherence to exposure control methods

Background: Chronic exposure to antineoplastic drugs (ADs) may result in reproductive, liver, renal, lung, and cardiac toxicity. Moreover, bone marrow suppression, mucosal ulcers, and cancer may develop. In developing countries, adverse health effects owing to occupational exposure to ADs and adherence to safe handling guidelines are not well documented.
Aim: This study was conducted to determine the health effect of occupational exposure to ADs and evaluate adherence to control methods.
Materials and Methods: A comparative cross-sectional approach was adopted. ADs-exposed nurses and clinical pharmacists (n=54) were compared with nonexposed group (n=54). Self-reported clinical manifestations. and use of exposure controls were reported via an interview questionnaire. Blood samples were collected for complete blood count and liver and kidney function tests.
Results: Significantly higher rate of impaired fertility (31%) and oral ulcers (36.36%) were reported by ADs-exposed nurses and clinical pharmacists compared with nonexposed group (3.8 and 7.4%, respectively; P=0.01 and P=0.00, respectively). Moreover, ADs-exposed group had significantly lower mean white blood cell count (6518±2064.79/μl) and significantly higher mean creatinine level (056±0.13 mg/dl) compared with nonexposed group (7307±2001.4/μl and 0.51±0.12 mg/dl, respectively; t=2.02, P=0.04; and P=0.04, respectively). Inadequate controls were reported, mainly lack of medical surveillance (100%), lack of training (69.1%), insufficient handling practices, and low usage of personal protective equipment, particularly among nurses.
Conclusion: The study highlighted chronic adverse effects associated with occupational exposure to ADs and inadequate implementation of exposure control methods. Findings necessitate raising awareness among ADs-exposed nurses and clinical pharmacists to introduce engineering controls, conduct hazard awareness training, initiate medical surveillance program, and ensure adherence to safe handling practices.