MONITORING OCCUPATIONAL EXPOSURE TO CANCER-CHEMOTHERAPY DRUGS

Reports of the health effects of handling cytotoxic drugs and complian ce with guidelines for handling these agents are briefly reviewed, and studies using analytical and biological methods of detecting exposure are evaluated. There is little conclusive evidence of detrimental hea lth effects from occupational exposure to cytotoxic drugs. Work practi ces have improved since the issuance of guidelines for handling these drugs, but compliance with the recommended practices is still inadequa te. Of 64 reports published since 1979 on studies of workers' exposure to these drugs, 53 involved studies of changes in cellular or molecul ar endpoints (biological markers) and 12 described chemical analyses o f drugs or their metabolites in urine (2 involved both, and 2 reported the same study). The primary biological markers used were urine mutag enicity, sister chromatid exchange, and chromosomal aberrations; other studies involved formation of micronuclei and measurements of urinary thioethers. The studies had small sample sizes, and the methods were qualitative, nonspecific, subject to many confounders, and possibly no t sensitive enough to detect most occupational exposures. Since none o f the currently available biological and analytical methods is suffici ently reliable or reproducible for routine monitoring of exposure in t he workplace, further studies using these methods are not recommended; efforts should focus instead on widespread implementation of improved practices for handling cytotoxic drugs.