Drugs hazardous to healthcare workers - Evaluation of methods for monitoring occupational exposure to cytostatic drugs

We review the literature concerning possible health risks for individuals ( e.g. healthcare workers and pharmaceutical plant employees) occupationally exposed to cytostatic drugs. Cytostatic drugs possess toxic properties and may therefore cause mutagenic, carcinogenic and teratogenic effects. Hence, individuals handling these drugs in the course of their employment may fac e health risks. For this reason, it is important to monitor occupational ex posure to these drugs. An overview of exposure monitoring methods is presented and their value is discussed. Most studies involve nonselective methods for biological monitor ing and biological effect monitoring, such as the urinary mutagenicity assa y and analysis of chromosomal aberrations and sister-chromatid exchanges in peripheral blood lymphocytes. The disadvantages of these biological method s are that their sensitivity is low and it cannot be proved beyond any doub t that the results found were caused by occupational exposure to cytostatic drugs. For occupational health services it is important to have sensitive and specific methods for monitoring exposure to cytostatic drugs. One of th e most promising methods seems to be the determination of cyclophosphamide in urine using gas chromatography-tandem mass spectrometry. Several studies have demonstrated exposure to cyclophosphamide and other cy tostatic drugs, even when protective measures were taken and safety guideli nes were followed. To estimate the magnitude of any health effects arising from this exposure, we calculated the risk of cancer due to occupational ex posure to cyclophosphamide on the basis of available human and animal dose- response data and the amounts of cyclophosphamide found in urine. The initi al results show an extra cancer risk for pharmacy technicians and nurses.