Risks associated with antineoplastic agents

With chemotherapy as one of the main cancer treatments, there is a global increase in the use of antineoplastic agents. Antineoplastic drugs, also known as cytotoxic drugs, are most often used in chemotherapy to treat cancer.   While they are used to treat cancer patients, they can be hazardous to healthy workers in health care, pharmacy, veterinary clinics and cleaning staff.   They have a toxic effect on cells within the body and there is no safe level of exposure to these cancer-causing agents. As a result, there is a need to implement rigorous health and safety practices with regard to these drugs. The OHS concerns are as follows:

  • Many antineoplastic drugs are carcinogenic;
  • Chronic issues can show up many years later;
  • Acute reactions can include skin irritation, eye and mucous membrane irritation, nausea, vomiting, hair loss and rashes;
  • Issues can include damage to the liver, kidney, lung and heart;
  • These drugs can affect fetal development.

Workers who may be exposed to cytotoxic drugs have to be aware of all of these risks, receive relevant training, use the engineering controls provided and wear all necessary personal protective equipment (PPE) to protect themselves. There are many exposure routes to take into account:

  • Skin absorption (direct contact with the drug or indirect contact with contaminated surfaces, clothing or handling patient excreta);
  • Inhalation (breathing in drug vapours or dust);
  • Accidental injection (needles or other sharps that puncture the skin); and
  • Ingestion (eating, drinking or smoking with unwashed hands or hand to mouth touching).

OHS Program basics

Working with cytotoxic drugs requires strict policies and procedures. Every employer using cytotoxic drugs in their facility should at least consider the basics such as outlined below.

The right equipment. Engineering controls may be required including primary containment such as Biological Safety Cabinets or Isolator Cabinets and secondary containment for pharmacy dispensing and needle safety devices to prevent needle sticks.  The PPE needs to be easily accessible and workers need to be trained on how to properly use the equipment as well.

Training and good communication about the types of hazards workers may encounter is also very important.  Administrative controls such as worker training on hazards of chemotherapy drugs, proper use of engineering controls and standard operating procedures have to start from the very beginning with a comprehensive orientation and it has to include everybody, from shipping and receiving to front-line workers and managers.  Furthermore, workers need to receive training in all of the emergency response procedures for the variety of scenarios that could occur. Both the training program and the Occupational Health and Safety Control program should clearly identify the emergency procedures to follow in case of accidental exposure to cytotoxic drugs and/or in a spill response operation.

Monitoring and professional oversight are key to bringing all of the above elements together in a meaningful way. Employers should establish a comprehensive Occupational Health and Safety Control program, encompassing all of the aforementioned aspects, to protect both the workers and reduce their business risks. Occupational Health and Safety professionals recommend conducting exposure monitoring on a regular basis to ensure workers are not exposed and work surfaces are not contaminated. Ideally, an employer should involve a Certified Industrial Hygienist (CIH) or Registered Occupational Hygienist (ROH) to assess and develop a comprehensive program to minimize the possibility of missing a potential hazard.

About THEM

Since 1979, T. Harris Environmental Management (THEM) is committed to understanding and providing our clients in the institutional, commercial and industrial (ICI) sectors, with a variety of environmental and occupational health and safety solutions to their concerns. We meet our client’s needs by informing them of their options, reducing riskanxiety, and formulating qualitative, practical, efficient, and cost-effective solutions.  Services include the following highlights:

  • Risk Assessments
  • Environmental Health and Safety Program and Policy Development
  • Occupational Exposure Evaluations & Management
  • Safety Training Sessions

The team members at THEM have over 30 of experience and certified expertise in managing OHS services for the pharmaceutical industry and for hospital environments. Ask THEM for a professional consultation.


Silliker, A. , 2018,  “Workers exposed to chemotherapy drugs at increased risk for cancer, organ damage, reproductive issues”, Canadian Occupational Safety Magazine, 06/05/2018, Accessed: 16/07/2018, website: http://www.cos-mag.com/occupational-hygiene/36966-workers-exposed-to-chemotherapy-drugs-at-increased-risk-for-cancer-organ-damage-reproductive-issues/

Steege A.L., James M. Boiano, 2014, “NIOSH Health and Safety Practices Survey of Healthcare Workers: Training and Awareness of Employer Safety Procedures”, 57(6) · American Journal of Industrial Medicine, June 2014 with 74