title: Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers.
abstract: Purpose There are health risks to workers occupationally exposed to antineoplastic drugs. We hypothesized that implementing a biological monitoring program would be feasible. The goal was to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs. Methods We recruited workers from the hematology-oncology department and control workers in a mother-child university health center. This study was preceded by an information period during which we aimed at enhancing the workers' awareness and knowledge of the risks of occupational exposure. Participants filled out a journal containing activities performed and personal protective equipment worn. One urine sample was collected at the end of their shift. Samples were analyzed by UPLC/MS-MS for the presence of cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (5-fluorouracile's main urinary metabolite). Results The participation rate was 85.7% (102/119). No urine sample had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians, and 0/7 doctors). In the 5 days before sampling, 67/92 (72.8%) hematology-oncology participants performed at least one activity with antineoplastic drugs. Nurses wore all of the recommended protection for technical activities (86.2%), but rarely for non-technical activities (14.9%). Pharmacists and pharmacy technicians wore all of the recommended protection for all activities (100.0%). Conclusions This pilot study had a good participation rate. The absence of positive samples was a good indication that the measures in place ensured workers' safety, even though we found areas where the worker protection can be enhanced.
authors.affiliation: 1 Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Poupeau
authors.affiliation: 1 Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Tanguay
authors.affiliation: 2 Nursing, CHU Sainte-Justine, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Plante
authors.affiliation: 3 Centre de toxicologie du Québec, Institut national de santé publique du Québec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gagné
authors.affiliation: 3 Centre de toxicologie du Québec, Institut national de santé publique du Québec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Caron
authors.affiliation: 1 Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada.|4 Factulty of pharmacy, Université de Montréal, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bussières
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000652:urine*; D002170:Canada; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000652:urine; D016903:Drug Monitoring / Q000379:methods; D004784:Environmental Monitoring / Q000379:methods*; D005260:Female; D006282:Health Personnel; D006801:Humans; D007069:Ifosfamide / Q000652:urine; D008297:Male; D008727:Methotrexate / Q000652:urine; D008875:Middle Aged; D016273:Occupational Exposure / Q000032:analysis* / Q000517:prevention & control; D000067393:Personal Protective Equipment / Q000706:statistics & numerical data; D010865:Pilot Projects; D053719:Tandem Mass Spectrometry; D055815:Young Adult; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000652:urine
chemical_list: D000970:Antineoplastic Agents; D015091:beta-Alanine; C032348:alpha-fluoro-beta-alanine; D003520:Cyclophosphamide; D007069:Ifosfamide; D008727:Methotrexate
keywords: Antineoplastic drugs; biological monitoring; occupational exposure; urine