[MCOH-EH] Chemo Medical Surveillance

[JimGarb]

I think Melanie is right on target.  Lab abnormalities and adverse outcomes
of pregnancy (or difficulty conceiving) are common and confounded by
multiple other factors beside occupational exposures.  I have always thought
that the most useful way to monitor this population of workers exposed to
hazardous drugs was by giving them the option of completing a confidential
health/exposure survey online using the medical center's intranet and
feeding that data into a database.  That would allow us to look at trends in
exposed groups (pharmacists, inpatient and outpatient oncology nurses) who
were exposed over time to various agents to try and determine if there are
unusual patterns of adverse outcomes of pregnancy or illness.  That might
yield more information than chasing down individual lab abnormalities or
symptoms. 

 

Unfortunately, this was never a high enough priority for the IT department
to set it up at my last place of employment, and we haven't even begun to
discuss it in any serious way at the health system where I currently
consult.  Perhaps someone else has developed and implemented this type of
approach.  

 

Jim

 

James Garb, MD FACOEM

Medical Director Occupational Health Services

Cape Cod Healthcare 

Hyannis, MA

 

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift,
Melanie
Sent: Friday, May 22, 2015 10:57 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] Chemo Medical Surveillance

 

What a frustrating topic. This would be lovely if there was a biomarker for
exposure that would be sensitive and specific for adverse effects from the
drugs being handled, but this does not exist. Beth Baker did an MCOH survey
several years back and found that some places do health and reproductive
surveys, others add basic labs like a CBC, U/A and LFTs, while others do not
do any routine medical surveillance except for acute exposures. Of those who
did symptom surveys or labs, none reported this being effective or
informative. (This is probably in the MCOH listserv archives somewhere, if
anyone has time to search.)

 

Laboratory abnormalities are very common in the general population
(estimates roughly 50% of the unexposed population would have some abnormal
value if you do random CBC, U/A and LFTs) and if you find it in the course
of a medical surveillance program, then you have some obligation to work it
up or refer the patient further. Malignancy is the main concern with most
chemotherapeutic agents, and CBC, U/A and LFTs are not recommended as
screening tests for any malignancy.

 

Furthermore, reproductive surveys run the very real risk of implying to the
workers that every miscarriage is work-related, even if  the rate of
miscarriage is the same or lower than the general population.

 

We do acute and f/u evaluations after a spill or identified exposure,
targeted to the specific drug and the findings one might expect at the
timing indicated for that drug.

 

We do have a policy that allows workers who are pregnant or attempting
pregnancy to request temporary reassignment.

 

Our safety colleagues do regular formal environmental monitoring with wipes
in the pharmacy rooms with BSCs where chemo is mixed. This has been the most
important thing to monitor for exposure risk and helps greatly to reassure
staff of their safety.

 

Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic

http://occupationalhealth.vanderbilt.edu

 

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Hodgson,
Michael - OSHA
Sent: Wednesday, May 20, 2015 11:59 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] Chemo Medical Surveillance

 

Hi, all, OSHA is interested in that letter, too, as we are trying to
consider / updating our web work.  Melanie and Mark, would you send that to
OSHA, too?

1.      It would be really interesting to know whether anyone does
"surveillance" , i.e., whether you collect a CBC, whether you collect
anything more, whether you collect information on reproductive efforts or
outcomes, and whether you ever collect biological monitoring samples, for
example after spills and other unexpected exposures (like ventilation system
failures in pharmacies)

2.      Do people formally acknowledge and follow Oncology Nursing Society
procedures?  Are those acknowledged and supported by your pharmacy and
nursing leadership?

3.      Do people have a formal policy on managing workers of reproductive
age who are considering / planning active reproduction?  Would this group be
willing to answer whether

a.      You offer people a chance to transfer to a job without exposure?
(men too?)

b.      Let people transfer out of an exposed job once they are pregnant?

c.       Mandate that people transfer out of an exposed job once pregnancy
is known? 

4.      Does anyone do formal exposure assessment, i.e., wipe samples
outside of pharmacy cabinets?

 

Exposed here means simply working with cytotoxic agents.

 

Michael Hodgson, MD

OSHA Office of Occupational Medicine and Nursing

 

From: MCOH-EH [mailto:mcoh-eh-bounces+hodgson.michael=dol.gov at mylist.net] On
Behalf Of Swift, Melanie
Sent: Wednesday, May 20, 2015 12:48 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Chemo Medical Surveillance

 

Our esteemed colleague Dr. Russi at Yale drafted a letter to NIOSH on this
subject last summer which encapsulates this quagmire nicely. 

Mark, would you to share this with the list or do you mind if I share it (I
have it handy, I read it often.)

 

Melanie Swift, MD

Director, Vanderbilt Occupational Health Clinic

http://occupationalhealth.vanderbilt.edu

 

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Schweitzer,
Kit
Sent: Wednesday, May 20, 2015 11:41 AM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Chemo Medical Surveillance

 

I am an Employee Health Nurse at a hospital in Oregon. Do any of you do
medical surveillance for staff administering or handling chemo drugs?

If so, can you please describe your policy. If not, can you please provide
reasons why.

Thank you in advance for your answer. 

 

Kit Schweitzer, RN, BSN, COHN

Employee Health Nurse

Employee Health and Safety

Sacred Heart Medical Center

(541) 222-2544 Office   

(541) 434-3140 e-Fax 

3333 RiverBend Drive, Springfield, OR 97477

www.peacehealth.org <http://www.peacehealth.org/> 

cid:image001.png at 01CBF05C.90368260            

 

This message is intended solely for the use of the individual and entity to
whom it is addressed, and may contain information that is privileged,
confidential, and exempt from disclosure under applicable state and federal
laws. If you are not the addressee, or are not authorized to receive for the
intended addressee, you are hereby notified that you may not use, copy,
distribute, or disclose to anyone this message or the information contained
herein. If you have received this message in error, immediately advise the
sender by reply email and destroy this message.

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://mylist.net/archives/mcoh-eh/attachments/20150522/3457ed1b/attachment.html>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.png
Type: image/png
Size: 5827 bytes
Desc: not available
URL: <http://mylist.net/archives/mcoh-eh/attachments/20150522/3457ed1b/attachment.png>