[MCOH-EH] IV Chemotherapy and return to work

[Swift, Melanie D., M.D., M.P.H.]

Hi Darryl, very interesting question. As a first step I would talk directly with the employee in question to clarify a few things as Kevin points out below.
The type of chemo and anticipated side effects matter as well as the schedule. Her oncologist will have prepared her for what to expect. Most SE appear in the 1 – 2 days following chemo. Some workers will schedule their chemo to precede a couple of days away from work (e.g. on a Friday afternoon if they work M-F). I’d want to be sure that she takes the time away from work she will need to feel well enough to be working. Trying to “power through” is not a good plan for anyone.

For most agents, toxic metabolites would be excreted in urine within 72 hrs. If she’s getting an agent that would still be getting excreted in urine while at work, there are some standard practices of double flushing and wiping down the seat. She should flush either with the lid down or while remaining seated (there may not be any lids in healthcare facility toilets). As Kevin notes, some chemo is excreted in sweat, but skin-to-skin contact with others should not be likely in the workplace. Here are some safety resources from the ACS about post-chemo safety including safety to others: https://www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy/chemotherapy-safety.html

Finally the rumor mill on her unit should be quelled. I’d recommend speaking with the manager to reassure them you’ve talked with the employee in question and ensured that her RTW plan is safe; and ask the manager to reassure any concerned coworkers and remind them of the need to respect the worker’s medical privacy.

Thanks,

Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Smith, Kevin
Sent: Monday, March 18, 2024 1:27 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] IV Chemotherapy and return to work

Darryl,

Interesting question. I assume the concern is for "secondhand" exposure to chemo agents?

My first thought would be getting with her provider to see what regimen she is on, assuming they send her to you for an evaluation and you can get a release to discuss her case with her provider. A brief review of the pharmacology of the agents should inform you regarding toxicity, half-life, routes of elimination (renal/liver) and whether or not excreted in sweat. Should also tell you if excreted unchanged or metabolized to inactive compounds, etc.

I would think the heme/onc folks may have some professional society guidelines/data on such questions they may be able to share.

This should help with a risk assessment/mitigation (if needed)/communication strategy for the area in question.

Hope this helps!

Good luck!

Kevin M. Smith, MD, MPH, FACOEM
Medical Director
Phoebe Corporate Health
Phoebe Employee Health Services
229-312-9220
229-889-7074 Fax
________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Lesoski, Darryl via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Sent: Monday, March 18, 2024 10:29 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Lesoski, Darryl <DLESOSKI at mhc.net<mailto:DLESOSKI at mhc.net>>
Subject: [MCOH-EH] IV Chemotherapy and return to work

SO SORRY for all my questions but they just keep popping up!! 😊 Here is a question from our administration staff: I have a question and not sure if you can help me or not. I have an employee who is getting IV chemo every 3 weeks, and
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SO SORRY for all my questions but they just keep popping up!! 😊



Here is a question from our administration staff:  I have a question and not sure if you can help me or not.  I have an employee who is getting IV chemo every 3 weeks, and she was told by her physician that she was safe to come back to work after that. I have staff questioning if that is true and asking to be trained on chem precautions. I reached out to HR and they thought you may be able to help.



Can anyone point me to a reliable source of information?  Do you have a policy in place that addresses this concern?  What approach do you take at your medical center?



Looking for voices of reason and sound expert advise which is why I turn to all of you!!!  THANKS ahead of time.



Darryl





Darryl Lesoski, MD, MPH, FACOEM



System Medical Director – Occupational Health and Medicine, Employee Health

Munson Medical Center

Munson Occupational Health and Medicine

Email: dlesoski at mhc.net<mailto:dlesoski at mhc.net>



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