Much of the discussion of medical surveillance for workers handling antineoplastic drugs (AD) has centered on measuring effects that have very limited value (CBC, metabolic panel, exams) for these conditions. I might suggest we as Occ Health providers shift the conversation from measuring effects to exposures.

 

My suggestion would to begin by measuring surface contamination by AD using wipe sampling. This has been demonstrated to help guide control efforts by identifying hot spots and poor compliance with recommended practices. Also as someone notices they are being measured they begin paying attention and consistently use good technique. This has been demonstrated repeatedly.

 

This may also be a shameless plug, but I wrote a review article on the relation of surface contamination and the rate of detectable AD in worker’s urine. (A review of surface wipe sampling compared to biologic monitoring for occupational exposure to antineoplastic drugs. J Occup Environ Hyg. 2017 Mar;14(3):159-174.  PMID:27676216.) There was an approximate relation between the level of contamination and how often AD appeared in the workers’ urine. While no one is suggesting collecting urine for AD, there is good support, such as in USP 800, for beginning at least semi-annual surface sampling.

 

Medical surveillance for AD workers is still lacking the tool to make it useful. However surface wipe sampling is a feasible exposure assessment alternative if a more active EHS approach for AD control is being considered.