8 Chemotherapy

Cancer Overview DNA is damaged & cells grow out of control Most cancers produce tumors Cancers behave differently, grow at different rates Treatment is specific to cancer type Early detection, treatment = better survival chances

Cancer Overview (cont’d) Treatment includes Surgical removal of tumor Chemotherapy Radiation

Cancer Overview (cont’d) Viruses linked to cancer Epstein-Barr virus HIV HPV Chemotherapy also used to treat Rheumatoid arthritis Lupus Psoriasis Autoimmune diseases

Cytotoxic Agents Also known as antineoplastics Used to treat patients with various forms of cancer Specific drugs indicated for specific tumors/cells Extremely toxic to cells Drugs can’t distinguish between healthy & sick cells

Cytotoxic Agents (cont’d) Many side effects (hair loss, etc.) Two main types Cycle-phase nonspecific Cycle-phase specific

Risk-Related Characteristics of Chemotherapy Agents Mutagenic: can cause cells to mutate Carcinogenic: can cause cancer Teratogenic: can cause birth defects Immunosuppressive: lowers immunity

Biological Safety Cabinets Vertical airflow, top to bottom Protects personnel, product, & environment ISO Class 5 environment

Biological Safety Cabinets (cont’d) Classes Class I: protects personnel & environment only Class II: protects personnel, product, & environment Class III: provides maximum protection

Compounding Aseptic Isolator Glove box isolator: a contained unit Restricts movement of contaminants Operator slips hands into long glovelike parts Highly favored by USP 797 for multitasking Requires less space, has monitoring controls

Proper Use of the BSC Keep insides & tops clear Turn off all UV lights when lab is occupied Wash hands & arms with germicidal soap Wear long-sleeved gown & gloves Don’t eat, drink, apply makeup, smoke in lab Dispose of sharps appropriately Clean up spills immediately

Proper Use of the BSC (cont’d) Dispose of all waste in biohazard containers Disinfect surfaces with sterile water & alcohol

Preparing to Use the Hood Turn off UV light upon entering room Check flow alarm system audio & visual Decontaminate surfaces & wait 10 min

Cleaning and Decontaminating the BSC Dress in usual garb + chemo-specific gown Wash hands & put on chemo & sterile gloves Clean bar at top of hood Clean back panel of hood Clean side panels Clean work surface area

Cleaning and Decontaminating the BSC (cont’d) With blower on, scrub from top to bottom Repeat steps 3-7 using 70% IPA Leave moveable parts in hood

Shutting Down the BSC Decontaminate all items in interior area Turn on UV light Allow 5 min of operation to purge system Turn off BSC blower, if it is facility’s procedure

Personnel Training Competency should be assessed Annually (at least) Any time employee is not following protocol

Personnel Training (cont’d) Training program Should include certification course Recertification required regularly (yearly) Trainer: several years experience with chemo Should cover chemo procurement, storage, safe handling procedures, prep & waste guidelines

Attire Guidelines Low-permeability, solid-front gown with ties in back Disposable, high-cuff, latex chemo/nitrile gloves Thickest gloves allowed by workplace 2 pairs of thinner gloves under outer gloves

Attire Guidelines (cont’d) Disposable lab coat, closed & with sleeves tucked into gloves Don’t wear lab coat outside the lab Eye protection (goggles)

Withdrawing a Cytotoxic Agent Gather all materials Don’t block airflow Swab rubber top with alcohol Use only Luer-lock syringe; make sure it’s tight Pull plunger back halfway from what is needed Remove cap from needle & insert needle

Withdrawing a Cytotoxic Agent (cont’d) Add air to vial, then withdraw drug Remove needle, remove air bubbles Recap syringe Perform final check

Handling Hazardous Drugs Ensure syringes/IV sets have Luer-to-Luer connection Don’t fill syringe >3/4 full Use venting devices with 0.2 micron hydrophobic filters 5 micron filter needles/straws Dispense final products ready to administer

Handling Hazardous Drugs (cont’d) Wipe outsides of containers, IV sets, IV ports Label final products; put in zip-lock container

PhaSeal Closed system Reduces/eliminates human exposure to chemo Set of disposable containment devices Used in drug mixing & administering Connect original drug vial, syringe & IV set Sealed pathway

PhaSeal (cont’d) Has double membrane to prevent drug leakage Expansion chamber equalizes pressure in system

Disposal of Cytotoxic Medications Use yellow, puncture-resistant hazardous container Chemo waste Discarded gloves Disposable gowns Disposable goggles IV bags/bottles, tubing, needles, syringes

Disposal of Cytotoxic Medications (cont’d) Place all cytotoxic waste in sealed zip-lock bag Don’t clip or cap needles & syringes

Chemo Spill Kit Chemical splash goggles Low-permeability disposable gown & shoe covers 2 sheets of absorbent, plastic-backed material 250 mL & 1 L spill control pillows Puncture-resistant sharps container Small scoop to collect glass fragments

Chemo Spill Kit (cont’d) 2 large, labeled, sealable hazardous drug waste bags Appropriate respirator

Chemo Spill Kit (cont’d) FIGURE 8-14 Chemotherapy waste container

ASHP Guidelines for Safe Handling of Cytotoxic Drugs Limit access Identify & label all hazardous drugs Educate patient & family of precautions Have a written procedure & kit for chemo spills Design facility to prevent easy spillage, breakage

ASHP Guidelines for Safe Handling of Cytotoxic Drugs (cont’d) Have written policies/procedures for chemo prep Conduct orientations & yearly process validations Keep MSDS for each hazardous drug accessible Require employees to wear appropriate apparel

A Final Caution Avoid compounding cytotoxic agents if pregnant Most cytotoxic drugs target fast-growing cells (ovaries & sperm) Some chemo drugs are mutagenic, which may increase risk of miscarriages & birth defects Drug may get out of container & into air

A Final Caution (cont’d) Drug may be inhaled, absorbed, ingested, or accidentally injected Drug may cause cell damage