ABSTRACT OF THE WEEK

The Veterinary record
Volume 180 | Issue 21 (May 2017)

Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey.

Vet Rec. May 2017;180(21):518.

E G Edery¹

¹ Pride Veterinary Centre, Riverside Road, Derby DE24 8HX, UK.

British Veterinary Association.

Abstract

To investigate how first opinion small animal veterinary surgeons in the UK handled chemotherapeutic agents, a questionnaire was distributed at the 2014 British Small Animal Veterinary Association congress and by internet. Chemotherapy was regularly offered by 70.4 per cent of the respondents. Gold standards defined according to available guidelines for safe handling of antineoplastic drugs were poorly followed by general practitioners with only 2 per cent of respondents complying with all of them. Dedicated facilities for preparation and administration of cytotoxic drugs were variably available among participants. The level of training of staff indirectly involved in handling chemotherapy was appropriate in less than 50 per cent of practices. No association was found between demographic characteristics of the sampled population and the decision to perform chemotherapy. The results of this study raise concerns about the safety of the veterinary staff in first opinion practices involved in handling chemotherapy.

Companion Notes

Questionnaire on chemotherapy drug handling in first opinion small animal practices in the UK

Introduction on chemotherapy drug handling

- chemotherapy offered more and more by first opinion UK practitioners

- chemotherapeutic cytotoxic agents in human medicine:

- have many late adverse effects

- 1^st evidence came from childhood cancer survivors

- they developed second malignancies

- particularly leukemias and myelodysplasias

- other adverse effects include the following:

- mutagenicity

- carcinogenicity

- teratogenicity

- adverse reproductive effects

- acute side effects reported as well

- in ’79 a new field of research on occupational hazards was started

- including hazards associated with handling chemotherapeutic agents

- numerous studies have since confirmed occupational exposure

- and various routes of exposure by environment monitoring

(air and surface sampling)

- many guidelines issued in last 30 years

- in veterinary oncology

- little research on occupational hazards in veterinary oncology

- in the UK

- 2 acts form a legal frame for employers to ensure workplace safety

- Health and Safety at Work Act (1974)

- Management of Health and Safety at Work (1999)

- cytotoxic drugs are hazardous substances

- fall under Control of Substances Hazardous to Health regulations

- Royal College of Veterinary Surgeons provides guidance

- in its Code of Professional

- it’s unknown if guidelines are followed in the UK

Study design

- study population:

- 71 respondents to questionnaire on handling of antineoplastic drugs

- veterinary surgeon, 66

- veterinary nurse, 5

- woman, 54

- procedure:

- questionnaire

- distributed at 2014 British Small Animal Veterinary Association congress

- distributed via internet

- survey answers compared with guidelines on handling chemotherapeutic agents

- those issued by European College of Veterinary Internal Medicine (2007)

(ECVIM. (2007) Preventing occupational and environmental exposure to

cytotoxic drugs in veterinary medicine. In European College of

Veterinary Internal Medicine-Companion Animals)

- set as highest (gold) standard

Results

- chemotherapy regularly offered by 70.4% of the 71 respondents

- 2% complied with gold standards for safe handling of antineoplastic drugs

(standards defined according to available guidelines)

- standards were poorly followed by general practitioners

- dedicated room for preparation of antineoplastics, 22% of responders

- ventilated cabinet, 4%

- antineoplastics predominantly prepared by veterinarians, 52%

- veterinary nurses also involved, 10%

- custom-prepared chemotherapy for individual patients, 24%

- from a specialist pharmacy

- infusion materials

- standard needles and infusion kits, 60%

- infusion kits with Luer lock fitting, 28%

- closed systems, 14%

- regular gloves, 66% (2% used no gloves)

- chemotherapy-specific gloves, 30%

- protective gowns

- disposable protective clothing not tested for handling cytotoxics, 52%

- standard of care, 26%

- non-disposable gowns, 12%

- no protective gown, 6% (4% did not provide details)

- face protection

- surgical masks, 50%

- only eye protection, 36%

- FFP2 or 3 respirator masks, 10%

- no mask at all, 26%

- conditions of administration

- in designated treatment room, 68%

- kennels, 16%

- in consultation room in absence of owner, 14%

- in consultation room with owner, 4%

- cytotoxic spill kit available, 48%

- purple flagged containers for disposal of cytotoxic agents, 90%

- specific training for other staff members involved, 44%

- including the following:

- informal in-house training, 38%

- training at veterinary nursing colleges, 20%

- information for owners

- verbal information, 54%

- written instructions, 44%

- did not inform clients of the potential hazards, 2%

- level of staff training indirectly involved in handling chemotherapy

- appropriate in under 50% of practices

- demographics of the respondents not associated with decision to do chemotherapy

- number of chemotherapy sessions per year

- 66% performed less than 10

- 20% performed 11-20

- 10% performed and 21-40

- most commonly cited drugs (cited by 6 or more respondents)

- vincristine, 40

- cyclophosphamide, 19

- doxorubicin, 15

- vinblastine, 7

- L-asparaginase, 6

“Of concern, more than 50 per cent reported that other members of staff involved in the handling of chemotherapy patients and cytotoxic waste had not been specifically trained.”

Keywords

Chemotherapy; Companion animals; Oncology; Public health; Surveys;

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