What are antineoplastic drugs?

Antineoplastic drugs can change cellular functions at low dosage and are used to treat cancer. If you work with or near antineoplastic drugs, you may be at risk of exposure and potential effects on your health.

Potential health effects could be acute and/or chronic:

• Acute effects are those that occur quickly after exposure and may include symptoms such as nausea, dizziness, rashes, and gastrointestinal problems
• Chronic effects develop slowly over time and may include cancers and reproductive issues, such as infertility

Your employer is responsible for keeping your exposure to antineoplastic drugs as low as reasonably achievable by implementing effective health and safety controls in your workplace.

How do exposures occur?

You may be exposed to antineoplastic drugs directly while handling these drugs, or indirectly via contact with contaminated surfaces and objects in the workplace.

Exposure to antineoplastic drugs can occur through:

• Inhalation
• Absorption through skin or mucous membranes
• Ingestion (e.g., eating with contaminated hands)
• Injection from a needlestick injury

Examples of exposure events may include:

• Handling incoming shipments of antineoplastic drugs that may have surface contamination on vials or packaging materials
• Preparing and mixing antineoplastic drugs (e.g., crushing pills, drug reconstitution), and priming administration equipment, which may cause spills and release antineoplastic drug particulates or vapours into the air
• Administering drugs that may cause spills or accidental needlestick injuries
• Handling wastes of treated animals (e.g., blood, vomit, stool, urine, sweat) or their contaminated bedding, cages, and kennels, since antineoplastic drugs can be excreted for 72 hours or more following chemotherapy treatment

Who is at risk?

Workers in veterinary settings who may be at risk include:

• General veterinarians and specialty veterinarians
• Veterinary technologists or technicians
• Veterinary assistants
• Pharmacists handling veterinary antineoplastic drugs
• Other supporting staff working in veterinary clinics or hospitals
• Janitorial and laundry workers
• Hazardous drug disposal and waste removal contractors

According to 2016 data from CAREX (CARcinogenEXposure) Canada, 3,500 veterinarians and 2,800 veterinary technicians are estimated to be exposed to antineoplastic drugs at work. These veterinary occupations are fifth and sixth, respectively, on the list of occupations with the most number of exposed workers in Canada.

In 2021 and 2022, WorkSafeBC conducted a series of inspections in both general and oncology-specialty veterinary clinics and hospitals. Inspections discovered workers were at higher risk of exposure in general veterinary clinics and hospitals that occasionally provided chemotherapy treatment and were not equipped with adequate equipment (e.g., biological safety cabinet for drug preparation). These workplaces were less aware of the risk of antineoplastic drugs and the suitable controls to reduce worker exposure.

Workplace health and safety is a shared responsibility

Stay informed of the risks in your workplace and the associated control mechanisms

Your employer is responsible for informing you about the risks in your workplace, including potential exposure to antineoplastic drugs. They also need to ensure you understand how to handle antineoplastic drugs properly and what controls have been implemented to reduce your risk of exposure. As a worker you’re responsible for applying control mechanisms, including safe work procedures, to protect yourself and others.

Some examples of specific information your employer needs to communicate to you include:

• A list of antineoplastic drugs present at the workplace
• Areas and surfaces (e.g., counters, pens, keyboards, fridge handles) at the workplace that may potentially be contaminated with antineoplastic drugs
• Safe work procedures to handle antineoplastic drugs and wastes of treated animals
• Procedures for decontamination and medical treatment, if incidentally exposed to antineoplastic drugs
• How to use the provided devices, equipment, and personal protective equipment to control antineoplastic drugs exposure, such as how to operate the biological safety cabinet and how to put on a respirator and perform a user seal check
• Policy and procedures (e.g., protective reassignment policy) for antineoplastic drugs that may cause reproductive harm
• Antineoplastic drug spill response procedures

Participate in health and safety activities in the workplace

Your insight as a worker is essential when it comes to highlighting and resolving health and safety issues, as well as suggestions for improvement. You have the right to participate in workplace health and safety activities, such as:

• Identifying exposure risks in the workplace
• Conducting risk assessments for antineoplastic drug exposure
• Developing safe work procedures
• Providing input on new and existing approaches to reduce exposure to antineoplastic drugs
• Conducting workplace inspections to ensure control measures are implemented and safe work procedures are followed
• Conducting investigations for antineoplastic drugs exposure incidents

Report health and safety concerns

It’s your right and responsibility as a worker to report any health and safety concerns, including concerns about antineoplastic drugs, to your supervisor or employer. Your employer is responsible for investigating the issue and correcting it as needed.

If you believe a work task is unsafe, you also have the right to refuse to perform that work without being disciplined. To learn more about the steps involved with refusing unsafe work, visit worksafebc.com/refusing-unsafe-work.

Additional information and resources

For more information about workplace health and safety, see the following resources:

• Best Practices for the Safe Handling of Hazardous Drugs (see section 17 for specific information for veterinary practices)
• WorkSafeBC Risk Advisory: Hazardous drug exposure
• For workers — WorkSafeBC
• Roles, rights & responsibilities — WorkSafeBC
• Basics of risk management: Four steps to a healthy and safe workplace
• Refusing unsafe work — WorkSafeBC

For regulatory information relating to antineoplastic (cytotoxic) drugs in B.C. workplaces, see sections 6.42–6.58 of the Occupational Health and Safety Regulation.

If you have any health and safety questions or would like information and assistance with health and safety issues in the workplace, call the WorkSafeBC Prevention Information Line at 604.276.3100 (Lower Mainland) or toll-free at 1.888.621.7233 (Canada).