The risk of occupational exposure to these mutagenic and potentially carcinogenic drugs has restricted the preparation of all cytotoxic doses to specialist facilities in the hospital pharmacy.
Cytotoxics
The risk of
occupational exposure to these mutagenic and potentially carcinogenic drugs has
restricted the preparation of all cytotoxic doses to specialist facilities in
the hospital pharmacy. The narrow therapeutic index, extreme toxicity and
complexity of cytotoxic treatment regimens provide strong clinical
justification for dose calculation and preparation by experienced staff using
well-controlled systems. A close working rela-tionship between clinical
pharmacy and technical services staff is desirable for all aseptic work, but is
essential in the case of cytotoxics.
Even with the use of
oral agents, pressures on pharmacy cytotoxic services include increased demand,
as more cancer patients receive chemotherapy and also an increasing trend
towards outpatient-based administration of chemotherapy. This places immediate
demands on the service to avoid lengthy patient waiting times and the risk of
errors caused by untrained staff administering chemotherapy outside normal working
hours. Strategies designed to offset these pressures include dose banding,
which enables doses to be prepared as standard prefilled syringes, which are
used in combination to provide the ‘banded’ dose. This approach is, of course,
dependent upon the stability of the reconstituted infusions. A recent survey
reported that dose banding of chemotherapy is now widely accepted by UK
oncologists and haematologists.
The introduction of
monoclonal antibodies or targeted therapies such as trastuzumab into chemotherapy
regimens has also created additional workload. These are not conventional
cytotoxic drugs and the occupational exposure risks are the subject of much
debate. However, given that tar-geted therapies are used to treat high-risk
patients who are immuno-compromised, many pharmacists feel these infusions
should be treated in the same way as conventional cytotoxic infusions.
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