Exposure to antineoplastic drugs among Ontario’s healthcare settings

Status: in progress


This eight-month long study will identify safe drug handling practices for antineoplastic drugs, the degree of adherence with these best practices and the perceived barriers to adherence in Ontario’s community pharmacies, veterinary clinics and long-term care homes.

Specifically, our study aims to answer the following research questions:

  • What is the adherence of veterinary clinics, community pharmacies and long-term care facilities to existing best practices for handling antineoplastic drugs and what barriers to adherence exist?
  • Can we identify the exposure levels to antineoplastic drugs in this group of healthcare workers and any related health effects?
  • Can we establish a standardized safe handling guideline for use with antineoplastic drugs within these non-acute healthcare settings?


Antineoplastic drugs are used in the treatment of cancers but are not selective and therefore disrupt the growth and function of both cancer cells and healthy, non-cancerous cells. Those who work with or handle antineoplastic drugs are at risk for acute health effects such as nausea and headaches. Chronic exposure can increase the risk of cardiotoxicity, reproductive toxic effects and may lead to cancer.

Exposure typically occurs through dermal contact with the drugs directly (vial or IV bag), indirectly (patient waste, saliva, sweat or vomit) or by touching drug-contaminated surfaces or objects. The drugs can be absorbed through the skin or accidentally ingested from hand-to-mouth contact. Healthcare workers in pharmacies, long-term care facilities, and veterinary clinics are at risk of exposure.


This study will incorporate a systematic literature review and an online survey. The systematic review will address measured levels of exposure in non-acute care facilities, health effects, and existing best practices. The online survey will be distributed to community pharmacies, veterinary clinics and long-term care facilities. Employees with extensive knowledge of the antineoplastic drug handling activities within their facility will answer questions about:

  1. The extent to which antineoplastic drugs are used in their workplace
  2. The safe drug handling practices for antineoplastic drugs at their workplace
  3. The degree of adherence with these best practices
  4. The perceived barriers to adherence

Our collaborations with the Public Services Health & Safety Association and Workplace Safety & Prevention Services are essential, as both organizations are well placed to disseminate and collect information to and from a broad audience in Ontario’s non-acute health care sector.


The information can be used to better understand the extent of antineoplastic drug exposures among healthcare workers in the non-acute health care sectors in Ontario. This information is important because:

  • Antineoplastic drug use is growing as a result of steadily increasing cancer incidence rates
  • Not all workplaces adopt and adhere to the guidelines that have been established for safe handling of antineoplastic drugs
  • Antineoplastic drug exposures among healthcare workers in the non-acute health care sectors in Ontario is not well characterized

Progress (updated February 2018):

This study commenced in May 2016 and is in the dissemination phase. Ethics approval has been granted.

Data collection and analysis for the study is complete.


Funding for this study was received from the Ontario Ministry of Labour.

The research team:

Dr. Paul Demers (Occupational Cancer Research Centre—Principal Investigator)
Dr. Chun-Yip Hon (Ryerson University—Co-investigator)
Dr. Kathy Vu (Cancer Care Ontario, University of Toronto)
Christopher Liddy (CAREX Canada)
Henrietta Van Hulle (Public Services Health & Safety Association)
Illia Tchernikov (Workplace Safety & Prevention Association)
Sheila Kalenge (Occupational Cancer Research Centre—Research Associate)
Christy Bou Fadel (Occupational Cancer Research Centre—Student Practicum (University of Toronto)

Clinical Lead, Safety Initiatives
Systemic Treatment Program
Cancer Care Ontario