Exposure to antineoplastic drugs among Ontario’s healthcare settings


To 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.

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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. The toxicity of these drugs has been documented since the 1940s. Health care workers who are exposed to antineoplastic drugs have exhibited a wide range of short-term and long-term health outcomes. Occupational exposure can occur via inhalation, dermal exposure, accidental ingestion, spills, and accidental injections from sharps and other needle stick injuries.

Exposure among nurses and pharmacists in acute care settings has been well characterized, but other groups are also at risk. Little is known about exposure among those working in non-acute care settings, such as community pharmacists and retail pharmacy personnel, nurses and health care workers in long-term care homes, and veterinarians and veterinary technicians.


This study included a literature review on measured levels of exposure to antineoplastic drugs in non-acute care facilities, and an online survey that asked about the frequency of use of antineoplastic drugs, existing safe drug handling practices or policies, adherence to safe drug handling policies, and barriers to adherence. The survey was distributed to the following groups:

  • select community pharmacists who were listed as members of the Ontario College of Pharmacists in 2017
  • registered veterinarians and veterinary technicians, via the College of Veterinarians of Ontario and the Ontario Association of Veterinary Technicians, respectively
  • the Ontario Association of Non-profit Homes & Services for Seniors

This project was done in collaboration with the Public Services Health & Safety Association and Workplace Safety & Prevention Services.


146 pharmacists, 92 veterinary workers, and representatives of 5 long-term care homes completed the study. Of those who responded to the survey (N=243), 79% reported that they handled (dispensed, prepared, or administered) antineoplastic drugs.

In general, low use and adherence to engineering and administrative controls and personal protective equipment was reported, especially for those who dispense antineoplastic drugs.

Some of the barriers to adhering to safe drug handling guidelines identified by the respondents included:

  • lack of training in or awareness of the skill required for handling and compounding antineoplastic drugs
  • inadequate staffing levels at the facilities with insufficient time to follow best practices
  • lack of access to best practice guidelines
  • lack of consensus in respective facilities about the risks of exposure to antineoplastic drugs.

Click here for complete survey results.


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

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

Research Team
Paul Demers
Chun-Yip Hon
Ryerson University
Kathy Vu
OCRC and University of Toronto
Christopher Liddy
CAREX Canada
Henrietta Van Hulle
Public Services Health & Safety Association
Illia Tchernikov
Workplace Safety & Prevention Services
Sheila Kalenge
Christy Bou Fadel
OCRC and University of Toronto
Clinical Lead, Safety Initiatives
Systemic Treatment Program, Ontario Health