Understanding Second-Hand Chemotherapy Exposure
What is second-hand chemotherapy exposure?
Chemotherapy is a type of cancer treatment that kills all rapidly dividing cells in the patient's body. Consequently, chemotherapy drugs are highly toxic, and therefore must be handled with utmost care. The body sees the drug as harmful, and therefore attemps to detoxify and excrete the drug; this is done through bodily fluids such as urine or sweat. Second-hand chemotherapy exposure refers to accidental contact with the bodily fluids of patients who have undergone chemotherapy, which contain the drug.
For example, in patients who received CHOP chemotherapy, a drug regimen containing four drugs used to treat lymphomas, cyclophosphamide (one of the four drugs) was detected in the sweat of all patients included in the study at concentrations between 7.38 and 160.77 ng/cm^2 [1]. Therefore, the clothes contaminated with the patients' sweat are a potential source of second-hand chemotherapy exposure.
What are the symptoms?
Exposure to chemotherapy drugs, even if accidental and at small doses, can lead to symptoms due to the toxicity of the drugs. The most common symptom is contact dermatitis - a reaction where the skin becomes irritated, red, itchy and swollen [2]. Absorption of the drug may cause headaches, dizziness, nausea and potentially vomiting, and headaches. In some cases, repeated second-hand chemotherapy exposure can lead to more serious problems such as organ damage, impaired fertility, and even mutagenic (disrupts DNA) effects on cells, potentially resulting in malignant transformation (development of cancer). However, more research needs to be conducted to fully understand these adverse effects [2].
What to do to prevent exposure?
Arguably the most effective way of battling second-hand chemotherapy exposure is prevention - safe handling of the drugs is very important. It is instrumental that healthcare providers, as well as caregivers and the patient's family are trained in handling of hazardous substances, and their correct disposal to minimise contamination.
Chemotherapy drugs are found mostly in sweat to urine, and traces of the medication can remain in the patient's body for up to 48 hours after receiving the dose [3, 4]. Therefore, it's important to handle any items contaminated with these fluids, such as laundry or sanitary products, with gloves and wash them separately and thoroughly in hot water [3]. The patient may also be advised to flush the toilet twice and keep the lid closed while flushing to minimise aerosolisation [3, 4]. If possible, the patient should use a separate bathroom from other family members [3, 4].
Chemotherapy medications should be stored in a dry, safe place to preserve the drugs and minimise accidental contact. If any drugs are stored in liquid form, a spill kit should be ready nearby and people in the home should be trained on how to use it [3]. When chemotherapy drugs are handled, the standard procedure is to wear two pairs of gloves, also when handling any contaminated item [3, 4].
Finally, general cleanliness of the living environment is important - household surfaces should be cleaned regularly and special caution should be taken with food preparation [4].
Caregivers and others in the household should wash any part of their body that comes into contact with the patient's bodily fluids or chemotherapy medications with warm water and soap [3].
I've been exposed, now what?
If you believe you have been in contact with chemotherapy drugs in any form, including the patient's bodily fluids, it is important to remain calm, but take immediate action. If the exposure is through the skin (which is usually the case with second-hand exposure) wash the affected area thoroughly with soap and warm water. Do not use harsh scrubbing or abrasive materials to mitigate further damage to the skin [5]. After, consult with medical professionals.
If the exposure is through inhalation (which can be the case with aerosol), move to an area with fresh air immediately. If any symptoms such as difficulty breathing, coughing, or a sore throat manifest, seek medical attention [5]. If the exposure occurs through ingestion, rinse your mouth with water and seek medical attention immediately. Do not attempt to induce vomitting [5].
Regardless of the mechanism of the exposure, it is important to promptly seek medical attention. It is helpful to provide as much detail as possible to your healthcare provider, including the name of the drug, how and when the exposure happened, and all the symptoms you are experiencing [5].
It is important to minimise exposure in the long term. This includes training in proper handling and disposal of chemotherapy drugs and other contaminated material, as well as correct use of personal protective equipment and observing the protocols given by healthcare professionals [1, 6, 7, 8, 9, 10, 11, 12].
