As a part of NewsHour Connect, which showcases some of the best public broadcasting reporting from around the country, Enrique Cerna of KCTS in Seattle reports on the potential dangers of chemotherapy to caregivers who handle them.



Lifesaving cancer drugs may put workers' lives at risk

Chemo could have a hidden deadly toll on pharmacists, nurses

By Carol Smith

InvestigateWest

updated 7/11/2010

Sue Crump braced as the chemo drugs dripped into her body. She knew treatment would be rough. She had seen its signature countless times in the ravaged bodies and hopeful faces of cancer patients in hospitals where she had spent 23 years mixing chemo as a pharmacist.

Now she hoped those same medicines would kill the tumor cells lurking in her belly. At the same time, though, she wondered whether those same drugs may have caused her cancer to begin with.

Sue Crump prepares to receive chemotherapy for pancreatic cancer at Evergreen Hospital in Kirkland, Wash., before her death last September. Before her diagnosis, she spent 23 years mixing chemo as a hospital pharmacist and believes the years of toxic exposure caused her own cancer.
Harnessing toxic agents to save a life demands a delicate balance. Chemo is poison, by design. Descended from deadly mustard gas first used against soldiers in World War I, now it’s deployed to stop the advance of cancer.

Crump knew she had her own war on her hands. And she wanted young pharmacists and nurses to pay attention to her story.

Little workplace regulation
The same powerful chemotherapy drugs that have saved hundreds of thousands of patients’ lives for decades have at the same time potentially taken a deadly toll on the hospital and clinic workers who handled them.

Crump, who died of pancreatic cancer last September at age 55, was one of thousands of health care workers who were chronically exposed to chemotherapy agents on the job for years before there were any safety guidelines in place.

Now, some of those workers, like Crump, are being diagnosed with cancers that occupational health specialists say could be linked to that exposure.


.Patty Allen, a long-time friend, holds Sue Crump's hand during a visit to say goodbye to her in hospice care in Kirkland, Wash.

Their ranks include Bruce Harrison of St. Louis, Karen Lewis of Baltimore — both pharmacists —and Brett Cordes, a veterinarian from Scottsdale, Ariz. All, like Crump, worked extensively with or around chemotherapy. (See profiles below.) All of them eventually got cancer, or in Lewis’ case a pre-cancerous condition. All believed their disease was linked to workplace exposures and became symbols for increased safety. Cordes, who was diagnosed four years ago at age 35, and Lewis, who was diagnosed in her 50s, are both undergoing treatment. Harrison died at age 59.

Tracing an individual’s cancer to a particular exposure is difficult. It’s one of the main reasons safety advocates have been thwarted in their efforts to get stricter regulations. But many who study these agents fear lax safety standards are resulting in ongoing exposures that continue to put current workers at future risk.

A just-completed study from the U.S. Centers for Disease Control, 10 years in the making and the largest to date, confirms that chemo continues to contaminate the workspaces where it’s used, and in some cases is still being found in the urine of those who handle it, despite knowledge of safety precautions.

"There is no other occupation population (that handles) so many known human carcinogens,” said Thomas Connor, a research biologist with the National Institute for Occupational Safety and Health. Connor has spent 40 years studying the effect of chemo agents on workers, and is one of the lead authors on the latest study.

Chemo agents have been classified as “hazardous drugs” by the Occupational Safety and Health Association (OSHA.) Hazardous drugs are those known, or suspected to cause cancer, miscarriages, birth defects, or other serious health consequences.

But an InvestigateWest investigation has found that OSHA does not regulate exposure to these toxic substances in the workplace, despite evidence of ongoing contamination and exposures.

While Deputy Assistant Secretary of Labor for OSHA Jordan Barab said the agency “has been concerned about the potential for healthcare workers to be exposed to hazardous drugs for some time,” he conceded in written responses to questions from InvestigateWest that the agency does not have the resources to issue standards “covering every safety and health hazard facing workers.”

“Although this is an important safety and health issue, OSHA has not considered a standard to specifically address hazardous drugs in the healthcare setting,” he wrote.

OSHA has no regulatory authority to enforce safety practices with fines or sanctions, other than under its “General Duty” clause — a catch-all regulation that allows OSHA inspectors to warn an employer if they see something that concerns them.

According to documents obtained by InvestigateWest through the Freedom of Information Act, OSHA has only used the clause once in 10 years to cite any health care institution, including hospitals, clinics, dental and veterinary offices, for their handling of hazardous drugs.

Longterm exposures to ‘just a little bit’
A few months before she died, Crump sat in a coffee shop near her home in suburban Seattle, and perused a list of chemo drugs now deemed hazardous for health care workers to handle. She ran her fingers down the page. It’s a long list: cyclophosphamide, doxorubicin, fluorouracil, methotrexate. And the list went on.

“Yeah, I worked with all of them,” she said.
.
Crump started at Seattle’s Swedish Medical Center in the early 1980s, before pharmacists used special protective “hoods” over countertops to contain spray and chemo contamination. They didn’t use gowns, or gloves.

They had no reason to think they should.

Occasionally, drugs would spill on the countertops.

“We would wipe if off and throw (the towels) in the garbage,” Crump said. “Most of the chemo came in vials, and we would transfer it into plastic IV bags
Sometimes there would be spray when they punctured the vials.

Other drugs came in ampoules and would be squirted, she said. “I’d file the neck of it, then snap real fast, she said. “A lot of times, I got cuts
http://www.nbcnews.com/id/38114586/ns/health-cancer/t/lifesaving-cancer-drugs-may-put-workers-lives-risk/#.VINoJlItDIU

https://www.youtube.com/watch?v=nvldyOyv--0

https://www.youtube.com/watch?v=UgTYIswJ9i8