Unsafe practices in handling chemotherapy persist in poorer countries

Handling of chemotherapy drugs remains unsafe in many low- (LICs) and middle-income countries (LMICs), reveals a study.

"Improvement strategies are needed to increase patient and staff safety and limit environmental contamination, especially in LICs,” the researchers said. “Safe handling programs should be part of continuing efforts to improve access to quality cancer drugs and should be integrated into national cancer control programs.”

An online survey was conducted from June 2018 to April 2019 among LMIC healthcare facilities dealing with chemotherapy agents. Facilities were asked to self-assess their handling processes using Cyto-SAT, a self-assessment tool that includes 134 items organized into 10 domains: management, personnel, logistics, prescription, preparation, administration, incident management, waste management, cleaning, and patient counselling. Data were recorded on www.datapharma.ch/cyto-SAT.

Fifty-three healthcare facilities (15 from low-income, 26 from lower-middle-income, and 12 from upper-middle-income countries) participated in the survey. The median level of implementation of safe practices was 63 percent (Q1: 39 percent to Q3: 77 percent). [J Oncol Pharm Pract 2022;28:410-420]

Facilities in LICs reported lower median levels of safe practices than did MICs (LICs: 32 percent [Q1: 24 percent to Q3: 62 percent]; lower-MICs: 63 percent [Q1: 49 percent to Q3: 70 percent]; upper-MICs: 85 percent [Q1: 77 percent to Q3: 93 percent]).

Differences between these country categories were biggest in terms of personnel, preparation processes, and incident management.

Previous studies conducted locally in resource-poor settings reported unsatisfactory levels of knowledge and unsafe practices regarding the preparation and use of chemotherapy drugs, according to the researchers. [Environ Health Prev Med 2020;25:11; OJN 2012;02:97-103; Malaysia Asian Pac J Cancer Prev 2013;14:69-73; JCT 2012;03:110-114]

The present survey did not examine the reasons or challenges behind inappropriate practices, but other studies had identified the following barriers to safety: insufficient knowledge, unsuitable infrastructure, the unavailability of materials, multitasking, work pressures, and high patient loads. [Asian Pac J Cancer Prev 2004;5:164-168; JCT 2012;03:110-114; Environ Health Prev Med 2020;25:11]

“The present survey shows that there remain many safety deficiencies in chemotherapy handling practices, particularly in countries with limited resources,” the researchers said. “There are thus many potential health hazards which will have to be fully addressed as patient numbers are expected to significantly increase in LMICs, as will the use of and exposure to chemotherapy drugs.”

The endorsement of the World Health Organization of safe handling guidelines and the integration of safe handling practices recommendations into National Cancer Control Plan models could help raise standards through advocacy and promote resource allocation for the improvement of practices.

In addition, the researchers recently developed an online training package to improve safe handling of chemotherapy in LMICs. Eleven e-learning lessons covering 10 domains addressed by the Cyto-SAT tool are available for free on this online platform: www.Pharm-Ed.net.

“A set of practical tools has also been developed to support the implementation of safe practices (eg, videos, checklists, procedures, etc),” the researchers said. “In the near future, we hope to evaluate this program’s impact on facilities in LMICs.”