Cytotoxic drugs

Cytotoxic drugs, also referred to as antineoplastic, anticancer or cancer chemotherapy drugs, include a wide range of chemical compounds. They are extensively used to treat cancer, as they kill tumour cells by interfering with cell division. However, their actions are not specific to tumour cells and normal cells may also be damaged. This means potentially serious side-effects in both patients or others exposed.

Advice to Health and Safety Reps

Under the OHS Act and the regulations, you have a right to inspect the workplace, and be part of the employer's process to identify, assess and control risks.  Talk to the members of your Designated Work Group, and if you need more assistance, contact your union.

Legal standards

The employer has a duty of care under both the Victorian Occupational Health and Safety Act (2004) and the Hazardous Substances and Materials Chapter of the Occupational Health and Safety Regulations 2007  to identify any associated hazard and risk, and then either eliminate, if practicable, or minimise the risk to workers with relation to chemicals in the workplace.  More information on the consolidated regulation.

Part 4.2 of the Regulations also specifies additional duties which apply to certain carcinogenic (cancer-causing) substances. Extra duties include the requirement for employers to apply for licences to use a scheduled substance, the ability of WorkSafe to cancel or suspend licences, maintenance and retention of records, and written statements to workers who have used these substances. This Part of the regulations applies to 'scheduled' carcinogenic substances only. ('Scheduled' means a prohibited or restricted carcinogen as listed in Schedule 10 under the WHS Model Regulations. Division 8 of Part 7 of the model regulations applies to carcinogens). These schedules can now also be accessed on this page of the Victorian WorkSafe website - note however, this has not been updated to reflect the WHS model reg. 

With many cytotoxic drugs, there is the requirement for the employer to either obtain a special license or notify the relevant government authority. In order to be granted a license, the employer must demonstrate what controls are in place to prevent exposure.

For more information, including on specific controls, waste diposal and more, the Health and Safety Executive in the UK has produced an 8-page leaflet Safe Handling of Cytotoxic Drugs.

The US National Institute of Occupational Safety & Health (NIOSH) has issued a guide: Antineoplastic Agents - Occupational Hazards in Hospitals, particularly in oncology departments, to caution them to adhere to control measures when working with cancer therapy drugs known as antineoplastic agents. Adverse health effects, such as abdominal pain, hair loss, disruption of menstrual cycle, foetal loss and birth defects have been reported in hospital workers exposed to the agents.

Health Effects

Acute health effects
Some cytotoxic drugs can irritate the skin, eyes and mucous membranes. Other acute effects, such as light-headedness and nausea, have been reported in circumstances where measures to control exposure have been inadequate.

Chronic health effects
While the information on the chronic effects of cytotoxic drugs is based on animal and patient data, occupational exposure is at much lower levels. However, there is a potential for workers to be repeatedly exposed over a prolonged period. Little is know about the consequences of repeated exposure to small quantities of cytotoxic drugs, but some of these compounds are mutagenic (exposure to it may produce changes in the genetic apparatus of the cell) and carcinogenic (cause cancer) in both animals and humans.

Some have also been classified as teratogenic (capable of entering a pregnant woman's bloodstream and crossing the placenta barrier to affect the developing foetus) in animals.

More information
  1. Health and Safety Solution from WorkSafe Victoria: Handling cytotoxic drugs in the workplace 
  2. Cytotoxic Drugs and related waste risk management guide: from Work Safe Queensland to assist employers and workers reduce the risks associated with handling cytotoxic drugs and related waste.  The guide highlights control measures to reduce the risk of exposure to these drugs and cover a range of issues including:
    • safety when preparing, dispensing and administering cytotoxic drugs;
    • managing cytotoxic contaminated body wastes;
    • spill and waste management;
    • caring for patients in community settings; and
    • cytotoxic drugs in veterinary practices

Also, from the National Institute for Occupational Safety and Health (NIOSH), the US government's occupational health research agency:  an updated dangerous drugs listing to accompany its guide to the hazards posed to healthcare workers by the medicines they administer (including cytotoxic drugs).

The new list is a supplement to its guide 'Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings'. In the introduction to the updated drugs list, NIOSH notes: "Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs." It adds: "The actual risk to health care workers depends on what is done with the drugs - how they are manipulated, how often they are handled, and what type of engineering controls and personal protective equipment (PPE) are used."
NIOSH news alert, and updated drug list, NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016

Last updated, May 2020