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Hazardous therapy

Veterinary workplace exposure to chemotherapeutic agents creates health risks, could have regulatory implications
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Nov 01, 2008

NATIONAL REPORT — Brett Cordes, DVM, turned 35 when he felt the lump in his neck.


Photo: Mark Peterrman
"The first question the human endocrinologist asked me was, 'Do you handle chemotherapy drugs?' My initial instinct was to panic. Then I said, 'yes.'"

Now 37, the small-animal practitioner markets safety systems designed to help protect health-care workers from exposure to chemotherapy drugs — human carcinogens known to cause secondary cancers in some patients. It's an issue he's passionate about because, like a growing number of his colleagues, Cordes (photo) links his battle with Hurthle cell carcinoma to years of chemotherapy exposure as he treated his oncology patients.

"I remember dumping drugs down the drain and handling them with the same gloves I used to treat anal glands," he says. "I'm healthy now, but whether or not there was an association between the drugs and my disease, I'll never know. It bothered me enough to quit my job, and I can guarantee that more veterinarians are going to get diseased and eventually get sued by the technicians who handle these agents."

If Cordes' prediction sounds extreme, it's one that appears to have captured the American Veterinary Medical Association's (AVMA) attention. At press time, the group's Council on Veterinary Service met to explore the safe handling of chemotherapeutic agents for its five-year review of the national association's policy on workplace hazards.


Guidelines at a glance
While AVMA officials refused to detail what prompted such action, the move follows alerts like the federal government's 2004 warning to 5.5 million American health-care workers, stating that the powerful drugs used in chemotherapy can themselves cause cancer and pose health risks to the nurses, pharmacists and veterinary-care workers who manage them.

"It seems counter-intuitive that the health-care industry, whose mission is the care of the sick, is itself a high-hazard industry for the workers it employs," the Centers for Disease Control and Prevention (CDC) statement says.

Yet with minute numbers handling such drugs off-label, federal agencies often overlook the role veterinary medicine plays in chemotherapy administration. Attention to safe-handling practices is an issue that's late to evolve in human medicine and even more sluggish for veterinary practices.

The reason? An estimated 20 percent of all veterinary hospitals use chemotherapy agents, which translates to a tiny market in comparison to the human sector. What's more, agencies like the Occupational Safety and Health Administration (OSHA) might have handling guidelines, but they're vague, and enforcement takes place only on a complaint-driven basis, critics contend.

OSHA representatives did not return DVM Newsmagazine's interview requests.

"There are no real regulations," oncology specialist Dr. Greg Ogilvie says, "but you put a gun to someone's head and ask them how many die from chemo-therapy exposure, and that number does not exist, either. I'm not a fan of government regulations. Look at the EPA (Environmental Protection Agency) or OSHA — they don't have a big enough enforcement branch to clean up horrible things down the street, let alone go into every veterinary practice."

Instead, Ogilvie pushes the need for safety education that empowers veterinarians to do their jobs better. To do it right, he estimates a veterinary practice must spend $50,000 to $100,000 in fixed costs, plus up to $20 per patient for disposable products to put the proper safety protocols in place. It's a price tag that's out of reach for many general practices, he admits.