[Survey of the Implementation Status of Personal Counseling among Cancer Patients in Red Cross Hospitals].

Red Cross Pharmaceutical Association conducted a questionnaire-based survey to evaluate the status of implementation of pharmaceutical intervention as well as personal counseling for outpatients with cancer undergoing chemotherapy. Based on the survey results from 93 hospitals across the country, it was found that pharmacists performed an intervention on outpatients receiving chemotherapy in 68 hospitals(73.1%)and conducted personal counseling for outpatients with cancer in 48 hospitals(51.6%). Out of the 68 hospitals, 20 did not conduct personal counseling for outpatients with cancer. This was attributable to the fact that 14 hospitals did not have a qualified pharmacist, 3 did not have sufficient manpower, and 3 did not have the required system. The results of a logistic regression analysis showed that the number of pharmacists significantly affected implementation of pharmaceutical intervention as well as personal counseling for outpatients with cancer undergoing chemotherapy(p=0.042, p=0.023, respectively). The pharmacists can receive a fee for medical services only after conducting personal counseling for outpatients with cancer undergoing chemotherapy. However, in hospitals with a small number of pharmacists, they could not claim their fees owing to lack of manpower. This survey found that lack of manpower is currently the most important issue.

Risks to health professionals from hazardous drugs in Japan: a pilot study of environmental and biological monitoring of occupational exposure to cyclophosphamide.

PURPOSE: In Japan, concerns exist regarding the dangers inherent when handling cytotoxic drugs, particularly drugs such as 5-FU, Thiotepa, Cytarabine, Tegaful, and Sizofiran which are contained in ampoules or vials, since nurses and medical doctors have been preparing these cytotoxic drugs in the open spaces of wards in the absence of appropriate garments and personal protective equipment. In addition, the administration tubes for these dangerous drugs have been exchanged at the patients' bedside, typically in rooms shared by several patients. To gain insight into the severity of the occupational hazards posed by these practices, we conducted a pilot study of environmental and biological monitoring of occupational exposure to cyclophosphamide (CP). SETTING: At Nagoya University Hospital, Nagoya, Japan, in February 2006, two departments, A and B, were monitored with surface-wipe, and urine samples were analyzed using the Sessink method (exposure control, The Netherlands). Department A had a preparation room with biological safety cabinet (BSC) where the pharmacists prepare cytotoxic drugs. Department B did not have a BSC. RESULTS: Many areas of the treatment rooms were contaminated with CP. CP was detected on tables and telephone stands where cytotoxic drugs were not used as well as tables used to prepare cytotoxic drugs. Significant differences in CP concentrations were detected from the urine of two of the three nurses who cared for the same patients without gloves. The nurses rotated and inherited the patient who had the highest risk of contamination. CP was detected only once from the urine of the medical doctor who prepared CP. He was not wearing any PPE other than gloves. All of the pharmacists wearing PPE were free from contamination of CP. DISCUSSION: Regardless of the use of BSC, wards were contaminated with CP. The contamination may not occur due to the sealing used in CP containers and administration tubes when discarding them. CP was detected only once in the urine of a medical doctor who prepared CP by warming it. The cause may be inhalation of CP gas from the injector. The contamination of the nurses may be from dermal absorption because absorption continued even after the shift ended and the nurses left the facility. CP was not detected in pharmacists who followed the guidelines for preparation of CP. All of the medical staff should follow the guidelines when they handle CP.

Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan.

PURPOSE: A multicenter field survey of environmental contamination and exposure of healthcare professionals to anticancer drugs were performed. SETTING: Three university hospitals, one cancer specialty hospital and two corporate hospitals from across Japan. METHOD: The environmental contamination with cyclophosphamide (CP) was investigated. A wipe examination was performed at six sites apiece in two divisions. The urinary excretion of the CP over 24 h was determined. The subjects of the survey included physicians, pharmacists, and nurses, for a total of seven at each facility irrespective of job title. The wipe samples were collected at 12 sites within two divisions at each facility. For the exposure survey, the total urine volume was determined, and a portion of the urine sample was then collected from each participants at each facility. Urine was collected for 24 h. The samples were determined by using the GC-MS method. RESULTS: Wipe examination: contamination with CP was identified at 50% of the sites. The concentration was high (CP > 1.00 ng/cm(2)) in the general environment in two hospitals and in the safety cabinet in one hospital. In the survey for the exposure of staff to anticancer drugs, 276 samples were obtained from 41 healthcare professionals. CP was detected in 90 samples obtained from 23 subjects. The amount of exposure was greatly different among the facilities. The urinary excretion of CP per subject was between 2.7 and 462.8 ng/24 h. The range of urinary excretion for each hospital was between 4.6 and 211.2 ng/24 h.

[Clinicopathological evaluation of preoperative chemotherapy with doxorubicin plus cyclophosphamide followed by paclitaxel for locally advanced breast cancer].

While the optimum regimen and therapeutic duration of preoperative chemotherapy have not been established for advanced breast cancer, the combination regimen of anthracycline series and taxane series, which has been well received as a postoperative chemotherapy, is also recommended for preoperative chemotherapy. We here present a clinicopathological evaluation of the safety and efficacy of the regimen and the predictors of the effectiveness of preoperative chemotherapy conducted retrospectively in patients with advanced breast cancer who were treated preoperatively with the combination of doxorubicin and cyclophosphamide followed by sequential weekly paclitaxel during the period between January 2004 and June 2007 at Yamada Red Cross Hospital. Eleven patients were treated preoperatively with the regimen during the study period. Tumors shrank in all patients following the preoperative chemotherapy with a mean reduction rate of 64.1%. Adverse reactions to the preoperative chemotherapy included leukopenia; grade 3 in 1 patient and grade 2 or less in the remaining patients. Response rates evaluated in the primary tumors and lymph nodes were high. As for the predictors of the effectiveness of the regimen as preoperative chemotherapy, estrogen receptor(ER)and the presence of HER2 were investigated, and antitumor effects were high in patients with negative ER and positive HRE2.

Impact of closed-system drug transfer device on exposure of environment and healthcare provider to cyclophosphamide in Japanese hospital.

In spite of current recommended safe handling procedures, the potential for the exposure of healthcare providers to hazardous drugs exists in the workplace. A reliance on biological safety cabinets to provide total protection against the exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimize cytotoxic drug exposure in healthcare providers. This study was conducted to compare surface contamination and personnel exposure to cyclophosphamide before and after the implementation of a closed-system drug transfer device, PhaSeal, under the influence of cleaning according to the Japanese guidelines. Personnel exposure was evaluated by collecting 24 h urine samples from 4 pharmacists. Surface contamination was assessed by the wiping test. Four of 6 wipe samples collected before PhaSeal indicated a detectable level of cyclophosphamide. About 7 months after the initiation of PhaSeal, only one of 6 wipe samples indicated a detectable level of cyclophosphamide. Although all 4 employees who provided urine samples had positive results for the urinary excretion of cyclophosphamide before PhaSeal, these levels returned to minimal levels in 2 pharmacists after PhaSeal. In combination with the biological safety cabinet and cleaning according to the Japanese guidelines, PhaSeal further reduces surface contamination and healthcare providers exposure to cyclophosphamide to almost undetectable levels.