An environmental and biological study of occupational exposure to cyclophosphamide in the pharmacy of a Japanese community hospital designated for the treatment of cancer

Cancer treatment in Japan is considered to be very progressive in the use of antineoplastic agents. Pharmacists are required to compound more antineoplastic preparations recently and thus are at risk for exposure to antineoplastic agents. In Japan, healthcare professionals have recognized the need for protection, but there have been few reports of environmental contamination or occupational exposure to antineoplastic agents. In the present study, urine samples over 24 hr from compounding pharmacists and wipe samples from the compounding room were collected to analyze levels of cyclophosphamide (CP). CP was detected in urine samples from all 4 pharmacists (mean = 165.3 ng/24 hr) and for all wipe samples of the compounding room. From the results of these tests, the standard operating procedure (SOP) of the pharmacy was revised as a protective measure. The tests were then repeated and CP was detected again in the urine of all 4 compounding pharmacists, though the mean CP level was reduced from 165.3 to 47.4 ng/24 hr after the revision of the SOP. Although there was no correlation between the amount of CP compounded and the CP levels in urine initially, the 2 values were significantly correlated after the revision of the SOP (R₂ = 0.87).