Biotherapy

The American Society of Clinical Oncology (ASCO) and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for safe administration of chemotherapy. Current ASCO/ONS standards address safety of all routes of chemotherapy administration to adult patients in the outpatient setting and inpatient setting.
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This extensive drug table describes the drug and food interactions associated with many oral therapies for cancer.
View this 16-minute presentation to learn how chemotherapy doses are calculated.
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A.B. is a 61‐year‐old woman with metastatic HER2‐positive breast cancer. She is a self-employed consultant and travels extensively in the United States and internationally to work with her diverse clients. She is divorced and has three adult married children. She is active, in good health, and has no comorbid conditions. A.B. was treated with adriamycin plus cyclophosphamide (AC) followed by paclitaxel plus trastuzumab in the adjuvant setting. Two years later, she recurred with symptomatic disease (pain) in the liver.
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Unlike radiation exposure, exposure to hazardous drugs cannot be measured with a badge or device. Instead, healthcare workers must strive to minimize exposure to these drugs. In addition to engineering controls, safer work practices, and the use of personal protective equipment (PPE), healthcare workers should be routinely monitored in a medical surveillance program. ONS, the Occupational Safety and Health Administration (OSHA), and the American Society of Health-System Pharmacists (ASHP) all have recommendations related to employee medical surveillance.
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Following is "Practice Safe Nursing With Oral Hazardous Drugs," an article featured in the January 2010 issue of ONS Connect.  The num­ber of cur­rently avail­able haz­ardous oral drugs is increas­ing and now includes small mol­e­cules and hor­mones in addi­tion to tra­di­tional agents such as cyclophos­phamide. Nurses are pre­sented with unique safety chal­lenges in han­dling these medications.
Oral formulations of chemotherapy and hormonal therapies have been used for decades and include many familiar agents, such as cyclophosphamide, melphalan, and tamoxifen. Cancer treatment has experienced a rapid increase in oral oncolytics, including cytotoxic agents, small-molecule inhibitors, and agents targeted at receptors that regulate cellular differentiation, growth, and survival. The expansion of oral oncolytics is projected to continue, as an estimated 25% of anticancer agents in the research pipeline are designated for oral administration (Michaud & Choi, 2008).
Nurses can minimize exposure to hazardous drugs with the use personal protective equipment and careful technique. Spill kits should be available wherever chemotherapy is located. Although they are commercially available, clinicians can assemble their own kits (American Society of Health-System Pharmacists, 2006). A hazardous drug spill kit should include the following contents.
Because many biotherapy agents are still relatively new in the treatment of cancer, there is still quite a bit of variability in how these agents are handled. However, it is important to note that some biologic agents are considered hazardous while others are not.
Recommendations for what personal protective equipment (PPE) to wear when handling chemotherapy or contaminated materials are consistent across several groups, including the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), American Public Health Association, and ONS. These recommendations don’t differentiate between high- and low-risk situations, as there is no known minimum safe exposure and always the potential for contamination. 
Guidelines for the safe handling of hazardous wastes have existed for 20 years or more, but with nearly six million healthcare workers handling these wastes as of 2009, the importance of maintaining safety guidelines has never been greater.
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