Wednesday, July 14, 2010

A Hazardous Career Choice

Image found here

Back in 1999, I was diagnosed with atypical endometrial hyperplasia, a very early cancer affecting the lining of the uterus. You can read more about AEH here and here. I was fortunate to have a physician that quickly and accurately diagnosed my condition, offered various treatment options, and respected my choice. I decided to have a hysterectomy, tolerated the surgery well, and that was that. My cancer cells had not begun to invade other surrounding tissues and so did not require any other treatment other than surgery. I haven't given it much thought since then.

That is, until today, when I read this news article in the Seattle Times, entitled Lifesaving Drugs May Be Killing Healthcare Workers. The article describes the journey of a pharmacist, Sue Crump, who after many years of handling chemotherapeutic agents, develops and succumbs to a fatal pancreatic cancer. Here's a few snippets from the moving story:
Sue Crump braced as the chemo drugs dripped into her body. She knew treatment would be rough. She had seen its signature countless times in the ravaged bodies and hopeful faces of cancer patients in hospitals where she had spent 23 years mixing chemo as a pharmacist. At the same time, though, she wondered whether those same drugs — experienced as a form of "secondhand chemo" while she mixed the drugs as a pharmacist at Swedish Medical Center and elsewhere — may have caused her cancer to begin with........Crump, who died of pancreatic cancer in September at age 55, was one of thousands of health-care workers who on the job was chronically exposed to chemotherapy agents for years before there were even voluntary safety guidelines in place.........Nurses, who occasionally spill the chemo drugs on their clothing or splash it on their skin, had a greater chance of premature labor if they administered nine or more doses of chemo per day. The survey also found that nurses who didn't use gloves as often while preparing chemo were more likely to have children with learning disabilities.........."Now all these people about my age are getting cancer — cervical, ovarian, prostate, endometrial, brain," Crump said. "All of us, at one time or another, worked with chemo — we wondered, well, is there a connection?"
It appears that Sue was right in asking this question, and the article goes on to acknowledge that these hazards to health care workers are significant:
A just-completed study from the U.S. Centers for Disease Control (CDC) — 10 years in the making and the largest to date — confirms that chemo continues to contaminate the work spaces where it's used and in some cases is still being found in the urine of those who handle it, despite knowledge of safety precautions........"There is no other occupation population (that handles) so many known human carcinogens," said Thomas Connor, a research biologist with National Institute for Occupational Safety and Health (NIOSH). Connor has spent 40 years studying the effect of chemo agents on workers and is one of the lead authors on the latest study.
The reason that this article caught my attention is the fact that I spent approximately two years working as a nurse in an outpatient chemotherapy clinic. We were responsible for handling and administering all chemotherapeutic agents. At the time, which was 1986 - 88, we were using laminar flow hoods, gowns, gloves, and masks during preparation of the drugs, but were required only to wear gloves during administration of the medications.

We were very careful when handling and administering these meds, but it now appears that the guidelines for safe handling of chemotherapy meds are drastically different, with many more requirements for additional protective environments and equipment.

I wonder if my history of an early endometrial cancer is related to the time I spent as a chemotherapy nurse? Of course, it is impossible to say whether this experience was the direct cause of my AEH. I'll never know for sure.

Would I have refused to work in Oncology had I been given the information that I have read today? Hard to say. I certainly was not advised of the risks I was taking when I slipped on that white lab coat. But as a young mom at 29 years old with three small children and my husband to think of, I would have given careful consideration not only to the impact that this could have on my own health, but also what implications it may have had on my family.

It's a difficult issue. There is no doubt that countless lives have been saved by the administration of these drugs. It doesn't seem fair, however, that those nurses and pharmacists administering these drugs are in turn putting their own lives at risk. But if most nurses and pharmacists refuse to administer these life-saving treatments, who will?

I know that in the long run, for me, it doesn't really matter. I was fortunate to have been treated quickly and appropriately. But for those young people entering the nursing and healthcare workforce, I am concerned. I hope that they are given this very important information regarding the risks of handling these and other potentially toxic agents BEFORE they agree to work in these areas.

You can read more about current NIOSH guidelines for personal protective equipment for chemo agents here.


RED said...

Hi Julia--great, informative post! I have a question for you--did your Sjogren's kick in AFTER your hysterectomy? The reason I'm asking is because I had a hysterectomy in 2007, and early 2008 is when I started getting sick. Have to wonder if changing hormone levels kicked in an autoimmune response. I know some women develop autoimmune problems after giving birth--I didn't. P.S. they left my ovaries--just took the uterus.

Julia said...

yes, I had my hyst and ovary removal in 2000, and was dx with Sjogren's syndrome in 2003. You're right - there definitely seems to be some link between sex hormones and autoimmune disease, as evidenced by several really interesting studies out there. But then, there's many other avenues of research such as virology and toxicology which also have data connecting to autoimmune disease. Such a tangled web Sjogren's weaves.....

annie said...

Thank you for bringing up a subject that I don't believe many of us really thought about.We take it for granted that we get a prescription and that prescription is filled and/or administered, but one never thinks of any hazards involved for the health workers. I hope there are better and safer procedures being put in place today.

From what I've read (and can remember!) a person usually inherits the genetic tendency to an autoimmune disease, but something will trigger the person to get the disease. I'm pretty sure in my case it was a virus, but who knows for certain?