Last March, the federal government issued an unusually detailed alert to the nation's 5.5 million health care workers: The powerful drugs used in chemotherapy can themselves cause cancer and pose a risk to nurses, pharmacists and others who handle them.
Four years in the making, the alert was issued by the National Institute for Occupational Safety and Health (NIOSH). Officials with the institute -- part of the Centers for Disease Control and Prevention (CDC) -- and members of a hazardous-drug advisory panel saw the document as a long-overdue first step toward addressing what could be a serious workplace health problem.
A NIOSH Alert , left, issued last March warned health care workers of risks from contact with chemo drugs. The drugs are usually administered to patients intravenously, right.
The next step was to be a study of actual exposures at three hospitals, operated by the universities of Maryland, North Carolina and Texas. The plan was to take blood and urine samples from about 50 pharmacists, nurses and pharmacy technicians at the hospitals and look for signs of drugs such as cyclophosphamide (usually administered intravenously to treat lymphoma, leukemia or breast cancer) and ifosfamide (also an IV drug, often used on lung, cervical and ovarian cancers).
But the study, formally proposed in July 2002, is on hold. Twice the CDC submitted the proposal to the Office of Management and Budget (OMB). Twice it was withdrawn, after the OMB raised questions. It has yet to be resubmitted.
OMB spokesman Chad Kolton would say only that the CDC withdrew the paperwork "to address ongoing technical concerns relating to the scope of the proposed study design." CDC spokesman Fred Blosser said, "Traditionally, we don't go into detail on pending discussions or reviews with OMB."
Study proponents, meanwhile, say that precious time is being lost.
"The study is very important," said Marty Polovich, an oncology nurse in Riverdale, Ga., and a member of the NIOSH Hazardous Drug Workgroup. "A lot of the information we have about employee exposures is fairly old."
NIOSH issued the alert on chemotherapy drugs because human and animal studies have shown they have the potential to cause cancer or reproductive problems, said Thomas Connor, a research biologist with the institute. Some studies have found higher-than-expected prevalence of these ailments among health care workers, he said.
Exposures can occur in a number of ways: The drugs can become airborne and be inhaled. They can collect on work surfaces and be absorbed through the skin. Traces of them also can be found on medical equipment, clothing and in patient excreta.
"People have exposures every day," said Bill Borwegen, occupational health and safety director for the Washington-based Service Employees International Union, which represents about 875,000 health care workers. "If you're piercing an IV bag and get a drop [of a drug] on your finger, you could be over the safe level."