Explainer: Profiles of exposure: Health care workers share lessons

  • Karen Lewis: Call for screening

    Image: Karen Lewis
    Courtesy of Karen Lewis

    Karen Lewis knew what the possibilities were when a routine medical exam returned an abnormal white blood cell count on her four years ago. “I worked in a cancer center,” she said. “I knew.”

    The long-time hospital pharmacist, 57, was soon diagnosed with a pre-cancerous blood disease called myelodysplastic syndrome. Her doctor immediately ordered her to stop working with or around chemo agents.

    “I started working with chemo in 1993,” said Lewis, who has worked for years at the University of Maryland Medical Center in Baltimore. “Back then there were much less restrictive policies (around handling chemo).”

    Her attitude then was similar to those of many of her peers. They had been advised to wear “chemo protective gowns” made of heavy paper, with little cuffs, and double gloves. “But nobody really did (wear double gloves) because it made it hard to manipulate needles. And no one said if we didn’t follow (the guidelines) we were at any greater risk.”

    She also doesn’t recall being advised to wear a mask. “My thinking was if I don’t actually stick myself or spill on skin, I’m OK,” she said. “I never thought of any other way (it could be) adversely affecting me.”

    In particular, she never realized that the type of “laminar flow hoods” the hospital used — the commonly recommended type at the time — blew potentially contaminated air back in her direction.

    Since her diagnosis, she said the pharmacy where she worked has tightened its controls and upgraded its safety equipment.

    Lewis has begun transfusions to try to keep her cell counts normal. Ultimately, her only hope for a cure lies in a bone marrow transplant. She advises others to be vigilant about cancer screening if they’ve worked with chemo.

    “Now, since I left, everybody who works with chemo has to have a blood test once a year and urinalysis,” she said. “Maybe that was my contribution.”

  • Brett Cordes: Veterinarian’s new role

    Image: Brett Cordes
    Courtesy of Brett Cordes

    Brett Cordes had been a practicing veterinarian for nearly a decade when he was diagnosed at age 35 with thyroid cancer. One of the first questions his doctor asked him was whether he handled chemotherapy agents. “He said they see a link between chemo and thyroid cancers,” Cordes said.

    Cordes is in good health now, four years later, after being successfully treated but said his diagnosis “changed my life. I quit my practice and made it my passion to improve oncology safety for vets.”

    Animal oncology has exploded within the last decade as some of the most common chemotherapeutic drugs became available as generics. Instead of paying $1,200 a vial, it is $12 to $15 a vial, he said. “That opened the flood gates.”

    Charlie Powell, spokesman for the College of Veterinary Medicine at Washington State University in Pullman, Wash., said the number of vets who handle chemo is low, and those who do receive specialized training and take precautions similar to those required for human medicine. "It's very safe to say the vast majority of vets in practice will never give a chemo dose and will refer to cancer specialists," he said.

    Cordes said he sees that changing. He estimates about 4,000 general practices in the United States administer a few doses a month, often with no special precautions in place

    The potential risk extends to pet owners, too, he said, because of the length of time the drugs persist in the environment. If someone brings their dog in for treatment, and the dog is later throwing up at home, the people in the house are potentially being exposed.

  • Bruce Harrison: Career may have cost him his life

    Image: Bruce and Kathy Harrison
    Courtesy of Harrison family

    Bruce Harrison had been an oncology pharmacist since the late 1970s. He had seen the evolution — or lack of it — in safety awareness during that time, but he spent much of his career trying to change attitudes toward safe practices through research.

    Harrison, who for years was a clinical pharmacy specialist with the Department of Veterans Affairs Medical Center in St. Louis, was also one of the authors of the strictest set of voluntary guidelines, issued in 2004 by the National Institute for Occupational Safety and Health, for the safe handling of chemo and other hazardous drugs for health care workers.

    These practices, had they been in place throughout his career, might have saved his own life.

    Harrison died at age 59 in St. Louis last August of a rare form of oral cancer. He had never smoked or chewed tobacco. He had no other known risk factors, except he had mixed a lot of chemo for other people in his career as a pharmacist. He discussed it with his doctor.

    “There was no way they could prove it, but the two of them decided it could be related,” said his widow, Kathy Harrison. “Bruce absolutely believed it was triggered by his exposure.”

    She’s grateful her husband had a long career doing something he loved. She’s also sad, and frustrated, that it may have cost him his life. And she worries it will cost others theirs.

    “What frustrated him the most, there was not enough done — not enough studies done to prove it was the danger it was,” said Harrison. “I think there needs to be more done to provide more providers with safe handling techniques.

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