Patients during cancer treatment excreted large amounts of cyclophosphamide (CPM). Urine, feces, blood and vomit from cancer patients under chemotherapy contain active anticancer agents, which other people who come in contact with them may be exposed to. During outpatient chemotherapy, patients spend most of their time at home. Therefore, the risk of exposure for family members living with patients treated with antineoplastic agents is a concern. The purpose of this study was to evaluate exposure of family members to CPM by measuring the drug in their urine during the 48 h after completion of the chemotherapy by the patients.
Thirteen family members living with five female patients with breast cancer participated in this study. Each family member collected their own urine samples during the 48-h post-administration period. Each family member was responsible for recording the frequency and time of voiding and measuring the urinary output at each urination. Ten millilitres of urine were collected (urine sample kit provided) and stored in a small freezer solely used for this purpose. All samples were stored frozen after sampling and during transport until sample preparation and analysis. CPM was analysed using LC/MS/MS (liquid chromatography - tandem four quadrupole type mass spectrometer) Analysis by internal standardization with Cyclophosphamide-d8 for the assay. The detection limit of the CPM is 0.03ng/mL.
During the first 48 h after chemotherapy, 94 urine samples were collected from 13 family members. CPM of family members was detected in 12% of the urine samples. The total amount of CPM detected in family members’ urine was highly variable, ranging from 4.64-123 ng per member.
Large concentrations of CPM were detected in samples collected from the family members of most (four out of five) patients. The home environment is more problematic regarding secondary drug exposure via the drug residue (such as excreta) of treated cancer patients. Family members do not wear protective equipment and common spaces are not sterilized on a daily basis. The prevention of contamination with antineoplastic agents at home should be stressed to avoid the exposure of family members to these toxic drugs.
Clinical trial identification
Legal entity responsible for the study
The Ethics Committee of the Hokkaido University
JSPS Kakenhi Grant Number 26671014 and The Policy-based Medical Services Foundation in 2016.
All authors have declared no conflicts of interest.