Safe handling of cytotoxic drugs in low and middle income countries: How to progress?

7 October 2016

S. von Grünigen1, P. Bonnabry1,2 1 Pharmacy, University Hospitals of Geneva, Geneva (HUG), Switzerland
2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland

With the rising burden of cancer in low and middle income countries (LMIC), substantial efforts have been made these past years to improve prevention and cancer control. Many international organizations and agencies such as the Union for International Cancer Control (UICC), the International Network for Cancer Treatment and Research (INCTR) or the Global Task Force on Expanded Access to Cancer and Control (GTF.CCC), have been active to improve cancer control strategies in collaboration with the World Health Organization (WHO). Expanding access to affordable chemotherapies has been one of their priorities. In 2015, more than 20 cytotoxic drugs have been added to the updated version of the WHO essential medicines list.

Handling and use of those drugs are meant to increase in the coming years, therefore beyond patients’ safety, risk of occupational exposure and environmental contamination should become a growing concern for the governments, especially in resource-poor settings where inadequate infrastructures and low capacities are prevailing.

To date, persistent weaknesses still exist in international and national cancer control programs regarding aspects related to safe handling of cytotoxic medicines (storage, preparation, administration, waste disposal, etc.). Unsafe practices when handling cytotoxic drugs have been highlighted in several studies, particularly in countries where access and use of those medicines have recently increased. Those results emphasize the need of implementing improvement quality strategies in LMIC.

As part of its Pharm-Ed project, an educational platform for responsible use of medicines in hospitals of developing countries (, the HUG Pharmacy is involved in securing the cytotoxic process. Its recent collaboration with Doctors Without Borders Switzerland (Médecins Sans Frontières, MSF-CH) in this area has also enabled to gain field experience and to better identify gaps and/or constraints.

Two tools developed in this context will be presented:

  • An e-learning module about cytotoxic medicines management
  • A self-assessment tool of the cytotoxic process, developed through a Delphi method

The overall goal is to ensure the highest quality and safety of the process in line with the appropriate standards adapted to the specific context of LMIC.

The authors report no potential conflict of interest with respect to the research. The Platform Pharm-Ed is financially supported by CSL Behring Switzerland, but the company has no influence on the content of the e-learning.

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