[Are the cytostatic drugs and their metabolites, excreted by patients during chemotherapy, hazardous for the family environment?].

In recent years the problem concerning adverse effects of excreted drugs and their active metabolites on other people and the environment has been found to be an important aspect of clinical pharmacology and environmental health. It is commonly known that antineoplastic drugs are hazardous to medical personnel who handle them, but cytostatics administered during ambulatory care are always transferred via the patient's organism to his home and hypothetically generate potential risk to other family members. The patient s home is a sub-set of the family environment where genetically determined predisposition to neoplastic disease could additionally appear. This could intensify the effect of exogenous factors responsible for carcinogenesis (e.g. cytostatics), and increase late consequences (e.g. mutations). To assess the risk the authors elaborated an algorithm for hazard identification and assessment of consequences of the hazard. Preliminary results indicated passage a/significant amounts of excreted cytostatics and their metabolites to the natural, hospital and also family environment. After excretion, mutagenic properties of these drugs were still observed. Chemical inactivation of the excreta of patients on chemotherapy completely eliminates or strongly reduces their mutagenicity. At the present time it is difficult to assess the total risk level of cytostalic drugs and their metabolites excreted by patients on chemotherapy, for their home environment. Risk identification based on dose-response and exposure assessment, will allow to determine the health, social and economic hazards and to establish standards of procedures with regard to the risk factor.