{"title":"儿科癌症患者家庭护理人员接触环磷酰胺的因素","authors":"Yuko Noda , Yuhki Koga , Kenichiro Yamamura , Junko Miyata , Yuko Hamada , Shouichi Ohga","doi":"10.1016/j.ijheh.2024.114402","DOIUrl":null,"url":null,"abstract":"<div><p>The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the amount of cyclophosphamide (CPM) that had adhered to the undershirts of patients and the personal protective equipment (PPE) of family caregivers as well as the caregivers' urine levels of CPM within the first three days after the first and second courses of high-dose CPM therapy. Liquid chromatography/mass spectrometry (LC/MS/MS) detected >0.03 ng/ml of CPM in 26% (23/88) of urine samples from 8 of 11 (72.7%) patients’ family caregivers, with a peak of 0.7 ng/ml from 24 to 48 h after administration. Since urine CPM concentrations in family caregivers varied after the first and second courses, the exposure risk factors were analyzed by scoring the PPE-wearing time index (caring minutes × PPE points from wearing masks, gloves, and/or gowns) and CPM adhesion of PPE items with the caring patterns of diaper change, washing body care, oral care, eating assistance, emotional support, and co-sleeping. The closest association was observed for CPM adhesion between oral care gloves and undershirts (correlation coefficient 0.67, p = 0.001). The mixed-effect model analysis indicated only a significant correlation between the PPE-wearing time index and emotional care (playing, cuddling, and physical contact) (p = 0.016). These results suggest that prolonged emotional support results in poor PPE protection, which increases the risk of exposure in family caregivers. Strict PPE care within 48 h after high-dose CPM controls the exposure to high-risk anticancer drugs in caregivers of pediatric patients.</p></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"260 ","pages":"Article 114402"},"PeriodicalIF":4.5000,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S143846392400083X/pdfft?md5=6de46dce1a6c5705c284fb968f6b88a7&pid=1-s2.0-S143846392400083X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Cyclophosphamide exposure factors in family caregivers for pediatric cancer patients\",\"authors\":\"Yuko Noda , Yuhki Koga , Kenichiro Yamamura , Junko Miyata , Yuko Hamada , Shouichi Ohga\",\"doi\":\"10.1016/j.ijheh.2024.114402\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the amount of cyclophosphamide (CPM) that had adhered to the undershirts of patients and the personal protective equipment (PPE) of family caregivers as well as the caregivers' urine levels of CPM within the first three days after the first and second courses of high-dose CPM therapy. Liquid chromatography/mass spectrometry (LC/MS/MS) detected >0.03 ng/ml of CPM in 26% (23/88) of urine samples from 8 of 11 (72.7%) patients’ family caregivers, with a peak of 0.7 ng/ml from 24 to 48 h after administration. Since urine CPM concentrations in family caregivers varied after the first and second courses, the exposure risk factors were analyzed by scoring the PPE-wearing time index (caring minutes × PPE points from wearing masks, gloves, and/or gowns) and CPM adhesion of PPE items with the caring patterns of diaper change, washing body care, oral care, eating assistance, emotional support, and co-sleeping. The closest association was observed for CPM adhesion between oral care gloves and undershirts (correlation coefficient 0.67, p = 0.001). The mixed-effect model analysis indicated only a significant correlation between the PPE-wearing time index and emotional care (playing, cuddling, and physical contact) (p = 0.016). These results suggest that prolonged emotional support results in poor PPE protection, which increases the risk of exposure in family caregivers. Strict PPE care within 48 h after high-dose CPM controls the exposure to high-risk anticancer drugs in caregivers of pediatric patients.</p></div>\",\"PeriodicalId\":13994,\"journal\":{\"name\":\"International journal of hygiene and environmental health\",\"volume\":\"260 \",\"pages\":\"Article 114402\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2024-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S143846392400083X/pdfft?md5=6de46dce1a6c5705c284fb968f6b88a7&pid=1-s2.0-S143846392400083X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International journal of hygiene and environmental health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S143846392400083X\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of hygiene and environmental health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S143846392400083X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
家庭护理人员接触儿科恶性肿瘤患者的抗癌药物是一种潜在的健康风险,需要将这种风险降至最低。我们监测了患者衬衣和家庭护理人员个人防护设备(PPE)上附着的环磷酰胺(CPM)量,以及护理人员在第一和第二疗程大剂量环磷酰胺治疗后三天内尿液中的环磷酰胺含量。液相色谱/质谱法(LC/MS/MS)在 11 位患者家属护理人员中的 8 位(72.7%)26%(23/88)的尿样中检测到了 0.03 纳克/毫升的 CPM,用药后 24 至 48 小时内达到峰值 0.7 纳克/毫升。由于家庭护理人员尿液中的 CPM 浓度在第一和第二个疗程后有所不同,因此通过对 PPE 佩戴时间指数(护理分钟数 × 佩戴口罩、手套和/或病号服的 PPE 分数)和 PPE 物品的 CPM 附着情况与换尿布、清洗身体、口腔护理、协助进食、情感支持和同床共枕等护理模式进行评分,分析了暴露风险因素。口腔护理手套和内衣之间的 CPM 附着力关系最为密切(相关系数 0.67,p = 0.001)。混合效应模型分析表明,仅个人防护设备穿戴时间指数与情感关怀(玩耍、拥抱和身体接触)之间存在显著相关性(p = 0.016)。这些结果表明,长时间的情感支持会导致 PPE 保护效果不佳,从而增加家庭护理人员的暴露风险。大剂量 CPM 后 48 小时内严格的 PPE 护理可控制儿科患者护理人员接触高风险抗癌药物的风险。
Cyclophosphamide exposure factors in family caregivers for pediatric cancer patients
The exposure of family caregivers to anticancer drugs for pediatric patients with malignancy is a potential health risk that needs to be minimized. We monitored the amount of cyclophosphamide (CPM) that had adhered to the undershirts of patients and the personal protective equipment (PPE) of family caregivers as well as the caregivers' urine levels of CPM within the first three days after the first and second courses of high-dose CPM therapy. Liquid chromatography/mass spectrometry (LC/MS/MS) detected >0.03 ng/ml of CPM in 26% (23/88) of urine samples from 8 of 11 (72.7%) patients’ family caregivers, with a peak of 0.7 ng/ml from 24 to 48 h after administration. Since urine CPM concentrations in family caregivers varied after the first and second courses, the exposure risk factors were analyzed by scoring the PPE-wearing time index (caring minutes × PPE points from wearing masks, gloves, and/or gowns) and CPM adhesion of PPE items with the caring patterns of diaper change, washing body care, oral care, eating assistance, emotional support, and co-sleeping. The closest association was observed for CPM adhesion between oral care gloves and undershirts (correlation coefficient 0.67, p = 0.001). The mixed-effect model analysis indicated only a significant correlation between the PPE-wearing time index and emotional care (playing, cuddling, and physical contact) (p = 0.016). These results suggest that prolonged emotional support results in poor PPE protection, which increases the risk of exposure in family caregivers. Strict PPE care within 48 h after high-dose CPM controls the exposure to high-risk anticancer drugs in caregivers of pediatric patients.
期刊介绍:
The International Journal of Hygiene and Environmental Health serves as a multidisciplinary forum for original reports on exposure assessment and the reactions to and consequences of human exposure to the biological, chemical, and physical environment. Research reports, short communications, reviews, scientific comments, technical notes, and editorials will be peer-reviewed before acceptance for publication. Priority will be given to articles on epidemiological aspects of environmental toxicology, health risk assessments, susceptible (sub) populations, sanitation and clean water, human biomonitoring, environmental medicine, and public health aspects of exposure-related outcomes.