Experience in Handling Systemic Anticancer Therapy among Healthcare Workers at the National Cancer Institute, Sri Lanka: A Qualitative Study.

Abstract

Background: The toxicity of systemic anti-cancer chemotherapy (SACT) is an inherent property. Although safety measures are effective, wide usage may increase possible exposure and related adverse effects. Exploration of experience handling SACT among healthcare professionals is essential in identifying phenomena. Objective: To explore the experience of handling SACT among healthcare workers at the National Cancer Institute, Sri Lanka Methods: Ten focus Group Discussions (FGDs) were carried out among doctors, pharmacists, nurses, nursing supportive staff (attendants) and cleaning personnel representing two FGDs in each occupational category using a semi-structured interview guide. Following the six steps of thematic analysis, data analysis was carried out separately considering the occupational category and the trustworthiness was preserved. Results: Role in handling, safety measures, occupational exposure, barriers of safety measures and possible exposure and cues to action were common themes derived from separate thematic analyses. The role in handling SACT is specific across profession. Pharmacists reported the highest level of adherence to standard guidelines. The use of gloves and masks is generally common and nurses use chemotherapy-specific personal protective equipment (PPE) during the dilution of drugs. Dermal contact, splashes and needle prick injuries were common routes of exposure. Headache, skin irritation and hair loss were common. Miscarriages were frequently reported among nurses. However, doctors and pharmacists did not report any perceived adverse effects. Less availability of PPE was reported except for pharmacists and doctors. Time pressure, increased patient count and irregular patient admissions were reported among both nurses and pharmacists. Patient-related barriers were also reported among nurses. Except the doctors, all occupational categories were willing to participate in education interventions. Conclusions: The role in handling SACT is specific across the occupational category. A variety of safety measures are applied in handling SACT. Headache, skin irritation, hair loss and miscarriages are generally reported. Education interventions and minimizing identified barriers of handling SACT are important in enhancing occupational health safety.