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Safety Precautions and Occupational Exposure to Systemic Anticancer Therapy (SACT): A Qualitative Study

This qualitative study at Sri Lanka's National Cancer Institute reveals that while pharmacists demonstrate high compliance with safety protocols, nurses face the greatest occupational risks and adverse health effects from systemic anticancer therapy due to barriers like work pressure and insufficient protection, highlighting an urgent need for role-specific training and improved safety infrastructure.

Original authors: Nanayakkara Senarath Appuhamilage Samanthi Nisansala Senarath, Meegoda Kankanange Dona Lalitha Meegoda, Sudath Shirley Pathmasiri Warnakulasuriya, Sudheera Sammanthi Jayasinghe, Darshan Sri Indrajith

Published 2026-06-24

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Nanayakkara Senarath Appuhamilage Samanthi Nisansala Senarath, Meegoda Kankanange Dona Lalitha Meegoda, Sudath Shirley Pathmasiri Warnakulasuriya, Sudheera Sammanthi Jayasinghe, Darshan Sri Indrajith Dammika De Silva, Rathnayaka Wasala Mohottalage Wasantha Kumara Rathnayaka

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a hospital as a high-stakes kitchen where the "ingredients" being cooked are powerful cancer-fighting drugs. These drugs are like invisible, toxic ghosts: they are brilliant at destroying bad cells (cancer), but they are just as happy to hurt the healthy people (the chefs) who handle them.

This study, conducted at Sri Lanka's National Cancer Institute, went behind the scenes to interview the people working in this "kitchen"—nurses, pharmacists, doctors, helpers, and cleaners. They wanted to know: How safe are these workers? What are they afraid of? And what stops them from staying safe?

Here is the story of their findings, broken down simply.

1. The Cast of Characters (Who Does What?)

Think of the hospital as a relay race where the baton is a dangerous drug.

The Pharmacists (The Master Chefs): They work in a special, sealed "clean room" (a biological safety cabinet). They mix the drugs. They are the most careful, wearing full "spacesuits" (masks, goggles, special gowns) and using machines that suck away any toxic fumes.
The Nurses (The Servers): They take the mixed drugs and give them to patients. They also handle the trash and the patients' vomit. They are the ones who get the most tired and the most sick.
The Attendants (The Runners): They carry the drugs from the kitchen to the wards. Some wear masks; others just wear gloves.
The Cleaners (The Janitors): They mop up spills and take out the trash. They often smell the drugs but don't always have the right masks to block the smell.
The Doctors (The Architects): They rarely touch the drugs directly, except for specific procedures like spinal injections.

2. The "Spacesuits" (Safety Gear)

Everyone agrees that gloves and masks are good.

The Pharmacists are the champions. They wear their "spacesuits" every single time, like a habit. They know the rules inside out.
The Nurses are a mixed bag. When they are mixing the drugs, they wear the full gear. But when they are giving the drug to a patient, they often skip the heavy masks and special gowns because it's too hot, too uncomfortable, or they feel they don't need it.
The Cleaners wear boots when cleaning toilets but often just wear their regular slippers in the wards, even though they are walking through areas where drugs might have spilled.

3. The "Ghost" Attacks (What Happens to Them?)

Because the drugs are toxic, the workers sometimes get "hit" by the invisible ghosts.

The Nurses suffer the most. They reported getting headaches, losing hair, feeling nauseous, and having skin rashes. Some even had trouble with their periods or suffered miscarriages. This usually happened when they were mixing drugs without enough protection or when the air wasn't clean.
The Cleaners often get dizzy or feel like they are going to faint because of the strong smell of the drugs.
The Pharmacists are mostly safe because of their "spacesuits," but they admitted that if the air filtration machine breaks, their liver enzymes can go up (a sign of stress on the body).

4. Why Don't They Always Wear the Gear? (The Barriers)

Even though they know the gear saves lives, they don't always use it. Why?

The "Too Hot" Problem: The special gowns and masks make them sweat and feel like they are wearing a sauna suit. It's uncomfortable and makes it hard to breathe or see.
The "Too Busy" Problem: There are too many patients and not enough time. Putting on a full suit takes time, and sometimes they feel they have to rush to help a patient.
The "Patient Fear" Problem: Sometimes patients get scared when they see a nurse in a full hazmat suit, thinking the cancer is contagious. Nurses sometimes take off their masks to make the patient feel more comfortable.
The "Missing Tools" Problem: Sometimes the special machines (like the ones that suck up toxic air) are broken, or there aren't enough sharps boxes for needles, so they have to use cardboard boxes instead.

5. What Needs to Change? (The Cues to Action)

The study suggests a few simple fixes to make the "kitchen" safer:

Better Training: Everyone needs to know the rules, not just the new hires.
Better Gear: We need masks that don't make people pass out from heat and gowns that are easier to move in.
More Help: We need more staff so no one is rushing.
Education for Patients: We need to tell patients, "The nurse is wearing a suit not because you are contagious, but because the drug is dangerous."

The Bottom Line

The study found that while everyone is trying their best, the system is still leaking. The Pharmacists are the best at staying safe because they have the best tools and training. The Nurses are the most at risk because they are on the front lines, often rushing, and sometimes forced to choose between patient comfort and their own safety.

To stop the "ghosts" from hurting the workers, the hospital needs to fix the broken machines, provide better gear, and make sure everyone knows that safety isn't just a rule—it's a lifeline.