Cytotoxic Drug Safety - Minimising the risk to veterinary staff and clients


Ratification Date: 05 Nov 2021


  1. The use of cytotoxic chemotherapy agents in veterinary practice must occur in a way which avoids harm to the personnel potentially exposed to the drugs, including veterinary practice staff and animal owners.
  2. Use of cytotoxic chemotherapy agents must be compliant with occupational health and safety requirements.


The purpose of this policy is to minimize potential harm to personnel who may be exposed to chemotherapeutic drugs, including veterinary practice staff and animal owners.


The use of cytotoxic chemotherapy agents in veterinary practice is increasing and poses an exposure risk to humans, both in the workplace and at the patient’s home. The handling of cytotoxic chemotherapy agents has been classified as an occupational health and safety hazard due to the potential of these drugs to increase the risk of stillbirth in addition to their being mutagenic, carcinogenic and teratogenic in nature.1-7 Small molecule inhibitors, newly available for veterinary treatment, carry similar risks as they are anti-angiogenic agents, which could also harm a growing foetus.34 The recommendation is that these agents should be handled in the same manner as other cytotoxic chemotherapy agents.

Personnel who may be potentially exposed to these drugs during and following use include the veterinarians, veterinary nurses and technicians, cleaners, animal attendants and pet owners.

Risks to veterinary practice staff

There is little information available regarding the rate of exposure of veterinary personnel to cytotoxic chemotherapy agents and the short- and long-term consequences of this. Limited early studies found that frequent contamination of personal protective equipment (gloves) and the veterinary clinic environment (door handles, administration areas, floors) occurred. In two studies, compliance with safety procedures was documented at a level of only 60-70%.8,9 In more recent studies, there has been a marked reduction in contamination found in hospitals that have implemented strict engineering controls (biological safety cabinet) in addition to supplemental controls (closed system transfer devices) for intravenous chemotherapy, however, contamination is still detected with oral chemotherapy drugs. 9,10

Human studies have found that health care workers handling chemotherapy agents have increased chromosomal aberrations in addition to urinary excretion of the chemotherapy agents and their metabolites. 11-20 Some larger studies have found an incrementally increased risk of infertility and miscarriage with occupational exposure to chemotherapy agents.4,21-23 Alkylating agents are associated with the highest number of abnormalities, at a frequency which increases with the amount of exposure. Constant exposure, even at low doses, can increase the risk of some cancers developing.24,25 Based on these studies, there is concern that the risk to veterinary staff may be similar. 11,12

Risks to pet owners

There is currently no information defining the risk to clients that care for their pets undergoing cytotoxic chemotherapy treatment. However, precautions should be taken by clients whose pets are undergoing chemotherapy whether they are receiving the drugs at the veterinary practice or at home, as there is potential for exposure of family members to contaminants.26 Contamination of the environment has been reported as a result of people receiving chemotherapy 27,28, so it is therefore reasonable to assume that a similar risk of environmental contamination will occur when treating animals with chemotherapy.

Known clearance levels

In veterinary oncology, chemotherapy is often performed on an outpatient basis. As there may be residue presence in canine urine, faeces and other bodily fluids, owners are at risk of exposure to cytotoxic drugs through these media. The following table 30-32 gives values for the cytotoxic drug residues in urine and serum of dogs receiving anticancer chemotherapy. There are currently no studies for cytotoxic residue in the faeces of dogs.

DRUGS – Veterinary Clearance





1-2 days (IV/ PO)

1 day (IV) 2 day (PO)


4 days

No detection 7 days


14 days

7 days (*1 dog)


21 days

No detection 7 days

There is also one recent study that reveals detectable levels of carboplatin, a cytotoxic chemotherapy agent in the sebum and cerumen of dogs. 33


Exposure to cytotoxic chemotherapy agents and clinical waste can occur if control measures fail.29 AVA Guidelines have been developed to assist in minimising the risks of exposure to cytotoxic chemotherapy agents, managing chemotherapy waste materials, managing potential exposures, and best practice protocols for the veterinary hospital and the animal’s home.


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  32. Knobloch1, S.A.I. Mohring1, N. Eberle, et al. Drug residues in serum of dogs receiving anticancer chemotherapy. J Vet Intern Med. 2010. 24:379-383.
  33. Janssens T, Brouwers EE, de Vos JP, et al. Determination of platinum originating from carboplatin in canine sebum and cerumen by inductively coupled plasma mass spectometry. J Pharm Biomed Anal. 2011 Jan; 54(2):395-400.
  34. https://www.zoetisus.com/products/dogs/palladia/index.aspx

Date of ratification by AVA Board 5 November 2021