Occupational Exposure to Antineoplastic Drugs Among Physiotherapists in Healthcare Settings

NCT07328464 | Not Yet Recruiting

• 2 other identifiers: RCAPHM24_02772025-A01689-40
• Study Type: observational
• Target: 20
• Locations: 1 country
• Sites: 2

Brief Summary

Many antineoplastic drugs are considered "hazardous to handle" for healthcare professionals, notably because of their carcinogenic, mutagenic and/or reprotoxic effects. Occupational exposure occurs mainly through the cutaneous route, either by direct contact with the drug and/or indirectly through contact with treated patients and their excreta, or through contact with contaminated surfaces or textiles. To date, physiotherapists have been little studied in terms of occupational exposure, even though they frequently perform care practices (massage, lymphatic drainage, limb mobilisation, respiratory physiotherapy) involving direct, prolonged and sustained skin contact with patients treated with antineoplastic drugs; these compounds may be eliminated in the sweat of the treated patient for several days after administration. In this context, the present study aims to assess the occupational exposure of physiotherapists to antineoplastic drugs in healthcare settings. The primary objective is to estimate the prevalence of internal contamination of physiotherapists by antineoplastic drugs after performing one of the care practices (massage, lymphatic drainage, limb mobilisation, respiratory physiotherapy) selected for the study, in patients receiving intravenous treatment with antineoplastic drugs. The secondary objectives are to describe for each antineoplastic drug studied the prevalence, the frequency of internal contamination of physiotherapists, and urinary concentration levels, to characterise the circumstances of exposure and the personal protective equipment worn, to describe the prevalence and the frequency of external cutaneous contamination on the hands and forearms of physiotherapists after performing an exposing care practice, to quantify this external cutaneous contamination, to identify the factors associated with internal and external contamination, and to co-develop preventive measures in collaboration with physiotherapists and stakeholders and to assess their acceptability. This study is a non-interventional (RIPH3), cross-sectional and multicenter study conducted at AP-HM (Public Assistance for Marseille hospitals) and Bordeaux University Hospital (CHU de Bordeaux). Twenty physiotherapists will be included in this study. Internal contamination will be assessed over 100 observation visits and external contamination over 70 observation visits (all participants combined). Observation visit include at least one " an exposing care practice" (massage, lymphatic drainage, limb mobilisation, respiratory physiotherapy) performed on a patient who received an intravenous antineoplastic drug from a predefined list, within a time window of 4 to 72 hours after the start of injection. \- Internal contamination assessment (urine samples collection) For each observation visit, two urine samples of the physiotherapist participant will be collected: one sample within the 3 hours preceding the start of the work shift, and a second sample 6 to 10 hours after the end of the shift (or the next morning after waking up). Data on exposure, activity and preventive practices (personal protective equipments worn) will be collected using an administered questionnaire (CRF). Information on the antineoplastic drugs administered to the patient receiving care by the physiotherapist will also be collected. \- Cutaneous external contamination assessment (dermal wipe sampling) For each observation visit, the physiotherapist will apply a standardized hands and forearms washing protocol, observed by the clinical research technician. Then, cutaneous swab samples will be taken immediately after the washing. The physiotherapist will then perform an exposing care practice, limiting contact with the environment (e.g., door handles/surfaces), and new samples will be taken immediately after the exposing care practice, without prior decontamination of hands and forearms. A total of eight cutaneous swab samples (four before and four after an exposing care practice) will be collected per observation visit, according to a protocol validated by the reference laboratory. The assessment of cutaneous external contamination of physiotherapists will be evaluated during visits separate from those used to study internal contamination. The expected outcomes of this study are: an individual assessment of exposure and potential internal contamination and/or external dermal contamination, for each physiotherapist; traceability of exposure in occupational health medical records, for each physiotherapist; improved knowledge on the proportion of contaminated physiotherapists (prevalence and frequency) and knowledge on urinary and cutaneous concentration levels of antineoplastic drugs in physiotherapists; increased awareness among physiotherapists regarding these exposures; implementation of co-developed preventive actions aiming to reduce exposures to the lowest possible level; and improved professional practices and working conditions.

Conditions

Internal and External Contamination of Physiotherapists by Antineoplastic Drugs

Keywords

Internal contamination; external contamination; physiotherapists; antineoplastic drugs; prevention measures; healthcare

Outcome Measures

Primary Outcomes (1)

• Internal contamination (All antineoplastic drugs combined)

  The primary outcome measure is the assessment of the prevalence of internal contamination of physiotherapists by antineoplastic drugs based on urinary assays. Internal contamination corresponds to the presence of at least one of the seven antineoplastic drugs studied (cyclophosphamide, ifosfamide, etoposide, doxorubicin, daunorubicin, epirubicin, methotrexate), in at least one of the urine samples collected for each physiotherapist included.

  between month 0 and month 40 after inclusion

Secondary Outcomes (5)

• Internal contamination (for each antineoplastic drug studied)

  between month 0 and month 40 after inclusion

• Urine concentration (for each antineoplastic drug studied)

  between month 0 and month 40 after inclusion

• External contamination

  between month 0 and month 40 after inclusion

• Identification of factors associated with internal and external contamination

  between month 0 and month 40 after inclusion

• Acceptability assessment of the co-constructed prevention measures

  between month 35 and month 37 after inclusion

Study Arms (1)

physiotherapists

physiotherapists exposed to antineoplastic drugs in healthcare settings

Other: urine sample; Other: dermal wipe sampling; Other: questionnaires

Interventions

urine sample OTHER

Internal contamination of antineoplastic drugs

physiotherapists

dermal wipe sampling OTHER

External contamination by antineoplastic drugs

physiotherapists

questionnaires OTHER

Participants will have questionnaires

physiotherapists

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

physiotherapists in healthcare settings exposed to antineoplastic drugs

You may qualify if:

• Being a state-certified physiotherapist or hold an equivalent qualification, Working in one of the healthcare departments selected for the study, Being a man or woman aged 18 or over, Having received information about the study and not expressed any opposition to participating in it
• Perform at least one physiotherapy treatment during this visit that must meet all of the following five criteria:
• The physiotherapy treatment taken into account for this observation visit must be carried out in one of the healthcare departments selected for the study, This physiotherapy treatment being at least one of the following: massage and/or manual/lymphatic drainage and/or limb mobilisation and/or respiratory physiotherapy, This physiotherapy treatment being performed on a patient who has received intravenously at least one of the seven antineoplastic drugs studied, This physiotherapy treatment being performed within 4 to 72 hours of the start of intravenous administration of the antineoplastic drug(s) studied, This physiotherapy treatment is performed on a patient who is not in septic isolation and/or in a protected area.
• Perform at least one physiotherapy treatment during this visit that must meet all of the following five criteria:
• The physiotherapy treatment taken into account for this observation visit, must be carried out in one of the healthcare departments selected for the study, This physiotherapy treatment being at least one of the following: massage and/or manual/lymphatic drainage and/or limb mobilisation and/or respiratory physiotherapy, This physiotherapy treatment being performed on a patient who has received intravenously at least one of the twelve antineoplastic drugs studied, This physiotherapy treatment being performed within 4 to 72 hours of the start of intravenous administration of the antineoplastic drug(s) studied, This physiotherapy treatment is performed on a patient who is not in septic isolation and/or in a protected area.

You may not qualify if:

• Being a physiotherapy student, Being treated with one of the 12 antineoplastic drugs studied during the study or having been treated with one of them in the 2 months prior to the start of the study, Having a person and/or animal in their household who has been treated with one of the 12 antineoplastic drugs during the study or in the 2 months prior to the start of the study.
• Being assessed for the internal contamination on the same day as the external contamination assessment, Being treated with one of the seven antineoplastic drugs studied during the study or having been treated with one of them during the two months preceding the observation visit, Having a person and/or animal in their household who is being treated with one of the seven antineoplastic drugs during the study or in the two months prior to the observation visit.
• Being assessed for the external contamination on the same day as the internal contamination assessment, Performing this physiotherapy treatment while wearing a long-sleeved gown and/or long-sleeved overgown, Performing this physiotherapy treatment while using a cream and/or gel and/or oil, Being treated oneself with one of the 12 antineoplastic drugs studied during the study or having been treated with one of them during the 2 months preceding the physiotherapy treatment, Having a person and/or animal in their household who is being treated with one of the 12 antineoplastic drugs during the study or in the 2 months prior to the physiotherapy treatment.

Sponsors & Collaborators

• Assistance Publique Hopitaux De Marseille: lead
• University Hospital, Bordeaux: collaborator

Study Sites (2)

CHU de Bordeaux

Bordeaux, France

Location

Assistance publique -Hôpitaux de Marseille

Marseille, France

Location

Biospecimen

Retention: SAMPLES WITH DNA

urine samples collection and dermal wipe sampling

MeSH Terms

Interventions

Surveys and Questionnaires

Intervention Hierarchy (Ancestors)

Data Collection; Epidemiologic Methods; Investigative Techniques; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health

Study Officials

• Francois Cremieux

  AP-HM

  STUDY DIRECTOR

Central Study Contacts

Antoine Villa, Pr

CONTACT

+33491385090; antoine.villa@ap-hm.fr

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 24, 2025
• First Posted: January 9, 2026
• Study Start: March 1, 2026
• Primary Completion: May 1, 2026
• Study Completion (Estimated): March 1, 2027
• Last Updated: March 16, 2026

Record last verified: 2026-03

Locations

FR (2)