Handling of cytotoxic drugs and related waste in low and middle-income countries: A toolkit to promote safe handling practices

Cancer is a global burden, including in low- and middle-income countries (LMICs). Cancer prevention and control have been part of the global agenda for some years. Many efforts were made to improve access to chemotherapies. Due to their intrinsic toxicity, cytotoxic drugs must be handled with great caution to ensure the safety of the patients and the personnel handling them. However, safe handling aspects still seem to be neglected in many LMIC cancer programs, where the increasing use of anti-cancer drugs is only recent. This PhD focused on the safe handling of chemotherapy drugs in LMICs. The primary objective was to promote the improvement of handling practices, wherever cytotoxic drugs are transported, received, stored, prepared, administered, and disposed of, to ensure the quality of services and the patient and staff safety. This PhD resulted in appropriate ready-to-use tools (assessment tools and e-learning) that can be easily used to assess and support the improvement of local practices. It also highlighted gaps and areas where improvements and corrective actions are needed to ensure patient and staff safety. This work represents a first step in the development of a comprehensive safe handling program. As a direct continuation of this thesis, there are three important objectives: (i) the large-scale deployment of these tools, (ii) the sustainability of their use, (iii) the optimization of the training program and its evaluation.