Anticancer drug exposure among family caregivers in pediatric oncology: Current evidence and practical challenges

Abstract

Anticancer drugs used in pediatric oncology may expose both healthcare professionals and family caregivers accompanying hospitalized children. In Japan, guidelines have been established to prevent occupational exposure to these drugs. However, implementing exposure control measures in pediatric settings is challenging because family caregivers provide not only assistance with daily activities, such as elimination, hygiene, and feeding, but also emotionally supportive care involving holding, play, and physical contact. This review focuses on the unique characteristics and challenges of pediatric oncology, summarizes fundamental knowledge regarding anticancer drug exposure, and examines current evidence on exposure among family caregivers. Previous investigations detected cyclophosphamide (CPM) in the urine of family caregivers accompanying children receiving CPM therapy and identified CPM contamination at multiple locations within the caregiving environment. Evaluation of caregiving activities and personal protective equipment (PPE) use suggested that prolonged close contact without appropriate PPE during emotionally supportive care may increase exposure risk. These findings highlight the need for practical exposure control strategies that protect family caregivers while preserving the psychological well-being of children.