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Chemotherapeutics or antineoplastics are a unique class of pharmaceuticals commonly used to kill cancer cells. The conventional chemotherapeutics are also toxic to noncancerous cells in the host, which makes an overdose of these pharmaceuticals a major concern to clinicians. Most overdoses from conventional chemotherapeutics are iatrogenic, and they involve misreading of the product label, and errors in dosing and transcription of orders (Chap. 134). A key element in these incidents is the lack of familiarity of the clinician with the use of these select pharmaceuticals. In the last several years, the use of chemotherapeutics has changed. For example, therapeutic indications now include other diseases, such as autoimmune diseases; the new chemotherapeutics target cancer cells and many of them are administered orally, and new delivery techniques are available. These new developments will increase the number and frequency of unintentional exposures and unintended dosing regimens, although the adoption of safety standards for the administration limits these errors (Chap. 134).24,31

Although overdoses of chemotherapeutics are infrequent, these events are of greater consequence than overdoses of many other xenobiotics because these drugs have a narrow therapeutic index. This is evident from surveillance data from poison control centers in the United States. From 1988 to 2015, the median annual number of people exposed to chemotherapeutics reported to US poison control centers was about 1200. In the last 10 years of data, the number of annual exposures to these chemotherapeutics went from 1649 in 2006 to 2039 in 2015 (Chap. 130). These exposures represent about 0.1–0.2% of pharmaceutical exposures, or 0.06–0.1% of all exposures annually reported to US poison control ­centers. Approximately two-thirds of the people exposed to chemotherapeutics in these reports were adults, one-fourth of the group were young children, and the remainder were adolescents. The annual trend for the proportion of exposures among adults and children remained at approximately 70% and 25%, respectively, from 2001 to 2015. Children and adolescents between the ages of 6 and 19 years accounted for approximately 6% of the population annually exposed, and this frequency did not change during these years. Although these differences among age groups might represent the incidence of cancer in these populations, further analysis is warranted to better define the reasons for these observations.

Among single exposures to chemotherapeutics reported to US poison control centers from 2007 to 2015, the annual percentage of unintentional exposures approached 90% and the annual percentage of exposures resulting in moderate or major severity in toxicity remained at approximately 6%. The mortality was about 0.2–0.3% of single exposures in this same period. These observations are attributed to the substantial toxicity of these chemotherapeutics. A prospective study on medication safety in the ambulatory chemotherapy setting demonstrated that potential adverse drug events from medical errors for chemotherapy orders were more likely to be serious than nonchemotherapy orders.21 The prevalence of the exposure to chemotherapeutics is expected to continue increasing ...

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