Kudos to AnnMarie L. Walton, assistant professor, and her entire team for the submission of her Duke School of Medicine Core Facility Voucher Grant application entitled: “Using Silicone Wristbands to Assess Nurses' Exposure to Antineoplastic Drugs: A Feasibility Study.” This proposal requests funding for a one-year period with a start date of January 1, 2021.

Research questions:

1. Is wearing a silicone wristband and keeping a daily exposure log acceptable to nurses?
2. Can silicone bands detect four antineoplastic drugs [ADs] to which the nurses were exposed?

Rationale: AD exposure remains a significant concern for nurses. Even at low levels, AD exposures can cause acute toxicities, reproductive problems, and abnormalities in chromosomes 5 and 7 which mirror therapy-related myelodysplastic syndrome and therapy-related acute myeloid leukemia. In health care settings, surface wipes have been used as a proxy for dermal exposure risk. It is suggested that surface wipe sampling be conducted as a measure of AD containment. However, these recommendations are not universally followed. By contrast, monitoring occupational radiation exposure is a fundamental aspect of radiation protection and a variety of personnel dosimeters and monitoring badges exist for nurses working in that space. Nurses who handle ADs also need an individualized measure of exposure. Deployed as personal passive samplers, silicone wristbands have been shown to detect over a thousand industrial and consumer product chemicals. Silicone wristbands integrate dermal and inhalation exposures and may provide a more relevant exposure estimate than indoor dust or surface wipe sampling. This study has the potential to identify a novel, passive measure for assessing nurses’ exposure to ADs. We will use this data as feasibility and preliminary data for an R03 application to NCI to examine the efficacy of using silicone wristbands to assess nurses’ exposure to ADs.

Study Plan: This study will employ a cross sectional design. Nurses who work in inpatient or outpatient oncology at DUMC will be invited to participate via an introduction at staff meetings, followed by an invitation via email until the target of 20 nurses is reached. Nurses who are actively receiving ADs will be excluded. Each nurse participating in this study will be given a study number and a silicone wristband and asked to wear the wristband for 14 consecutive days beginning with the study start date. Each day, all 20 participants will receive an email asking them to log in to a REDCap database and answer questions about whether or not they worked that day. On days they did work, they will be asked to log the names of the ADs they came into contact with, which tasks they performed (e.g. administration, take down, handling of excreta) and what PPE they used for each task. At the conclusion of the study, all 20 participants will be asked to participate in a brief semi-structured interview by telephone to assess acceptability of wearing the bracelets [e.g. ease, comfort] and acceptability of the log [e.g. time to complete, ease of completion]. At the end of the study, the bracelets will be collected from the participants at their workplace [DUMC] and stored in polypropylene vials in the -20C freezer of Dr. Spasojevic’s PK/PD Core lab until analysis. Liquid Chromatography-Tandem Mass Spectrometry will be used for analysis. The four ADs that we have chosen (cyclophosphamide, etoposide, ifosfamide, and methotrexate) are commonly used and thus regarded as prototypical markers for AD exposure. A common extraction solvent mixture and protocol will be developed to provide high recovery of all 4 selected ADs from wristband silicone material and sufficient sensitivity to detect and quantify the ADs at relevant levels. The methodology will be validated by injecting sub-ng levels into wristband, let dry overnight, then test the recovery by the developed protocol. Measured amount [ng] of ADs in the bands will be listed for each of the four ADs for each participant by their participant number. The levels of ADs will be compared to a report generated by REDcap which lists the number of times each AD was handled by each participant to ascertain the ability of the wristbands to measure exposure to these marker ADs. The PI will share aggregate study results with participants, the DCI, and the oncology nursing community.