Exploring cytotoxic drugs residues in hospital effluents: a narrative review

Background: Cytotoxic waste management is one of the significant issues in healthcare system. The aim of the present study was to review studies conducted on investigation of possible levels of cytotoxic drug residues in hospital effluents. Materials and methods: All peer-reviewed journal articles on investigation of possible levels of cytotoxic drugs residues in hospital effluents which were published before May 2019 were investigated. 51 publications which were mostly published between 2011 and 2016 were included. Results: Anticancer medication continue to enter hospital effluents and urbane wastewaters. Hospital effluents seem to be one of the main sources of water contamination in this regard. Cytotoxic drugs and their metabolites are detected in hospital effluents in different countries across the globe. Platinum-based antineoplastic drugs, methotrexate, cyclophosphamide, ifosfamide and tamoxifen were found with higher concentrations across different studies. Conclusion: Hospital waste management is one of the most important issues in health care system. According to the results of the present study, cytotoxic drugs residues are detected in the effluents of oncology wards of the investigated hospitals. Therefore, establishment of strict rules and regulations, provision of cytotoxic waste disposal and removal for the purpose of inactivating cytotoxic drugs in hospital effluents prior to entrance of the effluents to the sewage treatment systems is mandatory