There is no such thing as green chemotherapy, really. Doctors choose treatment regimens based on what they think is best for the patient, and pharmaceutical companies develop drugs to attack cancer – environmental concerns are not on their agenda or list of features and benefits considered by the development team.

However, chemotherapy agents are often hazardous materials. Responsible health care facilities and providers treat them as such. Waste generated at hospitals and oncology clinics, and even at the patients’ homes may be classified as hazardous waste under legal regulations.

Chemotherapy  waste may include

• Unused agent
• Packaging
• Delivery equipment used to deliver the agent (e.g. tubes)
• Swabs and related nursing materials
• Urine and feces from patient

Some chemotherapy agents are carcinogenic. That alone makes waste contaminated with them dangerous. Others are teratogenic (cause birth defects) or cause sterility. A few may part of preparations that are classified as reactive and unstable. Because they are products to be put in the body, you won’t find chemotherapy agents that are strong oxidizers or at extreme pH. Several chemo agents are on the US federal government’s listed waste under the Resource Conservation and Recovery Act.

https://www.pca.state.mn.us/sites/default/files/w-hw2-03.pdf

https://www.bu.edu/ehs/files/2011/05/P-listed-hazardous-wastes.pdf

And here is a PDF file of the National Institute of Occupational Safety and Health’s guidelines to preventing occupational exposure to chemotherapy drugs: NIOSHSafety

Industrial hygienists design, specify, and monitor the use of PPE (personal protective equipment) for health care workers who deal with chemotherapy drugs.  Ask your medical team if you or your family need any similar protective gear if you use chemotherapy at home.

Chemotherapy solutions are prepared in special areas with ventilation hoods. Technicians and nurses may wear rubber gloves and they will dispose of IV bags and tubes in the medical waste collection system. All hospitals, clinics, and doctors’ offices of any significant size have procedures for collecting and storing medical waste – this includes infectious waste and material that is hazardous for other reasons, like chemotherapy-contaminated items. Medical supply companies sell chemotherapy handling gloves. They are pretty expensive – more than regular medical gloves. Washington University’s website recommends using either special chemotherapy gloves or double gloves (one glove inside the other) where the gloves are surgical latex or nitrile gloves.

ASTM International (formerly called the American Society for Testing and Materials) has standards for testing chemotherapy gloves.

Home Use and Management

It is also possible that the patient’s urine and feces will contain unmetabolized chemotherapy medicine or hazardous metabolites. Discuss this with your medical team, who may insist that waste products be collected at home and delivered to a medical facility for disposal, to avoid flushing them to the septic system or public sewer. Special attention to pets and other household members may be required for chemotherapy patients at home. Check with your medical team if you have concerns. Toilet use may be modified. You might be told to flush twice to ensure residual drug doesn’t sit in the pipes. You might have to take precautions to avoid splashing urine. You might be advised to use disposable towels to dry your hands after using the bathroom rather than cloth towels.

You may also be given or told to have a special container for anything that came into contact with the drug. Urine and feces may also have to be collected separately. You might be told to keep the chemotherapy drug in the refrigerator or in the dark. Ask about these issues if pursuing a home chemotherapy regimen.

One side benefit of the development of “targeted therapy” drugs is that they tend to be less toxic. So these are the best hope for truly green chemotherapy.

Synthetic vs Natural Materials

Most chemotherapy drugs are synthetic and do not occur in nature. Some plant products are employed in oncology. Going back to the nineteenth Century, the word alkaloid was applied to plant derivatives that contained a nitrogen atom in their structure and that has a physiological or medical effect. Modern chemistry has more precise terms, but the word alkaloid sticks around for some products.

The vinca alkaloids and taxanes are of course derived from plants. Epipodophyllotoxins are taken from the American Mayapple and these include the topoisomerase inhibitor etoposide.

In 2004 Bristol Myers Squibb won a Green Chemistry award from the EPA for coming up with a cleaner way to make paclitaxel. And the drug manufacturers are subject to the same laws governing emissions and waste disposal as other chemical companies.