Chemotherapy Waste Handling Practices among Veterinary Oncology Personnel in Tehran, Iran: A Cross-Sectional Knowledge, Attitude, and Practice Study with One Health Implications

Introduction:
Cytotoxic drugs from veterinary chemotherapy threaten human and environmental health when discarded improperly. Personnel behavior remains understudied in Iran. This study evaluated knowledge, attitudes, and practices (KAP) of veterinary oncology staff in Tehran regarding safe chemotherapy waste disposal.

Methods:
A cross-sectional survey was administered between May and June 2026 to 187 veterinary professionals (veterinarians and technicians) working in oncology and referral services across Tehran. A 24-item questionnaire was developed, validated through expert review, and pilot-tested on 20 eligible staff (Cronbach's alpha = 0.84). The instrument assessed three domains: hazard knowledge (eight items), disposal attitudes (six items, five-point Likert), and reported practices (10 items). Good knowledge and good practice were defined as scores of 75 percent or higher. Positive attitude was defined as a mean Likert score of 4.0 or above. Statistical analysis included descriptive statistics, chi-square tests, and Pearson correlation using SPSS (alpha = 0.05). Ethical approval was obtained (IR.ADONIS.REC.1405.008), and all participants provided informed consent.

Results:

Of 187 respondents, 64 percent were veterinarians and 36 percent were technicians. Mean age was 37.1 years. While 70 percent demonstrated good knowledge of cytotoxic hazards and 78 percent held positive attitudes toward safe disposal, only 41 percent reported consistently good practices. A majority (55 percent) acknowledged discarding chemotherapy-contaminated gloves, IV lines, or syringes into ordinary waste. More than half (53 percent) had never received formal hazardous waste training. Prior training was associated with significantly better practices (59 percent versus 33 percent, p = 0.006). Knowledge scores correlated positively with practice scores (r = 0.48, p = 0.003).

Conclusions:
A substantial knowledge-practice gap exists in chemotherapy waste management among Tehran veterinary oncology personnel. Findings support urgent needs for structured training, institutional protocols, and regulatory oversight under One Health