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Handling of Cytotoxic Drugs by Healthcare Workers

A Review of the Risks of Exposure

  • Pharmacoepidemiology
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Summary

Increasing utilisation of chemotherapeutic agents in treating patients with malignancy has led to the potential for widespread exposure of healthcare workers who come into contact with patients or these agents in the work place. Unfortunately, these drugs are toxic to both the abnormal and normal somatic cell. This occurs in the patient, and is also likely to affect any individual exposed. There appear to be widely divergent opinions concerning the extent of hazard of coming into contact with these agents, in spite of which caution and minimising exposure risk seems only prudent and appropriate.

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References

  • Abe T, Tsuda S, Maekawa T, Taniwaki M, Sonoda Y, et al. Sister chromatid exchanges induced by cancer chemotherapeutic agents in vitro and in vivo: consideration of the hazard of drugs as possible mutagens and carcinogens causing second malignancies. Cancer Treatment Reports 69: 505–514, 1985

    PubMed  CAS  Google Scholar 

  • Burgaz S, Ozdamar N, Karakaya AE. A signal assay for the detection of genotoxic compounds: application on the urines of cancer patients on chemotherapy and of nurses handling cyto-toxic drugs. Human Toxicology 7: 557–560, 1988

    Article  PubMed  CAS  Google Scholar 

  • Casciato DA, Scott JL. Acute leukemia following prolonged cyto-toxic agent therapy. Medicine 58: 32–47, 1979

    Article  PubMed  CAS  Google Scholar 

  • Cloak MM, Connor TH, Stevens KR, Theiss JC, Alt JM, et al. Occupational exposure of nursing personnel to antineoplastic agents. Oncology Nursing Forum 12: 33–39, 1985

    PubMed  CAS  Google Scholar 

  • Corder MP, Jochimsen PR. Marrow neutrophil reserve after adjuvant chemotherapy for carcinoma of the breast. Cancer 49: 2455–2458, 1982

    Article  PubMed  CAS  Google Scholar 

  • Falck K, Grohn P, Sorsa M, Vaino H, Heinonen E, et al. Mu-tagenicity in urine of nurses handling cytostatic drugs. Lancet 1: 1250–1251, 1979

    Article  PubMed  CAS  Google Scholar 

  • Hemminki K, Kyyronen P, Lindbohm M-L. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. Journal of Epidemiology and Community Health 39: 141–147, 1985

    Article  PubMed  CAS  Google Scholar 

  • Hoffman DM. Lack of urine mutagenicity of nurses administering pharmacy prepared doses of antineoplastic agents. American Journal ol Intravenous Therapy and Clinical Nutrition 10: 28–31, 1983

    Google Scholar 

  • Jochimsen PR, Corder MP, Lachenbruch PA, Spaight ME. Preparation and administration of chemotherapy: haematological consequences for hospital-based nurses. Medical Toxicology 3: 59–63, 1988

    PubMed  CAS  Google Scholar 

  • Jochimsen PR, Spaight ME, Urdaneta LF. Pregnancy during adjuvant chemotherapy for breast cancer. Journal of the American Medical Association 245: 1660–1661, 1981

    Article  PubMed  CAS  Google Scholar 

  • Jordan DK, Patil SR, Jochimsen PR, Lachenbruch PA, Corder MP. Sister chromatid exchange analysis in nurses handling antineoplastic drugs. Cancer Investigation 4: 101–107, 1986

    Article  PubMed  CAS  Google Scholar 

  • Kolmodin-Hedman B, Hartvig P, Sorsa M, Falck K. Occupational handling of cytostatic drugs. Archives of Toxicology 54: 25–33, 1983

    Article  PubMed  CAS  Google Scholar 

  • Lee CC, Castles TR, Kintner LD. Single-dose toxicity of cyclo-phosphamide (NSC-26271) in dogs and monkeys. Cancer Chemotherapy Reports 4: 51–76, 1973

    CAS  Google Scholar 

  • Lee LM, de Peyster A, Carson C. Reproductive effects of occupational exposure to antineoplastic agents: a pilot study. Abstract. Oncology Nursing Forum 15 (Suppl.): 170, 1988

    Google Scholar 

  • Lohrmann HP, Schreml W, Lang M, Betzler M, Fliendner TM, et al. Changes of granulopoiesis during and after adjuvant chemotherapy of breast cancer. British Journal of Haematol-ogy 40: 369–381, 1978

    Article  CAS  Google Scholar 

  • Makinoden T, Santos GW, Quinn RP. Immunosuppressive drugs. Pharmacological Reviews 22: 189–247, 1970

    Google Scholar 

  • Nguyen TV, Theiss JC, Matney TS. Exposure of pharmacy personnel to mutagenic antineoplastic drugs. Cancer Research 42: 4792–4796, 1982

    PubMed  CAS  Google Scholar 

  • Nikula E, Kiviniitty K, Leisti J, Taskinen P. Chromosome aberrations in lymphocytes of nurses handling cytostatic agents. Scandinavian Journal of Work Environment and Health 10: 71–74, 1984

    Article  CAS  Google Scholar 

  • OSHA. Work practice guidelines for personnel dealing with cyto-toxic (antineoplastic) drugs. In OSHA Instruction Publication 8-1.1. Office of Occupational Medicine, US Department of Labor, 1986

  • Oestreicher U, Stephan G, Glatzel M. Chromosome and SCE analysis in peripheral lymphocytes of persons occupationally exposed to cytostatic drugs handled with and without use of safety covers. Mutation Research 242: 271–277, 1990

    Article  PubMed  CAS  Google Scholar 

  • Purdom CE. Mutagenic effects of nitrogen mustard derivative of azobenzene compounds in Drosophilia melanogaster. Biochemical Pharmacology 5: 206–218, 1960

    Article  PubMed  CAS  Google Scholar 

  • Reich SD. Antineoplastic agents as potential carcinogents: are nurses and pharmacists at risk?. Cancer Nursing 4: 500–502, 1981

    PubMed  CAS  Google Scholar 

  • Reimer RR, Hoover R, Fraumeni Jr JF, Young RC. Acute leukemia after alkylating-agent therapy of ovarian cancer. New England Journal of Medicine 297: 177–181, 1977

    Article  PubMed  CAS  Google Scholar 

  • Schein PS, Winokur SH. Immunosuppressive and cytotoxic chemotherapy: long-term complications. Annals of Internal Medicine 82: 84–95, 1975

    PubMed  CAS  Google Scholar 

  • Selevan SG, Lindbohm M-L, Hornung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. New England Journal of Medicine 313: 1173–1177, 1985

    Article  PubMed  CAS  Google Scholar 

  • Sherman BM, Wallace RB, Jochimsen PR. Hormonal regulation of the menstrual cycle in women with breast cancer: effect of adjuvant chemotherapy. Clinical Endocrinology 10: 287–296, 1979

    Article  PubMed  CAS  Google Scholar 

  • Sieber SM, Adamson RH. The clastogenic, mutagenic, teratogenic and carcinogenic effects of various antineoplastic agents. In Pharmacological basis of cancer chemotherapy, pp. 401–468, Williams and Wilkins, Baltimore, 1975

    Google Scholar 

  • Sorsa M, Hemminki K, Vainio H. Occupational exposure to anticancer drugs — potential and real hazards. Mutation Research 154: 135–139, 1985

    Article  PubMed  CAS  Google Scholar 

  • Stiller A, Obe G, Boll I, Pribilla W. No elevation of the frequencies of chromosomal alterations as a consequence of handling cytostatic drugs: analyses with peripheral blood and urine of hospital personnel. Mutation Research 121: 253–259, 1983

    PubMed  CAS  Google Scholar 

  • Thiringer G, Granung G, Holmen A, Hogstedt B, Jarvholm B, et al. Comparison of methods for the biomonitoring of nurses handling antitumor drugs. Scandinavian Journal of Work Environment and Health 17: 133–138, 1991

    Article  CAS  Google Scholar 

  • Toledo TM, Harper RC, Moser RH. Fetal effects during cyclo-phosphamide and irradiation therapy. Annals of Internal Medicine 74: 87–91, 1971

    PubMed  CAS  Google Scholar 

  • Tortorici MP. Precautions followed by personnel involved with the preparation of parenteral antineoplastic medications. Hospital Pharmacy 15: 294–301, 1980

    Google Scholar 

  • Tuffnell PG, Gannon MT, Dong A, DeBoer G, Erlichman C. Limitations of urinary mutagen assays for monitoring occupational exposure to antineoplastic drugs. American Journal of Hospital Pharmacy 43: 344–348, 1986

    PubMed  CAS  Google Scholar 

  • Vahlsing HL, Feringa ER, Britten AG, Kinning WK. Dental abnormalities in rats after large dose of cyclophosphamide. Cancer Research 35: 2199–2202, 1975

    PubMed  CAS  Google Scholar 

  • Valanis B. Environmental and direct measures of exposure. Occupational Medicine — State of the Art Reviews 1: 431–444, 1986

    CAS  Google Scholar 

  • Valanis B, Shortridge L. Self protective practices of nurses handling antineoplastic drugs. Oncology Nursing Forum 14: 23–27, 1987

    PubMed  CAS  Google Scholar 

  • Venitt S, Crofton-Sleigh C, Hunt J, Speechley V, Briggs K. Monitoring exposure of nursing and pharmacy personnel to cytotoxic drugs: urinary mutation assays and urinary platinum as markers of absorption. Lancet 1: 74–76, 1984

    Article  PubMed  CAS  Google Scholar 

  • Waksvik H, Klepp O, Brogger A. Chromosome analyses of nurses handling cytostatic agents. Cancer Treatment Reports 65: 607–610, 1981

    PubMed  CAS  Google Scholar 

  • Young RL, Du Vall EM. Chemotherapy exposure file. American Journal of Hospital Pharmacy 42: 1990–1991, 1985

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of lowa Hospitals and Clinics, Iowa City, Iowa, 52242, USA

    Peter R. Jochimsen

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  1. Peter R. Jochimsen
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Jochimsen, P.R. Handling of Cytotoxic Drugs by Healthcare Workers. Drug-Safety 7, 374–380 (1992). https://doi.org/10.2165/00002018-199207050-00005

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