Acute Effects
Various acute toxic effects of antineoplastic agents are well documented
in patients treated with high doses of these agents. These include such
effects as nausea, rashes, hair loss, liver and kidney damage, hearing
loss, cardiac and hematapoetic toxicities and others. Some of these effects
have been documented in workers handling antineoplastic agents. A number
of studies have shown these effects to be more prevalent in workers exposed
to the antineoplastic agents than in control populations.
Jochimsen PR, Corder MP, Lachenbruch AP and Spaight ME. Preparation and
administration of chemotherapy: Haematological consequences for hospital-based
nurses. Med Toxicol. 1988;3:59-63.
Jochimsen PR. Handling of cytotoxic drugs by healthcare workers: A review
of the risks of exposure. Drug Safety. 1992;7:374-380.
Kreckel H, Hepp R, Kloer H, Hausenschild, Holbach I and Schnell-Kretschmer
H. Symptom Control in Oncology Pharmacy. J Oncol Pharm Practice. 1997;3:49.
Krstev S, Perunicic B and Vidakovic A. Work practice and some adverse
health effects in nurses handling antineoplastic drugs. Med Lav. 2003;
94:432-439.
McDiarmid M and Egan T. Acute occupational exposure to antineoplastic
agents. J Occup Med. 1988;30:984-987.
Niklasson B, Bjorkner B and Hansen L. Occupational contact dermatitis
from antitumor agent intermediates. Contact Dermatitis. 1990;22:233-235.
Reynolds RD, Ignoffo R, Lawrence J, Torti FM, Kuretz M, Anson N and Meier
A. Adverse reactions to AMSA in medical personnel. Cancer Treat Rep. 1982;66:1885
Stücker I, Caillard J-F, Collin R, Gout M, Poyen D and Hémon
D. Risk of spontaneous abortion among nurses handling antineoplastic drugs.
Scand J Work Environ Health. 1990; 16:102-107.
Valanis BG, Vollmer WM, Labuhn KT and Glass AG. Acute symptoms associated
with antineoplastic drug handling among nurses. Cancer Nurs. 1993;16:288-295.
Valanis BG, Vollmer WM, Labuhn KT and Glass AG. Association of antineoplastic
drug handling with acute adverse effects in pharmacy personnel. Am J Hosp
Pharm. 1993;50:455-462.
Walusiak J, Wittczak T, Ruta U and Palczynski C. Occupational asthma due
to mitoxantrone. Allergy. 2002; 57: 461.
Walusiak J, Wagrowska-Koski E, Palczynski C. Health effects of occupational
exposure to cytotoxics in medical personnel in the light of compulsory
prophylactics: A cross-sectional study. Medycyna Pracy. 2003; 54:229-236.
Chronic Effects
Only a limited number of studies have examined chronic health effects
related to occupational exposure to antineoplastic agents. However, chronic
effects in patients treated with these agents are well documented. Other
areas where chronic effects may be seen are in effects on fertility and
the observation of cancer in health care workers handling antineoplastic
agents.
Lassila O, Toivanen A and Nordman E. Immune function in nurses handling
cytostatic drugs. Lancet. 1980;2:482.
Sessink PJM, Verplanke AJW, Herber RFM and Bos RP. Occupational exposure
to antineoplastic agents and parameters for renal dysfunction. Int Arch
Occup Environ Health. 1997;69:215-218.
Sotaniemi EA, Sutinen S, Arranto AJ, Sutinen S, Sotaniemi KA, Lehtola
J and Pelkonen RO. Liver damage in nurses handling cytostatic agents.
Acta Med Scand. 1983;214:181-189.
Effects on Fertility and Reproductive
Outcomes
Effects on fertility and reproductive health have been seen in a number
of studies, mainly in female nurses.
Bouyer J, Saurel-Cubizolles M-J, Grenier C, Aussel L and Job-Spira N.
Ectopic pregancy and occupational exposure of hospital personnel. Scand
J Work Environ Health. 1998;24:98-103.
Dranitsaris G, Johnston M, Poirier S, Schueller T, Milliken D, Green
E, Zanke B. Are health care providers who work with cancer drugs at an
increased risk for toxic events? A systematic review and meta-analysis
of the literature. J Oncol Pharm practice. 2005; 11:69-78.
Hemminki K, Kyyrönen P and Lindbohm ML. 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. J Epidemiol Community Health. 1985;39:141-147.
Hoffman DM. Reproductive risks associated with exposure to antineoplastic
agents: a review of the literature. Hosp Pharm.1986; 21: 930-932.
Lorente C, Cordier S, Bergeret A, De Walle HEK, Goujard J, Ayme S, Knill-Jones
R, Calzolari E and Bianchi F. Maternal occupation risk factors for oral
clefts. Scand J Work Environ Health. 2000; 26: 137-145.
McAbee RR, Gallucci BJ and Checkoway H. Adverse reproductive outcomes
and occupational exposure among nurses. AAOHN Journal. 1993; 41: 110-119.
McDonald AD, McDonald JC, Armstrong B, Cherry NM, Côté R,
Lavoie J, Nolin AD and Robert D. Congenital defects and work in pregnancy.
Br J Ind Med. 1988;45:581-588.
Meirow D, Schiff E. Appraisal of chemotherapy effects on reproductive outcomes according to animal studies and clinical data. J Nat Can Inst Monograph. 2005; No. 34:21-25.
Peelen S, Roeleveld N, Heederik D, Krombout H and de Kort W. Toxic effects
on reproduction in hospital personnel. 1999;Dutch Ministry of Social Affairs
and Employment.
Saurel-Cubizolles MJ, Job-Spira N and Estryn-Behar M. Ectopic pregnancy
and occupational exposure to antineoplastic drugs. Lancet. 1993;341:1169-1171.
Selevan SG, Lindbohm M-L, Hornung RW and Hemminki K. A study of occupational
exposure to antineoplastic drugs and fetal loss in nurses. N Eng J Med.
1985;313:1173-78.
Shortridge LA, Lemasters GK, Valanis B and Hertzberg V. Menstrual cycles
in nurses handling antineoplastic drugs. Cancer Nurs. 1995;18:439-444.
Skov T, Maarup B, Olsen J, Rorth M, WinthereikH and Lynge E. Leukaemia
and reproductive outcome among nurses handling antineoplastic drugs. Br
J Ind Med. 1992;49:855-861.
Stücker I, Caillard J-F, Collin R, Gout M, Poyen D and Hémon
D. Risk of spontaneous abortion among nurses handling antineoplastic drugs.
Scand J Work Environ Health. 1990; 16:102-107.
Stücker I, Mandereau L and Hémon D. Relationship between
birthweight and occupational exposure to cytotoxic drugs during or before
pregnancy. Scand J Work Environ Health. 1993; 19:148-153.
Timpe EM, Motl SE. Environmental exposure of health care workers to category D and X medications. 2004;61:1556-1561.
Valanis B, Vollmer W, Labuhn K and Glass A. Occupational exposure to antineoplastic
agents and self-reported infertility among nurses and pharmacists. J Occup
Environ Med. 1997;39:574-580.
Valanis B, Vollmer WM and Steele P. Occupational exposure to antineoplastic
agents: Self-reported miscarriages and stillbirths among nurses and pharmacists.
J Occup Environ Med. 1999; 41: 632-638.
Walusiak J, Wagrowska-Koski E, Palczynski C. Health effects of occupational
exposure to cytostatics in medical personnel in the light of compulsory
prophylactics: A cross-sectional study. Medycyna Pracy. 2003;54: 229-236.
Xie J, Wang J, Li H, Zhou S, Zhao S, Lu Y, Zhao R and Xue L. Epidemiological
study of effect of occupational exposure to antineoplastic drugs on reproductive
outcome in nurses. Cin J Ind Hyg Occup Dis. 2001; 19: 87-90.
Association of Exposure to Antineoplastic
Agents with Cancer
There is a limited amount of evidence in the literature concerning occupational
cancer related to antineoplastic agents. There are a few case reports
that have appeared in the literature and two epidemiological studies that
address this issue. In addition, Sessink et al (1993) have calculated
the risk of excess cancer in workers exposed to cyclophosphamide.
Blair A, Zheng T, Linos A, Stewart PA, Zhang YW and Cantor KP. Occupation
and leukemia: A population-based case-control study in Iowa and Minnesota.
Am J Ind Med. 2001; 40: 3-14.
Forslind E. Cancer was occupational injury. Vardfaket. 1997; 21:58.
Gabriele P, Airoldi M, Succo G, Brando V and Ruo Redda, MG. Undifferentiated
nasopharyngeal-type carcinoma in a nurse handling cytostatic agents. Oral
Oncol, Eur J Cancer. 1993;29B:153. Letter.
Gunnarsdottir HK, Aspelund T, Karlsson T and Rafnsson V. Occupational
risk factors for breast cancer among nurses. Int J Occup Environ Health.1997;
3: 254-258.
Hansen, J and Olsen JH. Cancer morbidity among Danish female pharmacy
technicians. Scand J Work Environ Health. 1994;20:22-26.
Levin LI, Holly EA and Seward JP. Bladder cancer in a 39-year-old female
pharmacist. J Natl Cancer Inst. 1993;85:1089-1090.
Petralia SA, Dosemeci M, Adams EE and Zahm SH. Cancer mortality among
women in health care occupations in 24 U.S. states, 1984-1993. Am J Ind
med. 1999; 36: 159-165.
Sessink PJM, Kroese ED, van Kranen HJ and Bos RP. Cancer risk assessment
for health care workers occupationally exposed to cyclophosphamide. Inter
Arch Occup Environ Health. 1993;67:317-323.
Skov T, Lynge E, Maarup B, Oslen J, Rorth M and Winthereik H. Risks for
physicians handling antineoplastic drugs. Lancet. 1990;336: 1446.
Skov T, Maarup B, Olsen J, Rørth M, Winthereik H and Lynge E.
Leukaemia and reproductive outcome among nurses handling antineoplastic
drugs. Brit J Ind Med. 1992; 49:855-861.
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