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NIOSH Safety and Health Topic:Occupational Exposure to Antineoplastic Agents |
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Acute EffectsVarious 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. Balcarová O, Zavázal V, Seberová E, Kuklová D, Halík J. The risk of work with cytostatics and immunomodulation compounds. Pracov Lék. 1993; 45:195-201. (English abstarct) 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. Valanis BG, Vollmer WM, Labuhn KT and Glass AG. Acute symptoms associated
with antineoplastic drug handling among nurses. Cancer Nurs. 1993;16:288-295. 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 EffectsOnly 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. Roller M, Eickmann U, Nies E. Krebsrisiko durch beruflichen Umgang mit Zytostatika- quantitative Betrachtungen. Hauptverband der gewerblichen Berufsgenossenschaften; BIA-Report 5/2001.(English Abstarct) 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 OutcomesEffects on fertility and reproductive health have been seen in a number
of studies, mainly in female nurses. 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. Fransman W, Roeleveld N, Peelen S, Kort de W, Kromhout H, Heedrik D. Nurses with dermal exposure to antineoplastic drugs Reproductive Outcomes. Epidemiology. 2007; 18:112-119. 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. 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. Association of Exposure to Antineoplastic Agents with CancerThere 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. 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. Page last updated:
December 5, 2008
Page last reviewed: September 11, 2008 Content Source: National Institute for Occupational Safety and Health (NIOSH) Education and Information Division |
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