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OCCUPATIONAL EXPOSURE TO ANTINEOPLASTIC AGENTS

Effects of Occupational Exposure

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.

Balcarová O, Zavázal V, Seberová E, Kuklová D and Halík J. The risk of work with cytostatics and immunomodulation compounds. Pracov Lék. 1993; 45:195-201. (English abstract)

Muti-channel infusion pump for delivery of chemotherapy and needle and syringe

Friese CR, Himes-Ferris L, Frasier MN, McCullagh MC, Griggs JJ. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf. 2012; 21:753-759.

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.

Kusnetz E and Condon M. Acute effects from occupational exposure to antineoplastic drugs in a para-professional health care worker. Am J Ind Med. 2003; 44:107-109.

McDiarmid M and Egan T. Acute occupational exposure to antineoplastic agents. J Occup Med. 1988; 30:984-987.

Meyer HW and Skov PS. Occupational rhinosinusitis due to etoposide, an antineoplastic agent. Scand J Work Environ Health. 2010; 36:266-267.

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 and 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.

Roller M, Eickmann U and 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 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 and 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 and Heedrik D. Nurses with dermal exposure to antineoplastic drugs Reproductive Outcomes. Epidemiology. 2007; 18:112-119.

Gonzalez C. Occupational reproductive health and pregnancy hazards confronting health care workers. AAOHN J. 2011; 59:373-376.

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.

Lawson CC, Whelan EA, Hibert EN, Grajewski B, Spiegelman D and Rich-Edwards JW. Occupational factors and risk of preterm birth in nurses. Am J Obstet Gynecol. 2009; 200 (1):51.e1-51.e8.

Lawson CC, Rocheleau CM, Whelan EA, Lividoti Hibert E, Grajewski B, Spiegelman D and Rich-Edwards JW. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol. 2012; 206:327.e1-8.

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 and 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 and Hogan ML. 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 and 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.

Barle EL, Winkler GC, Ulrich P, Perino C, Kuster M, Probst A, Thielen S and Bechter R. Cancer risk of immunosuppressants in manufacturing. Regul Toxicol Pharmacol.(2014) hppt://dx.doi.org/10.1016/j.yrtph.2014.06.025.

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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  • Page last reviewed: July 15, 2014
  • Page last updated: July 15, 2014
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