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HAZARDOUS DRUG EXPOSURES IN HEALTHCARE

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.

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  • 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.
  • Zhang X, Zheng Q, Lv Y, An M, Zhang Y, Wei Y and Feng W. Evaluation of adverse health risks associated with antineoplastic drug exposure in nurses at two Chinese hospitals: the effects of implementing a pharmacy intravenous admixture service. Am J Ind Med. 2016; 59:264–273.

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.

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Effects on Fertility and Reproductive Outcomes

Effects on fertility and reproductive health have been seen in a number of studies, mainly in female nurses.

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  • Connor TH, Lawson CC, Polovich M and McDiarmid. Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings. J Occup Environ Med. 2014; 56:901-910.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
  • Ratner PA, Spinelli JJ, Beking K, Lorenzi M, Chow Y, Teschke K, Le ND, Gallagher RP, Dimich-Ward H. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs. BMC Nurs. 2010; 9:15.
  • 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.
  • Shirangi A, Bower C, Holman CDJ, Preen DB and Bruce N. A study of handling cytotoxic drugs and risk of birth defects in offspring of female veterinarians. Int J Environ Res Public Health. 2014; 11:6216-6230.
  • 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.

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  • Forslind E. Cancer was occupational injury. Vardfaket. 1997; 21:58.
  • Fransman W, Kager H, Meijster T, Heederik D, Kromhout H, Portengen L and Blaauboer BJ. Leukemia from dermal exposure to cyclophosphamide among nurses in the Netherlands: quantitative assessment of the risk. Ann Occup Hyg. 2014; 58:271-282.
  • 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.
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  • Ratner PA, Spinelli JJ, Beking K, Lorenzi M, Chow Y, Teschke K, Le ND, Gallagher RP, Dimich-Ward H. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs. BMC Nurs. 2010; 9:15.
  • 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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