This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Dranitsaris, G. Articles by Zanke, B. Search for Related Content PubMed PubMed Citation Articles by Dranitsaris, G. Articles by Zanke, B. Pubmed/NCBI databases Medline Plus Health Information Cancer Social Bookmarking                         What's this?

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

Cancer Care Ontario, Safe Handling of Cytotoxics Working Group

Mary Johnston, MS

Program in Evidence-Based Care, Cancer Care Ontario, Safe Handling of Cytotoxics Working Group

Susan Poirier, BScPhm

London Regional Cancer Centre, Safe Handling of Cytotoxics Working Group

Trudi Schueller, BScPhm

Toronto-Sunnybrook Regional Cancer Centre, Safe Handling of Cytotoxics Working Group

Debbie Milliken, BScPhm

Cancer Care Ontario, Safe Handling of Cytotoxics Working Group

Esther Green, RN

Cancer Care Ontario, Safe Handling of Cytotoxics Working Group

Brent Zanke, MD, PhD

Cancer Care Ontario, Safe Handling of Cytotoxics Working Group

Objective. A systematic review and meta-analysis was conducted to test the hypothesis that oncology health care workers are at an increased risk of cancer, reproductive complications and acute toxic events.

Design. A structured literature search of Index Medicus/MEDLINE, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews and Healthstar was performed from 1966 to December 2004 for human epidemiological studies evaluating the risk of toxic events in health care workers exposed to cytotoxic drugs. Raw data and adjusted odds ratios (OR) reported in eligible studies were combined using a random effects model to calculate point estimates and 95% confidence intervals (CI) for each potential risk outcome.

Main outcome measures. Adjusted OR for congenital malformations, stillbirths and spontaneous abortions among health care workers exposure to cytotoxic agents compared to a non-exposed control group.

Results. The systematic review identified 14 studies evaluating the outcomes of interest, seven of which were suitable for statistical pooling. Due to lack of evidence, we were unable to estimate a pooled OR for the risk of cancer and acute toxic events. However, no significant association was detected between exposure to cytotoxic drugs and; congenital malformations (OR=1.64; 95% CI: 0.91-2.94) and stillbirths (OR=1.16; 95% CI: 0.73-1.82). In contrast, an association was identified between exposure to chemotherapy and spontaneous abortions (OR=1.46; 95% CI: 1.11-1.92).

Conclusions. The results of this systematic review identified a small incremental risk for spontaneous abortions in female staff working with cytotoxic agents. Health policy decision makers should effectively communicate the magnitude of this risk to their staff and implement cost effective interventions for its reduction or elimination.

Key Words: administration • health care workers • chemotherapy • health risks • preparation • workers

Journal of Oncology Pharmacy Practice, Vol. 11, No. 2, 69-78 (2005)
DOI: 10.1191/1078155205jp155oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. Schierl, A. Bohlandt, and D. Nowak Guidance Values for Surface Monitoring of Antineoplastic Drugs in German Pharmacies Ann. Hyg., October 1, 2009; 53(7): 703 - 711. [Abstract] [Full Text] [PDF]

				E. Green, M. Johnston, M. Trudeau, L. Schwartz, S. Poirier, G. Macartney, and D. Milliken Safe Handling of Parenteral Cytotoxics: Recommendations for Ontario J. Oncol. Pract, September 1, 2009; 5(5): 245 - 249. [Abstract] [Full Text] [PDF]

				T. H. Connor and M. A. McDiarmid Preventing Occupational Exposures to Antineoplastic Drugs in Health Care Settings CA Cancer J Clin, November 1, 2006; 56(6): 354 - 365. [Abstract] [Full Text] [PDF]