Assessment of Genotoxic Effects in Nurses Handling Cytostatic Drugs

Abstract

Several antineoplastic drugs have been classified as carcinogens by the International Agency for Research on Cancer (IARC) on the basis of epidemiological findings, animal carcinogenicity data, and outcomes of in vitro genotoxicity studies. 5-Fluorouracil (5-FU), which is easily absorbed through the skin, is the most frequently used antineoplastic agent in Portuguese hospitals and therefore may be used as an indicator of surface contamination. The aims of the present investigation were to (1) examine surface contamination by 5-FU and (2) assess the genotoxic risk using cytokinesis-block micronucleus assay in nurses from two Portuguese hospitals. The study consisted of 2 groups: 27 nurses occupationally exposed to cytostatic agents (cases) and 111 unexposed individuals (controls). Peripheral blood lymphocytes (PBL) were collected in order to measure micronuclei (MN) in both groups. Hospital B showed a higher numerical level of contamination but not significantly different from Hospital A. However; Hospital A presented the highest value of contamination and also a higher proportion of contaminated samples. The mean frequency of MN was significantly higher in exposed workers compared with controls. No significant differences were found among MN levels between the two hospitals. The analysis of confounding factors showed that age is a significant variable in MN frequency occurrence. Data suggest that there is a potential genotoxic damage related to occupational exposure to cytostatic drugs in oncology nurses.

Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach

“…Similar to our findings, positive results for both MN and CA induction were reported in other investigations on workers exposed to ANPD (Bouraoui et al 2011;El-Ebiary et al 2013;Kopjar et al 2009); positive results have been reported also in studies evaluating only MN (Cornetta et al 2008;Ladeira et al 2014;Maluf and Erdtmann 2000b;Rekhadevi et al 2007; Table 2 Frequencies of ANPD handling Data reported as the percentage of subject who have handled each drug at least once over a period of 6 months (data obtained from questionnaires) ANPD classified by the International Agency of Research as 1 carcinogenic to humans (Group 1), 2A probably carcinogenic to humans (Group 2A), 2B possibly carcinogenic to humans (Group 2B), 3 not classifiable as to its carcinogenicity to humans (Group 3), NL not listed by IARC (refs. : IARC 1976, 1981, 1987, 2000 ANPD % ANPD % Rombaldi et al 2009), or CA (Burgaz et al 2002;Jakab et al 2001;Musak et al 2009;Testa et al 2007).…”

“…Burgaz et al (1999) evaluated exposure to ANPD by measuring the urinary concentrations of CP. Environmental monitoring, by the evaluation of contamination of surfaces by 5-fluorouracil (i.e., wipe test), was performed by Ladeira et al (2014). Overall, the findings in the present and the abovecited studies confirm that ANPD contamination of the work environment in hospital is still possible, and safety measures adopted may not be sufficient to prevent exposure to genotoxic xenobiotics (Hedmer and Wohlfart 2012).…”

Prevalence of burnout syndrome in oncology nursing: A meta‐analytic study

“…The following variables were extracted from each study: (1) firstnamed author, (2) year of publication, (3) language of publication (English-Spanish-Portuguese), (4) country of study, (5) type of study, (6) sampling method (random vs intentional), (7) MBI type (Human Services Survey vs General Survey), (8) total sample of oncology nurses, (9) sample with high EE, (10) sample with high DP, and (11) sample with low PA. The prevalence rates or the number of oncology nurses for each burnout dimension were directly obtained from each study.…”

“…The hospital setting is characterised by the presence of numerous psychosocial and work stressors related to patient and family care, co‐workers, shiftwork, and the chemical and biological risks involved in this work, such as radiation or contact with infectious diseases. The development of chronic stress in health care professionals, as a consequence of these factors, can provoke burnout, a syndrome characterised by the presence of emotional exhaustion (EE), depersonalisation (DP) in dealings with patients, and low levels of personal accomplishment (PA) .…”

Forgotten public health impacts of cancer – an overview

“…All of these cases could be avoided by eliminating the presence of carcinogenic substances in workplaces through alternative means of production including substitution of chemicals, by a systematic implementation of preventative measures and by an organisation of work that aims to avoid contact with carcinogenic substances (9).…”