International Journal of Cancer Management

Published by: Kowsar

Biological Monitoring of the Oncology Healthcare Staff Exposed to Cyclophosphamide in Two Hospitals in Tehran

Mansour Rezazadeh Azari 1 , Mohammad Esmail Akbari 2 , Mohammad Bagher Abdollahi 3 , Hamid Reza Mirzaei 4 , Ali Salehi Sahlabadi 5 , Ramin Tabibi 6 , Alireza Rahmati 5 and Davoud Panahi 5 , *
Authors Information
1 Safety Promotion and Prevent of Injuries Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
4 Department of Radiation Oncology, Cancer Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Occupational Health Department, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
6 Department of Occupational Health Engineering, Abadan School of Medical Sciences, Abadan, Iran
Article information
  • International Journal of Cancer Management: 12 (1); e86537
  • Published Online: January 19, 2019
  • Article Type: Research Article
  • Received: November 19, 2018
  • Revised: January 12, 2019
  • Accepted: January 12, 2019
  • DOI: 10.5812/ijcm.86537

To Cite: Rezazadeh Azari M, Akbari M E, Abdollahi M B, Mirzaei H R, Salehi Sahlabadi A, et al. Biological Monitoring of the Oncology Healthcare Staff Exposed to Cyclophosphamide in Two Hospitals in Tehran, Int J Cancer Manag. Online ahead of Print ; 12(1):e86537. doi: 10.5812/ijcm.86537.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Sorsa M, Hemminki K, Vainio H. Occupational exposure to anticancer drugs: Potential and real hazards. Mutat Res-Genet Tox. 1985;154(2):135-49. doi: 10.1016/0165-1110(85)90024-7.
  • 2. Jochimsen PR. Handling of cytotoxic drugs by healthcare workers. A review of the risks of exposure. Drug Saf. 1992;7(5):374-80. doi: 10.2165/00002018-199207050-00005. [PubMed: 1418694].
  • 3. Sessink PJ, Kroese ED, van Kranen HJ, Bos RP. Cancer risk assessment for health care workers occupationally exposed to cyclophosphamide. Int Arch Occup Environ Health. 1995;67(5):317-23. [PubMed: 8543380].
  • 4. Constantinidis TC, Vagka E, Dallidou P, Basta P, Drakopoulos V, Kakolyris S, et al. Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals. Eur J Cancer Care (Engl). 2011;20(1):123-31. doi: 10.1111/j.1365-2354.2009.01150.x. [PubMed: 20148939].
  • 5. Sugiura S, Nakanishi H, Asano M, Hashida T, Tanimura M, Hama T, et al. Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan. J Oncol Pharm Pract. 2011;17(1):20-8. doi: 10.1177/1078155210369851. [PubMed: 20472603].
  • 6. The National Institute for Occupational Safety and Health (NIOSH). Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Centers for Disease Control and Prevention (CDC); 2004.
  • 7. American Society of Health-System Pharmacists. ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm. 2006;63(12):1172-91. doi: 10.2146/ajhp050529.
  • 8. Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, et al. Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract. 2012;8(6):344-9. 1 p following 349. doi: 10.1200/JOP.2012.000600. [PubMed: 23598843]. [PubMed Central: PMC3500478].
  • 9. Sessink PJ, Leclercq GM, Wouters DM, Halbardier L, Hammad C, Kassoul N. Environmental contamination, product contamination and workers exposure using a robotic system for antineoplastic drug preparation. J Oncol Pharm Pract. 2015;21(2):118-27. doi: 10.1177/1078155214522840. [PubMed: 24567041].
  • 10. Connor TH, Anderson RW, Sessink PJ, Spivey SM. Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area. Am J Health Syst Pharm. 2002;59(1):68-72. [PubMed: 11813470].
  • 11. Sessink PJ, Trahan J, Coyne JW. Reduction in Surface contamination with cyclophosphamide in 30 US Hospital pharmacies following implementation of a closed-system drug transfer device. Hosp Pharm. 2013;48(3):204-12. doi: 10.1310/hpj4803-204. [PubMed: 24421463]. [PubMed Central: PMC3839517].
  • 12. Wick C, Slawson MH, Jorgenson JA, Tyler LS. Using a closed-system protective device to reduce personnel exposure to antineoplastic agents. Am J Health Syst Pharm. 2003;60(22):2314-20. [PubMed: 14652980].
  • 13. Zock MD, Soefje S, Rickabaugh K. Evaluation of surface contamination with cyclophosphamide following simulated hazardous drug preparation activities using two closed-system products. J Oncol Pharm Pract. 2011;17(1):49-54. doi: 10.1177/1078155210374673. [PubMed: 20584743]. [PubMed Central: PMC3160203].
  • 14. Okeke CC, Allen LV Jr. Basics of compounding: Considerations for implementing United States pharmacopeia chapter 797 pharmaceutical compounding-sterile preparations, part 14: environmental quality and control (continued). Int J Pharm Compd. 2009;13(4):322-9. [PubMed: 23966523].
  • 15. Iran Ministry Industries. Instruction for work related hazardous agent measurement. 2015. Report No.: 60/123731-1008.
  • 16. Turci R, Sottani C, Spagnoli G, Minoia C. Biological and environmental monitoring of hospital personnel exposed to antineoplastic agents: A review of analytical methods. J Chromatogr B Analyt Technol Biomed Life Sci. 2003;789(2):169-209. [PubMed: 12742111].
  • 17. Jakubowski M. Biological monitoring versus air monitoring strategies in assessing environmental-occupational exposure. J Environ Monit. 2012;14(2):348-52. doi: 10.1039/c1em10706b. [PubMed: 22130625].
  • 18. Sessink PJ, Cerna M, Rossner P, Pastorkova A, Bavarova H, Frankova K, et al. Urinary cyclophosphamide excretion and chromosomal aberrations in peripheral blood lymphocytes after occupational exposure to antineoplastic agents. Mutat Res. 1994;309(2):193-9. [PubMed: 7520976].
  • 19. Sessink PJ, Boer KA, Scheefhals AP, Anzion RB, Bos RP. Occupational exposure to antineoplastic agents at several departments in a hospital. Environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. Int Arch Occup Environ Health. 1992;64(2):105-12. [PubMed: 1399019].
  • 20. Sessink PJ, Van de Kerkhof MC, Anzion RB, Noordhoek J, Bos RP. Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route? Arch Environ Health. 1994;49(3):165-9. doi: 10.1080/00039896.1994.9940377. [PubMed: 8185386].
  • 21. Ensslin AS, Stoll Y, Pethran A, Pfaller A, Rommelt H, Fruhmann G. Biological monitoring of cyclophosphamide and ifosfamide in urine of hospital personnel occupationally exposed to cytostatic drugs. Occup Environ Med. 1994;51(4):229-33. [PubMed: 8199663]. [PubMed Central: PMC1127952].
  • 22. DeMeo MP, Merono S, DeBaille AD, Botta A, Laget M, Guiraud H, et al. Monitoring exposure of hospital personnel handling cytostatic drugs and contaminated materials. Int Arch Occup Environ Health. 1995;66(6):363-8. [PubMed: 7782118].
  • 23. Nixon S, Schulmeister L. Safe handling of hazardous drugs: Are you protected? Clin J Oncol Nurs. 2009;13(4):433-9. doi: 10.1188/09.CJON.433-439. [PubMed: 19648100].
  • 24. Sorsa M, Anderson D. Monitoring of occupational exposure to cytostatic anticancer agents. Mutat Res. 1996;355(1-2):253-61. [PubMed: 8781586].
  • 25. Sessink PJ, Bos RP. Drugs hazardous to healthcare workers. Evaluation of methods for monitoring occupational exposure to cytostatic drugs. Drug Saf. 1999;20(4):347-59. doi: 10.2165/00002018-199920040-00004. [PubMed: 10230582].
  • 26. Sottani C, Turci R, Schierl R, Gaggeri R, Barbieri A, Violante FS, et al. Simultaneous determination of gemcitabine, taxol, cyclophosphamide and ifosfamide in wipe samples by high-performance liquid chromatography/tandem mass spectrometry: protocol of validation and uncertainty of measurement. Rapid Commun Mass Spectrom. 2007;21(7):1289-96. doi: 10.1002/rcm.2960. [PubMed: 17340557].
  • 27. Connor TH, Lawson CC, Polovich M, McDiarmid MA. Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: A review of the evidence. J Occup Environ Med. 2014;56(9):901-10. doi: 10.1097/JOM.0000000000000249. [PubMed: 25153300]. [PubMed Central: PMC4569003].
  • 28. Huttunen KM, Raunio H, Rautio J. Prodrugs--from serendipity to rational design. Pharmacol Rev. 2011;63(3):750-71. doi: 10.1124/pr.110.003459. [PubMed: 21737530].
  • 29. Villarini M, Dominici L, Piccinini R, Fatigoni C, Ambrogi M, Curti G, et al. Assessment of primary, oxidative and excision repaired DNA damage in hospital personnel handling antineoplastic drugs. Mutagenesis. 2011;26(3):359-69. doi: 10.1093/mutage/geq102. [PubMed: 21112930].
  • 30. Harrison TR. Risks of handling cytotoxic drugs. In: Perry MC, editor. The chemotherapy source book. 3rd ed. Philadelphia, PA, Lippincott: Williams & Wilkins; 2001. p. 566-82.
  • 31. Sessink PJ, Scholtes MM, Anzion RB, Bos RP. Determination of cyclophosphamide in urine by gas chromatography-mass spectrometry. J Chromatogr. 1993;616(2):333-7. [PubMed: 8376516].
  • 32. Center for Drug Evaluation Research; Center for Veterinary Medicine. Guidance for industry: Bioanalytical method validation. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research; 2001.
  • 33. Feyerherm F, Westland J, Marvin C. Quantitiation and confirmation of blood ethanol content using a new GC/FID/MS blood alcohol aanalyzer. USA: Agilent Technologies, Inc; 2014.
  • 34. Azari M, Panahi D, Akbari ME, Mirzaei HR, Rezvani HR, Zendehdel R, et al. Environmental monitoring of occupational exposure to cyclophosphamide drug in two Iranian hospitals. Iran J Cancer Prevent. 2016;In Press(In Press). doi: 10.17795/ijcp-7229.
  • 35. Ramphal R, Bains T, Vaillancourt R, Osmond MH, Barrowman N. Occupational exposure to cyclophosphamide in nurses at a single center. J Occup Environ Med. 2014;56(3):304-12. doi: 10.1097/JOM.0000000000000097. [PubMed: 24481248].
  • 36. Sabatini L, Barbieri A, Lodi V, Violante FS. Biological monitoring of occupational exposure to antineoplastic drugs in hospital settings. Med Lav. 2012;103(5):394-401. [PubMed: 23077799].
  • 37. Fransman W, Huizer D, Tuerk J, Kromhout H. Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility. Int Arch Occup Environ Health. 2007;80(5):396-403. doi: 10.1007/s00420-006-0148-x. [PubMed: 17021843].
  • 38. Panahi D, Azari M, Akbari ME, Zendehdel R, Mirzaei HR, Hatami H, et al. Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug. Environ Monit Assess. 2016;188(4):238. doi: 10.1007/s10661-016-5255-x. [PubMed: 27003403].
  • 39. Turk M, Davas A, Ciceklioglu M, Sacaklioglu F, Mercan T. Knowledge, attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital. Asian Pac J Cancer Prev. 2004;5(2):164-8. [PubMed: 15244519].
  • 40. Polovich M, Martin S. Nurses' use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum. 2011;38(6):718-26. doi: 10.1188/11.ONF.718-726. [PubMed: 22037334].
  • 41. Willemsen-McBride T, Gehan K. Safe handling of cytotoxic agents: A team approach. AORN J. 2009;90(5):731-2. 735-40. doi: 10.1016/j.aorn.2009.06.021. [PubMed: 19895929].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments