ANTİNEOPLASTİK MARUZİYETİNİN SAĞLIK ÇALIŞANLARININ ÜREME SAĞLIĞI ÜZERİNE ETKİLERİ

Öz

Hastanelerde bulunan çeşitli kimyasal ve ilaçlara maruz kalmanın personel sağlığı üzerindeki etkileri yaygın biçimde araştırılmaktadır. Gelişmiş ülkelerde, bu konuda yapılmış çok sayıdaki epidemiyolojik araştırmaların ışığında güvenli çalışma protokolleri geliştirilmiştir. Bu önlemler antineoplastiklerin yaygın olarak kullanıldığı onkoloji kliniği, klinik farmakoloji üniteleri ve ilgili sağlık personelini de kapsamaktadır. Araştırmalar maruziyet bulgularının önlemlere rağmen devam ettiğine işaret etmektedir. Antineoplastik ilaçların elde taşınması, hazırlanması ve hatta kemoterapi alan hastaların klinik bakımı, sorumlu personelin üreme sağlığı üzerinde olumsuz etkiler yaratabilir. Dolayısıyla ilgili birimlerde çalışan ve özellikle aktif üreme çağında olan kadın sağlık personelinin konu ile ilgili endişeleri süregelmektedir. Bu endişeler arasında düşükler ve konjenital anomaliler ilk sıraları alsa da intrauterin gelişme geriliği, ölü doğum, preterm doğum gibi etkiler de bazı çalışmalarca ileri sürülmüştür. Bu nedenle hastanelerde antineoplastik ilaçlarla çalışan kadın sağlık personelinin üreme sağlığı üzerindeki olası etkilerini literatürdeki verileri gözden geçirerek netleştirmeye çalışacağız.

Anahtar Kelimeler

• Antineoplastik ajanlar, Üreme sağlığı, Sağlık personeli, Düşük.

EFFECTS OF OCCUPATIONAL ANTINEOPLASTIC EXPOSURE ON REPRODUCTIVE HEALTH OF HEALTHCARE PERSONNEL

Öz

Occupational hazards have been studied in detail for their impact on healthcare workers in hospitals. In the light of many epidemiologic studies on the issue, standard safety protocols have been issued in developed countries. These protocols cover for places where routine antineoplastic medications are used, such as clinical pharmacology units, oncology clinics and for related healthcare personnel. Despite these precautions, studies continued to point exposure findings. Handling and preparation of antineoplastic medications or even caring of chemotherapy patients may cause adverse outcomes on reproductive health of personnel. Such a possibility is continued to generate significant concern among personnel who is working with antineoplastic medications, especially among female workers in their reproductive age. Even though these concerns are mainly for miscarriages and congenital anomalies, some studies have also suggested possible risks for stillbirth, intrauterine growth retardation, preterm delivery and infertility. Therefore we will attempt to clarify

Anahtar Kelimeler

• Antineoplastic agents, Reproductive health, Healthcare personnel, Abortion

Kaynakça

1. 1. Ricci MS, Zong WX. Chemotherapeutic approaches for targeting cell death pathways. Oncologist 2006;11(4):342-57.
2. 2. Rekhadevi PV, Sailaja N, Chandrasekhar M, Mahboob M, Rahman MF, Grover P. Genotoxicity assessment in oncology nurses handling anti-neoplastic drugs. Mutagenesis 2007;22(6):395-401.
3. 3. Cavallo D, Ursini CL, Perniconi B, Francesco AD, Giglio M, Rubino FM, Marinaccio A, Iavicoli S. Evaluation of genotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees Mutat Res. 2005;587(1-2):45-51.
4. 4. 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.
5. 5. Connor TH, DeBord DG, Pretty JR, Oliver MS, Roth TS, Lees PS, Krieg EF Jr, Rogers B, Escalante CP, Toennis CA, Clark JC, Johnson BC, McDiarmid MA. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med 2010;52(10):1019-27.
6. 6. National Institute for Occupational Safety and Health (NIOSH). NIOSH alert: preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings. http://www.cdc.gov/niosh/docs/2004-165/ pdfs/2004-165.pdf. DHHS (NIOSH) publication no. 2004–165:2004.
7. 7. Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D. Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes. Epidemiology 2007;18(1):112-9.
8. 8. Fransman W, Vermeulen R, Kromhout H. Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities. Int Arch Occup Environ Health 2005;78(5):403-12.

9. 9. Kromhout H, Hoek F, Uitterhoeve R, Huijbers R, Overmars RF, Anzion R, Vermeulen R.Ann. Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. Occup Hyg 2000;44(7):551-60.
10. 10. Baykal U, Seren S, Sokmen S. A description of oncology nurses’ working conditions in Turkey. Eur J Oncol Nurs 2009;13(5):368-75.
11. 11. Fransman W, Vermeulen R, Kromhout H. Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study. Ann Occup Hyg 2004;48(3):237-44.
12. 12. Kiffmeyer TK, Kube C, Opiolka S, Schmidt KG, Schöppe G, Sessink. Va¬por pressures, evaporation behaviour and airborne concentrations of hazardous drugs: implications for occupational safety. PJM Pharmeaceut J 2002 268:331–337.
13. 13. Connor TH, Shults M, Fraser MP. Determination of the vaporization of solutions of mutagenic antineoplastic agents at 23 and 37 degrees C using a desiccator technique. Mutat Res 2000 ;470(1):85-92.
14. 14. US Department of Labor. OSHA, Office of Occupational Medicine. Guidelines for cytotoxic (antineoplastic) drugs. http://www.osha.gov. 15. Oncology Nursing Society. Standards for Cancer Nursing Practice. 1982.
15. 16. American Society of Hospital Pharmacists. Technical assistance bulletin on handling cytotoxic drugs in hospitals. Am J Hosp Pharm 1985;42:131-137.
16. 17. https://osha.europa.eu/en. European Agency for Safety and Health at Work (EU-OSHA) web site. 18. http://www.esop.li. European Society of Oncology Pharmacology web site.
17. 19. http://eur-lex.europa.eu/en/index.htm. European Comission Legislation web site.
18. 20. Quansah R, Jaakkola JJ. Occupational exposures and adverse pregnancy outcomes among nurses: a systematic review and meta-analysis. J Womens Health (Larchmt) 2010;19(10):1851-62.
19. 21. R.J.M. Gardner, Grant R. Sutherland. Gametogenesis and Conception, Pregnancy Loss and Infertility. In: Chromosome Abnormalities and Genetic Counseling. 3rd edition, New York: Oxford University Press; 2004.p.341-360.
20. 22. Lawson CC, Rocheleau CM, Whelan EA, Lividoti Hibert EN, Grajewski B, Spiegelman D, Rich-Edwards JW. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol 2012;206(4):327.e1-8.
21. 23. http://www.nhs3.org Nurses’ Health Study Official Web Page.
22. 24. Stücker I, Caillard JF, Collin R, Gout M, Poyen D, Hémon D. Scand. Risk of spontaneous abortion among nurses handling antineoplastic drugs. J Work Environ Health 1990;16(2):102-7.
23. 25. Valanis B, Vollmer WM, Steele P. Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists. J Occup Environ Med 1999;41(8):632-8.
24. 26. Selevan SG, Lindbohm ML, Hornung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med 1985;313(19):1173- 8.
25. 27. Dranitsaris G, Johnston M, Poirier S, Schueller T, Milliken D, Green E, Zanke. 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. B.J Oncol Pharm Pract 2005;11(2):69-78.
26. 28. McDonald AD, McDonald JC, Armstrong B, Cherry NM, Côté R, Lavoie J, Nolin AD, Robert D. Fetal death and work in pregnancy. Br J Ind Med 1988;45(3):148-57.
27. 29. 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.