Pharmaceutisch Weekblad

, Volume 12, Issue 6, pp 228–235 | Cite as

The risks of handling cytotoxic drugs

II. Recommendations for working with cytotoxic drugs
  • G. P. Kaijser
  • W. J. M. Underberg
  • J. H. Beijnen


Presuming that preparation of antineoplastic drugs without proper protection may lead to mutagenic urine (of which the effects are uncertain), one has to take great care when preparing these drugs. Apart from Norway no other country has national regulations issued by the government for handling cytostatic agents. Many organizations in various countries have made their own guidelines, which may be adapted to the situations in local hospitals. The following recommendations have been compiled after a review of the literature. They reflect a personal set of guidelines for preparation, administration and disposal of cytotoxic drugs. They are probably the minimum precautions that should be taken, and have not been approved by any committee or agency. Further precautions must first have their potential benefit weighed against probable inconvenience and additional costs.


Antineoplastic agents Drug compounding Drug contamination Health-care personnel Occupational health Protective devices Waste products 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson RW, Puckett WH Jr, Dana WJ, et al. Risk of handling injectable antineoplastic agents. Am J Hosp Pharm 1982;39:1881–7.PubMedGoogle Scholar
  2. 2.
    Caudell KA, Vredevoe DL, Dietrich MF. Quantification of urinary mutagens in nurses during potential antineoplastic agent exposure. Cancer Nurs 1988;11:41–50.PubMedGoogle Scholar
  3. 3.
    Falck K, Grohn P, Sorsa M, et al. Mutagenicity in urine of nurses handling cytostatic drugs. Lancet 1979;1:1250–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Nguyen TV, Theiss JC, Matney TS. Exposure of pharmacy personnel to mutagenic antineoplastic drugs. Cancer Res 1982;42:4792–6.PubMedGoogle Scholar
  5. 5.
    Signori O, Palchaudhuri S. Observations on the occupational exposure of health care workers to chemotherapeutic agents [Abstract]. Proc Am Soc Clin Oncol 1983;4:23.Google Scholar
  6. 6.
    Stucker I, Hirsch A, Doloy T, Bastie-Sigeac I, Hemon D. Urine mutagenicity, chromosomal abnormalities and sister chromatid exchanges in lymphocytes of nurses handling cytostatic drugs. Int Arch Occup Environ Health 1986;57:195–205.CrossRefPubMedGoogle Scholar
  7. 7.
    Theiss JC, et al. Results of their study presented at an international colloquium on cancer sponsored by the M.D. Anderson Hospital van Tumor Institute in Houston [Abstract]. JAMA 1982;184:11–12.Google Scholar
  8. 8.
    Benhamou S, Callais F, Sancho-Garnier H, et al. Mutagenicity in urine from nurses handling cytostatic agents. Eur J Cancer Cl Oncol 1986;22:1489–93.CrossRefGoogle Scholar
  9. 9.
    Kolmodin-Hedman B, Hartvig P, Sorsa M, et al. Occupational handling of cytotoxic drugs. Arch Toxicol 1983;54:25–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Kaijser GP, Underberg WJM, Beijnen JH. The risks of handling cytotoxic drugs. I. Methods of testing exposure. Pharm Weekbl [Sci] 1990;12:217–27.Google Scholar
  11. 11.
    Eriksen IL. Handling of cytotoxic drugs: government regulations and practical solutions. Pharm Int 1982;3:264–7.Google Scholar
  12. 12.
    Harrison BR. Developing guidelines for working with antineoplastic drugs. Am J Hosp Pharm 1981;38:1686–93.PubMedGoogle Scholar
  13. 13.
    American Society of Hospital Pharmacists. Technical assistance bulletin on handling cytotoxic drugs in hospitals. Am J Hosp Pharm 1985;42:131–7.Google Scholar
  14. 14.
    Hoffman DM. Handling of antineoplastic drugs in a major cancer center. Hosp Pharm 1980;15:302–4.PubMedGoogle Scholar
  15. 15.
    Anonymous. Nijmegen: Werkgroep Cytostatica van het Integraal Kankercentrum Noord (IKN) en het Integraal Kankercentrum Oost (IKO)/IKN, 1986.Google Scholar
  16. 16.
    Knowles RS, Virden JE. Handling of injectable antineoplastic agents. Br Med J 1980;281:589–91.PubMedGoogle Scholar
  17. 17.
    Mattia MA, Blake SL. Hospital hazards: cancer drugs. Am J Nurs 1983;83:758–62.Google Scholar
  18. 18.
    Murphy CP, Goldspiel BR, Koeller J. Costs of implementing veterans administration directives for handling antineoplastic agents. Am J Hosp Pharm 1987;44:788–91.PubMedGoogle Scholar
  19. 19.
    Anonymous. Richtlijnen voor het bereiden en toedienen van cytostatica op de verpleegafdelingen [Guidelines for the preparation and administration of cytostatic drugs on hospital wards]. Deventer: Nederlandse Vereniging van Ziekenhuisapothekers, 1983.Google Scholar
  20. 20.
    Occupational Safety and Health Administration. OSHA work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs. Am J Hosp Pharm 1986;43:1193–204.Google Scholar
  21. 21.
    Pharmaceutical Society Working Party Report. Guidelines for the handling of cytotoxic drugs. Pharm J 1983;230:230–1.Google Scholar
  22. 22.
    Society of Hospital Pharmacists of Australia's Specialty Practice Committee on Parenteral Services. Guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards. Hosp Pharm 1981;16:17–20.Google Scholar
  23. 23.
    Stolar MH, Power LA, Viele CS. Recommendations for handling cytotoxic drugs in hospitals. Am J Hosp Pharm 1983;40:1163–71.PubMedGoogle Scholar
  24. 24.
    Zimmerman PF, Larson RK, Barkely EW, et al. Recommendations for the safe handling of injectable antineoplastic drug products. Am J Hosp Pharm 1981;38:1693–5.PubMedGoogle Scholar
  25. 25.
    Verwey SL, Simonetti GPC. Verpleegkundigen ondergaan risico's bij het omgaan met cytostatica [Nursing personnel face risks when handling cytostatic drugs]. Tijdschr Kanker 1987;5:148–50.Google Scholar
  26. 26.
    Cohen A, Newland SJ, Kirking DM. Injectable antineoplastic drug practices in Michigan hospitals. Am J Hosp Pharm 1987;44:1096–105.PubMedGoogle Scholar
  27. 27.
    Barry LK, Booker RB. Promoting the responsible handling of antineoplastic agents in the community. Oncol Nurs Forum 1985;12(May):41–6.Google Scholar
  28. 28.
    Gregoire RE, Segal R, Hale KM. Handling antineoplastic drug admixtures at cancer centers: practices and pharmacist attitudes. Am J Hosp Pharm 1987;44:1090–5.PubMedGoogle Scholar
  29. 29.
    Leroy ML, Roberts MJ, Theisen JA. Procedures for handling antineoplastic injections in comprehensive cancer centers. Am J Hosp Pharm 1983;40:601–3.PubMedGoogle Scholar
  30. 30.
    Moody DG. Veterans Administration Medical Center policies and procedures for handling injectable antineoplastic drugs. Am J Hosp Pharm 1984;41:916–9.PubMedGoogle Scholar
  31. 31.
    Smeets M. Inventariserend onderzoek naar het omgaan met cytostatica in zes ziekenhuizen [Stageverslag] [Research on handling of cytostatic drugs in six hospitals (Report)]. Wageningen: Landbouwhogeschool, 1986.Google Scholar
  32. 32.
    Tortorici MP. Precautions followed by personnel involved with the preparations of parenteral antineoplastic medications. Hosp Pharm 1980;15:293–301.PubMedGoogle Scholar
  33. 33.
    De Werk NA, Wadden RA, Chiou WL. Exposure of hospital workers to airborne antineoplastic agents. Am J Hosp Pharm 1983;40:597–601.PubMedGoogle Scholar
  34. 34.
    Hirst M, Tse S, Mills DG, et al. Occupational exposure to cyclophosphamide. Lancet 1984;1:186–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Sorsa M, Pyy L, Salomaa S, et al. Biological and environmental monitoring of occupational exposure to cyclophosphamide in industry and hospitals. Mutat Res 1988;204:465–79.PubMedGoogle Scholar
  36. 36.
    Reich SD. Antineoplastic agents as potential carcinogens: Are nurses and pharmacists at risk? Cancer Nurs 1981;4:500.PubMedGoogle Scholar
  37. 37.
    Crudi CB. A compounding dilemma: I've kept the drug sterile but have I contaminated myself? Natl IV Ther J 1980;3:77–80.Google Scholar
  38. 38.
    Ladik DF, Stoehr GP, Maurer MA. Precautionary measures in the preparation of antineoplastics. Am J Hosp Pharm 1980;37:1184–6.PubMedGoogle Scholar
  39. 39.
    Reynolds RD, Ignoffo R, Lawrence J, et al. Adverse reactions to AMSA in medical personnel. Cancer Treat Rep 1982;66:1885.PubMedGoogle Scholar
  40. 40.
    Meier K, Donislawski S. Zentrale Zytostatikazubereitung in der Krankenhausapotheke. Krankenhauspharmazie 1988;8:278–84.Google Scholar
  41. 41.
    Sotaniemi EA, Sutinen S, Arranto AJ, et al. Liver damage in nurses handling cytostatic agents. Acta Med Scand 1983;214:181–9.PubMedGoogle Scholar
  42. 42.
    Williams CJ. Handling cytotoxics. Br Med J 1985;291:1299–300.Google Scholar
  43. 43.
    Wilson JP, Solimando DA. Antineoplastics: a safety hazard? Am J Hosp Pharm 1981;38:624.PubMedGoogle Scholar
  44. 44.
    Scott SA, Schrott DB, Loesch GA. Pharmacy program for improved handling of antineoplastic agents. Am J Hosp Pharm 1983;40:1179–82.PubMedGoogle Scholar
  45. 45.
    Solimando DA Jr. Preparation of antineoplastic drugs: a review. Am J IV Ther Clin Nutr 1983;10:16–27.Google Scholar
  46. 46.
    Thoma K. Zytostatika: Wie sicher sind sie in der Handhabung. Dtsch Apotheker Ztg 1987;127:197–9.Google Scholar
  47. 47.
    Oakley PA, Reeves E. The value of a centralised reconstitution service. Pharm J 1984;232:391–2.Google Scholar
  48. 48.
    Anderson M, Brassington D, Bolger J. Development and operation of a pharmacy-based intravenous cytotoxic reconstitution device. Br Med J 1983;286:32–5.Google Scholar
  49. 49.
    Zelickson AS, Mottaz J, Weiss LW. Effects of topical fluorouracil on normal skin. Arch Dermatol 1975;111:1301–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Levantine A, Almeyda J. Cutaneous reactions to cytostatic agents. Br J Dermatol 1974;90:239–42.PubMedGoogle Scholar
  51. 51.
    Connor TH, Laidlaw JL, Theiss JC, et al. Permeability of latex and Polyvinylchloride gloves to carmustine. Am J Hosp Pharm 1984;41:676–9.PubMedGoogle Scholar
  52. 52.
    Gough TA, Webb KS, McPhail MF. Diffusion of nitrosamines through protective gloves. In: Walker EA, Gricrute L, Castegnaro M, et al, eds. IARC Scientific publication; No. 19. Environmental aspects ofN- nitroso compounds. Lyon: International Agency for Research on Cancer, 1978:531–4.Google Scholar
  53. 53.
    Laidlaw JL, Connor TH, Theiss JC, et al. Permeability of latex and Polyvinylchloride gloves to 20 antineoplastic drugs. Am J Hosp Pharm 1984;41:2618–23.PubMedGoogle Scholar
  54. 54.
    Sansone EB, Tewari YB. The permeability of laboratory gloves to selected nitrosamines. In: Walker EA, Gricrute L, Castegnaro M, et al., eds. IARC Scientific publication; No. 19. Environmental aspects ofN- nitroso compounds. Lyon: International Agency for Research on Cancer, 1978:517–29.Google Scholar
  55. 55.
    Sansone EB, Teari YB. The permeability of laboratory gloves to selected solvents. Am Ind Hyg Assoc J 1978;39:169–74.PubMedGoogle Scholar
  56. 56.
    Thomsen K, Mikkelsen HI. Protective capacity of gloves used for handling of nitrogen mustard. Contact Dermatitis 1975;1:268–9.Google Scholar
  57. 57.
    Stoikes ME, Carlson JD, Farris FF, et al. Permeability of latex and Polyvinylchloride gloves to fluorouracil and methotrexate. Am J Hosp Pharm 1987;44:1341–6.PubMedGoogle Scholar
  58. 58.
    Slevin ML, Ang LM, Johnston A, Turner P. The efficiency of protective gloves used in the handling of cytotoxic drugs. Cancer Chemother Pharmacol 1984;12:151–3.CrossRefPubMedGoogle Scholar
  59. 59.
    Anonymous. Handling cytotoxic agents. An international roundtable. Zurich, 1984. Zurich: Bristol-Myers Company, 1984:11.Google Scholar
  60. 60.
    Van der Walle HB. Huidafwijkingen door het gebruik van rubber handschoenen [Skin defects through the use of rubber gloves]. Ned Tijdschr Geneeskd 1988;132:952–56.PubMedGoogle Scholar
  61. 61.
    Van der Meeren HLM, Boezeman JBM, Rampen FHJ. Contactdermatitis door het gebruik van chirurgische handschoenen [Contact dermatitis due to surgical gloves]. Ned Tijdschr Geneeskd 1988;132:963–5.PubMedGoogle Scholar
  62. 62.
    Laidlaw JL, Connor TH, Thomas H, et al. Permeability of four disposable protective-clothing materials to seven antineoplastic drugs. Am J Hosp Pharm 1985;42:2449–54.PubMedGoogle Scholar
  63. 63.
    Barhamond BA. Difficulties encountered in implementing guidelines for handling antineoplastics in the physician's office. Cancer Nurs 1986;9(3):138–43.PubMedGoogle Scholar
  64. 64.
    Montesano R, Bartsch H, Boyland E, eds. Handling chemical carcinogens in the laboratory. Problems of safety. IARC Scientific Publications; No. 33. Lyon: International Agency for Research on Cancer, 1979:8.Google Scholar
  65. 65.
    Briggs KM. Caring for cytotoxic drug handlers. Occup Health 1983;35:273–81.Google Scholar
  66. 66.
    Kleinberg ML, Quinn MJ. Airborne drug levels in a laminar flow hood. Am J Hosp Pharm 1981;38:1301–3.PubMedGoogle Scholar
  67. 67.
    Zellmer WA. Fear of anticancer drugs. Am J Hosp Pharm 1984;41:665.PubMedGoogle Scholar
  68. 68.
    Donner AL. Possible risks of working with antineoplastic drugs in horizontal laminar flow hoods. Am J Hosp Pharm 1978;35:900.PubMedGoogle Scholar
  69. 69.
    Harrison BR. Developing guidelines for working with antineoplastic drugs. Am J Hosp Pharm 1981;38:1686–93.PubMedGoogle Scholar
  70. 70.
    De Weerd G, Van der Meer YG. Is er noodzaak een down-flow LAF kast te voorzien van een afvoer naar buiten? [Is venting to the outside necessary in a downflow LAF cabinet?]. Ziekenhuisfarmacie 1987;3:122–4.Google Scholar
  71. 71.
    McDiarmid MA, Egan T, Furio M, et al. Sampling for airborne fluorouracil in a hospital drug preparation area. Am J Hosp Pharm 1986;43:1942–5.PubMedGoogle Scholar
  72. 72.
    Hoy RH, Stump LM. Effect of an air-venting filter device on aerosol production from vials. Am J Hosp Pharm 1984;41:324–6.PubMedGoogle Scholar
  73. 73.
    Anonymous. Handling cytotoxic agents. An international roundtable. Zurich, 1984. Zurich: Bristol-Myers Company, 1984:9.Google Scholar
  74. 74.
    Avis DE, Levchuk JW. Special considerations in the use of vertical laminar flow workbenches. Am J Hosp Pharm 1984;41:81–7.PubMedGoogle Scholar
  75. 75.
    Bos RP, Leenaars AO, Theuws JL, et al. Mutagenicity of urine from nurses handling cytostatic drugs: influence of smoking. Int Arch Occup Environ Health 1982;50:359–69.CrossRefPubMedGoogle Scholar
  76. 76.
    McLendon BF, Bron AF. Corneal toxicity from vinblastin solution. Br J Ophthalmol 1978;62:97–9.PubMedGoogle Scholar
  77. 77.
    Duvall E, Baumann B. Unusual accident during the administration of chemotherapy. Cancer Nurs 1980;3:305–6.PubMedGoogle Scholar
  78. 78.
    Anonymous. Handling cytotoxic agents. An international roundtable. Zurich, 1984. Zurich: Bristol-Myers Company, 1984:10.Google Scholar
  79. 79.
    Barcon DL, Presant CA, Melville J. Purging procedure eliminates antineoplastic spillage. Am J Hosp Pharm 1987;44:2254.Google Scholar
  80. 80.
    Handling cytotoxic agents. An international round-table. Zurich, 1984. Bristol-Myers Company, 1984:15.Google Scholar
  81. 81.
    Wagener DJTh. Beroepsrisico's bij het omgaan met chemotherapeutische middelen [Occupational risks when handling chemotherapeutic drugs]. Ned Tijdschr Geneeskd 1986;130:2292–4.PubMedGoogle Scholar
  82. 82.
    Venitt S, Crofton-Sleigh C, Hunt J, et al. Monitoring exposure of nursing and pharmacy personnel to cytotoxic drugs: urinary mutation assays and urinary platinum as markers of absorption. Lancet 1984;1:74–6.CrossRefPubMedGoogle Scholar
  83. 83.
    Safirstein R, Daye M, Guttenplan JB. Mutagenic activity and identification of excreted platinum in human and rat urine and rat plasma after administration of cisplatin. Cancer Lett 1983;18:329–38.CrossRefPubMedGoogle Scholar
  84. 84.
    Juma FD, Rogers HJ, Trounce JR, et al. Pharmacokinetics of i.v. cyclophosphamide in man, estimated by gas-liquid chromatography. Cancer Chemother Pharmacol 1978;1:229–31.CrossRefPubMedGoogle Scholar
  85. 85.
    Balbinder E, Reich CI, Shugarts D, et al. Relative mutagenicity of some urinary metabolites of the antitumor drug cyclophosphamide. Cancer Res 1981;41:2967–72.PubMedGoogle Scholar
  86. 86.
    Harris J, Dodds LJ. Handling waste from patients receiving cytotoxic drugs. Pharm J 1985;235:289–91.Google Scholar
  87. 87.
    Heggie GD, Sommadossi JP, Cross DS, et al. Clinical pharmacokinetics of 5-fluorouracil and its metabolites in plasma, urine and bile. Cancer Res 1987;47:2203–6.PubMedGoogle Scholar
  88. 88.
    Hull WE, Port RE, Herrmann R, et al. Metabolites of 5-fluorouracil in plasma and urine. Cancer Res 1988;48:1680–8.PubMedGoogle Scholar
  89. 89.
    Siebert D, Simon U. Cyclophosphamide: pilot study of genetically active metabolites in the urine of a treated human patient. Mutat Res 1973;19:65–72.PubMedGoogle Scholar
  90. 90.
    Minnich V, Smith VE, Thompson D, et al. Detection of mutagenic activity in human urine. Cancer 1976;38:1253–8.PubMedGoogle Scholar
  91. 91.
    Cloak MM, Connor TH, Stevens KR, et al. Occupational exposure of nursing personnel to antineoplastic agents. Oncol Nurs Forum 1985;12(5):33–9.Google Scholar
  92. 92.
    Vaccari PL, Tonat K, DeChristoforo R, et al. Disposal of antineoplastic wasted at the NIH. Am J Hosp Pharm 1984;41:87–92.PubMedGoogle Scholar
  93. 93.
    Wilson SJ. Safe disposal of some commonly used injectable antineoplastic drugs. J Clin Hosp Pharm 1983;8:295–9.PubMedGoogle Scholar
  94. 94.
    Montesano R, Bartsch H, Boyland E. Handling chemical carcinogens in the laboratory — problems of safety. IARC Scientific publications; No. 33. Lyon: International Agency for Research on Cancer, 1979:13–4.Google Scholar
  95. 95.
    D'Arcy PF. Reactions and interactions in handling anticancer drugs. Drug Intell Clin Pharm 1983;4:532–8.Google Scholar
  96. 96.
    Johnson EG, Janosik JE. Manufacturers' recommendations for handling spilled antineoplastic agents. Am J Hosp Pharm 1989;46:318–9.PubMedGoogle Scholar
  97. 97.
    Lunn G, Jansone EB. Validated methods for handling spilled antineoplastic drugs. Am J Hosp Pharm 1989;46:1131.Google Scholar
  98. 98.
    Batty KT, Plumridge RJ. Cytotoxic-spill kit and spillcontrol procedure. Am J Hosp Pharm 1986;43:2235–6.PubMedGoogle Scholar
  99. 99.
    Colls BM. Safety of handling cytotoxic agents: a cause for concern by pharmaceutical companies? Br Med J 1985;291:1318–9.Google Scholar
  100. 100.
    Lunn G, Sansone B, Andrews AW, Hellwig CC. Degradation and disposal of some antineoplastic drugs. J Pharm Sci 1989;78:652–9.PubMedGoogle Scholar
  101. 101.
    Montesano R, Bartsch H, Boyland E. Handling chemical carcinogens in the laboratory — problems of safety. IARC Scientific Publications; No. 33. Lyon: International Agency for Research on Cancer, 1979:14.Google Scholar
  102. 102.
    Hannan MA, Recio L, Deluca PP, Enoch H. Coutagenic effects of 2-aminoanthracene and cigarette smoke condensate or smoker's urine in the AmesSalmonella assay system. Cancer Lett 1981;13:203.CrossRefPubMedGoogle Scholar
  103. 103.
    Falck K, Sorsa M, Vainio H. Mutagenicity in urine from workers in rubber industry. Mut Res 1980;79:45–52.Google Scholar
  104. 104.
    Zielhuis RL. Roken tijdens het werk: interactie met omgevingsfactoren [Smoking during work: interaction with environmental factors]. Tijdschr Soc Geneeskd 1979;57:471.Google Scholar
  105. 105.
    Joosting PE. Wat is de betekenis van arbeidshygiënische ‘normen’ met en zonder tabak? [What is the meaning of occupational hygienic standards with and without smoking?]. Tijdschr Soc Geneeskd 1981;59:762–71.Google Scholar
  106. 106.
    Anonymous. Health effects of combined exposures in the work environment. WHO Tech Rep Ser 1981:(662).Google Scholar
  107. 107.
    Hemminki K, Kyyronen P, Lindbohm ML. Spontaneous abortions and malformations in the offspring of nurses exposed to cytostatic drugs. J Epidemiol Commun Health 1985;39:141–7.Google Scholar
  108. 108.
    Selevan SG, Lindbolm ML, Hornung RW, et al. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med 1985;313:1173–221.PubMedGoogle Scholar
  109. 109.
    Badr FM, Badr RS. Induction of dominant lethal mutation in male mice by ethylalcohol. Nature 1975;253:134–6.PubMedGoogle Scholar
  110. 110.
    Harlap S, Shiono PH. Alcohol, smoking and incidence of spontaneous abortions in the first and second trimester. Lancet 1980;2:173–6.CrossRefPubMedGoogle Scholar
  111. 111.
    Kline J, Shrout P, Steinz Z, Susser M, Warburton P. Drinking during pregnancy and spontaneous abortion. Lancet 1980;2:176–80.CrossRefPubMedGoogle Scholar
  112. 112.
    Harlap S, Shiono PH, Ramcharan S, Berendes H, Pellegrin F. A prospective study of spontaneous fetal losses after induced abortions. N Engl J Med 1979;301:677–81.PubMedGoogle Scholar
  113. 113.
    Schaffner A. Safety precautions in home chemotherapy. Am J Nurs 1984;84:346–7.PubMedGoogle Scholar
  114. 114.
    Berg S. Precautions for handling antineoplastic agents in the home. Am J Hosp Pharm 1987;44:1024.PubMedGoogle Scholar
  115. 115.
    Asscher W. Handling cytotoxic drugs. Br Med J 1986;292:59–60.Google Scholar
  116. 116.
    Siebert S, Adamson RH. Toxicity of antineoplastic agents in man: chromosomal aberrations, antifertility effects, congenital malformations and carcinogenic potential. Adv Cancer Res 1975;22:57–155.PubMedGoogle Scholar
  117. 117.
    Bingham E. Hazards to health workers from antineoplastic drugs. N Engl J Med 1985;313:1220–1.PubMedGoogle Scholar
  118. 118.
    Kalter H. Antineoplastic drugs and spontaneous abortion in nurses. N Engl J Med 1986;314:1048–9.PubMedGoogle Scholar
  119. 119.
    Schoemaker TJ, Van Wezel-Engbersen MB, Dalderup LM. Letter containing an advice concerning working with cytostatic agents by pregnant women. Amsterdam: Arbeidsinspectie, 1985.Google Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1990

Authors and Affiliations

  • G. P. Kaijser
    • 1
  • W. J. M. Underberg
    • 1
  • J. H. Beijnen
    • 2
    • 3
  1. 1.Pharmaceutical LaboratoryUtrecht UniversityGH Utrechtthe Netherlands
  2. 2.Slotervaart HospitalEC Amsterdamthe Netherlands
  3. 3.Antoni Van Leeuwenhoek HospitalCX Amsterdamthe Netherlands

Personalised recommendations