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

Abstract

6082 Background: It has been well documented in the literature that cancer patients receiving certain chemotherapy drugs are at an increased risk for developing secondary malignancies. This concern has also been extended to health care staff involved in the preparation and administration of cancer therapy. To evaluate this risk, a systematic review and meta analysis of the literature was conducted to test the hypothesis that health care providers involved in the preparation and administration of chemotherapy are at an increased risk of cancer, reproductive complications and acute toxic events. Methods: A structured literature search of Medline, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews and Healthstar was performed from 1966 to October 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 for each potential risk outcome. Results: The systematic review identified 14 studies evaluating the outcomes of interest, 7 of which were suitable for statistical pooling. Due to lack of evidence, we were unable to estimate a pooled odds ratio for the risk of cancer and acute toxic events. However, no statistically 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. No significant financial relationships to disclose.