Job requires mixing chemo and breastfeeding

rebeckah · May 21, 2010

i can't answer your question very well myself, but i'll give you what i have.

first, i am also curious. i just got a job as an admixture technician and found out i was pregnant about the same time. the doc i'm working for says he's not worried in the least, but i work with another nurse who is 20 weeks and won't even hang chemo. i don't know if he is underreacting or if she is overreacting. so i am looking for numbers and studies, not just opinions based on here-say.

that being said, my brother who is a pharmacist says he's not worried because pregnant women go through chemo all the time with healthy babies. the idea that even if you spilled chemo on your skin or breathed in some droplets, it's still not even close to a whole shot of it going into the blood. according to him, the only birth complications that can be correlated to exposure are low birth weight and occasional hyponatremia.

here's a peer-reviewed article you can have a look at. basically, it says that the information we have is pretty inconclusive. here's the link and a quote from the article

http://cms.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/volume92004/no3sept04/hazardousdrugs.aspx

epidemiology:

january 2007 - volume 18 - issue 1 - pp 112-119

doi: 10.1097/01.ede.0000246827.44093.c1

original article

nurses with dermal exposure to antineoplastic drugs: reproductive outcomes

fransman, wouter; roeleveld, nel; peelen, susan; de kort, wim; kromhout, hans; heederik, dick

abstract

background: nurses and other hospital workers are exposed to antineoplastic drugs during daily activities. previous studies suggest that antineoplastic drugs at occupational exposure levels may be toxic to reproduction, but these studies are not consistent or conclusive.

methods: self-administered questionnaires were completed by 4393 exposed and nonexposed nurses employed between 1990 and 1997 (79% response). questions were asked about pregnancy outcome, work-related exposures, and lifestyle. exposure to antineoplastic drugs was estimated using task-based dermal exposure measurements and self-reported task frequencies. time to pregnancy was modeled using survival analysis, and odds ratios (ors) with 95% confidence intervals (cis) were calculated for other reproductive outcomes using multiple logistic regression analysis. associations were further explored by nonparametric regression modeling.

results: nurses highly exposed to antineoplastic drugs took longer to conceive than referent nurses (adjusted hazard ratio = 0.8; ci = 0.6-0.9). exposure to antineoplastic drugs was associated with premature delivery (or per unit increase in ln[exposure] = 1.08; ci = 1.00-1.17) and low birth weight (or per unit increase in ln[exposure] = 1.11; 1.01-1.21). penalized smoothed spline plots corroborated these log-linear relations. spontaneous abortion, stillbirth, congenital anomalies, and sex of offspring appeared not to be related to exposure to antineoplastic drugs.

conclusion: antineoplastic drugs may reduce fertility and increase poor neonatal outcomes among occupationally exposed oncology nurses.

also, here is a quote from the osha website:

reproductive effects associated with occupational exposure to cd's have been well documented. hemminki et al.32 found no difference in exposure between nurses who had spontaneous abortions and those who had normal pregnancies. however, the study group consisted of nurses who were employed in surgical or medical floors of a general hospital. when the relationship between cd exposure and congenital malformations was explored, the study group was expanded to include oncology nurses, among others, and an odds ratio of 4.7 was found for exposures of more than once per week. this observed odds ratio is statistically significant.

b. selevan et al.89 found a relationship between cd exposure and spontaneous abortion in a case-control study of finnish nurses. this well-designed study reviewed the reproductive histories of 568 women (167 cases) and found a statistically significant odds ratio of 2.3. similar results were obtained in another large case-control study of french nurses,102 and a study of baltimore-area nurses found a significantly higher proportion of adverse pregnancy outcomes when exposure to antineoplastic agents occurred during the pregnancy.85 the nurses involved in these studies usually prepared and administered the drugs. therefore, workplace exposure of these groups of professionals to such products has been associated with adverse reproductive outcomes in several investigations.

2. chromosomal aberrations can result from chemotherapy treatment as well. one study, on chlorambucil, reveals chromosomal damage in recipients to be cumulative and related to both dose and duration of therapy.77 numerous case reports have linked chemotherapeutic treatment to adverse reproductive outcomes.7,88,91,98 testicular and ovarian dysfunction, including permanent sterility, have occurred in male and female patients who have received cd's either singly or in combination.14 in addition, some antineoplastic agents are known or suspected to be transmitted to infants through breast milk.79

and here is that link:

http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#5

i hope that this is at least a little helpful to you. the next thing i can tell you is only a "he said she said" kind of thing because i did the phone call myself.

i talked to the head of nuclear medicine for the idaho state board of pharmacy today, i won't include his name but it's easy enough to find. you should call your states pharm board so you know for yourself, but he told me that there's essentially no way to not get exposed when you're working with chemo, but that the exposure is negligible (even without a gown and gloves) and has no correlation with miscarriage or malformations. he said that in his own hospital, he always offers his pregnant and breastfeeding nurses to transfer out of oncology, but they never do and have been just fine.

i wish i could say yes or no. more, i wish someone could just tell me yes or no. but it's up to us to check the facts and make an informed decision that we're comfortable with.

good luck and let me know if you find out anything else conclusive and reliable.

nurse_runner · May 21, 2010

thank you so much for your response and great info. i too wish someone could tell me yes or no. i don't want to pass up a good job because my worries are just worries. but, i also would never forgive myself if something happened to my child now or any child i have in the future. i will call my states head of nuclear medicine and see what they have to say and compare with the response you received. i have been hanging chemo for a few years now but not mixing it. two years ago i became pregnant and miscarried and now i have a healthy child. i wonder if there could be any correlation to working with chemo or just bad luck. good luck on your decision

Alloush, BSN, MSN · Jun 1, 2010

Salam

it is preferable not to get urself exposed. when any one of my friends r pregnant we ( the males ) usually hang the bags and connect them to the patient's IV set. and then we deaccess them. it is better to stay away from chemo.

JaniceRN1 · Jul 1, 2013

"that being said, my brother who is a pharmacist says he's not worried because pregnant women go through chemo all the time with healthy babies."

I mean no disrespect to your brother, but in my experience pharmacists have always been more laid back than other disciplines in regard to chemotherapy exposure. The ONS recognizes that RNs working with chemotherapeutic agents are at an increased risk of miscarriage and other forms of fetal harm. Also, those women undergoing chemotherapy are receiving a specific drug. Not all chemotherapy is safe to administer to a pregnant woman.

I know this is an old thread, but I am curious. What did you decide and how did it work out?

rebeckah · Jul 2, 2013

@JaniceRN!

No disrespect taken. You make an excellent point. We are all on the same team here, trying to decide what's best for ourselves and our babies.

After carefully considering my options, I decided to stay at my job and miscarried twice while working there. The first time was about a month after I got the job. The second was about a year later.

My guts, deep down inside, tell me that it may have been the chemo mixed with the overall stress of the job (a constant feeling of, "if you screw up, someone could die" you know?). I can't blame the chemo by itself since there are data to show otherwise as well. Even a nurse I worked with both mixed and hung chemo throughout all four of her pregnancies, which resulted in healthy, normal children.

I switched jobs and fields and ended up in malaria research. No contamination hazard, very little stress. We weren't even supposed to be able to get pregnant (had a hsg, turned out my tubes were scarred shut from a total of 3 miscarriages) but we did. It was a perfectly normal pregnancy that resulted in a perfectly normal baby.

It may be worth note that I found out in the hsg that I have a bicornuate uterus, which is associated with a higher rate of miscarriage.

So, that's what I decided and that's how it worked out. So hard to say what caused what, but in the end I wouldn't work oncology again.