What Was Learned

A total of 200 people responded, although results from 5 respondents were excluded as those participants indicated they did not administer systemic chemotherapy. Nearly half of respondents (46%) reported experiencing adverse events during preparation, administration, or postadministration of systemic cytotoxic chemotherapy.


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Participants who identified experiencing an AE (n=90) were most likely to identify headache (n=57), dizziness (n=30), or nausea (n=27) alone or in combination. Participants attributed hair loss (n=18), miscarriage (n=12), and fertility problems (n=7) to exposure. Twenty-six respondents identified “other” AEs.

Although headaches could be attributed to a variety of factors not related to administration of chemotherapy, the experience of nausea and dizziness specifically during administration of these agents suggests these AEs are related to exposure and warrants further investigation.

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Only 44% of respondents reported using closed systems when handling these agents. “[I]t is not clear from this whether these were totally closed systems or not, as closed systems may mean different things to different people owing to the different definitions that are used in practice. This is compounded by the fact that some healthcare providers may use partial closed systems, and some may have totally closed systems,” explained the authors.

“There are also differing practices in the use of these systems; for example, some units may not use them for certain types of [systemic anticancer therapy], such as monoclonal antibodies, while others may not use closed systems for any [systemic anticancer therapy] administration.”

Respondents came from only 55 healthcare centers, which is a very small sample of total centers administering systemic cytotoxic chemotherapy across England. This small sample might not be representative of nationwide trends, although these results encourage larger, more formal research on exposure and the subsequent experience of AEs.