Practices On Safe-Handling of Cytotoxic Drugs Among Oncology Nurses in Two Public Sector Hospitals

Safe-Handling of Cytotoxic Drugs Among Oncology Nurses


  • Naila Khalid Lahore School of Nursing, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
  • Sarfraz Masih Lahore School of Nursing, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
  • Muhammad Afzal Lahore School of Nursing, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan



Practices, Nurses, Safe Handling, Cytotoxic Drugs


Administration of cytotoxic medicines (CDs) and occupational exposure to them are global issues. Inappropriate handling can lead to harmful residues getting into patient care areas, hospitals, and even the homes of patients. Objectives: To access the practices of nurses regarding safe handling of cytotoxic drugs and to evaluate the association among the level of practices and socio-demographic profile of the participants. Methods: Analytical cross-sectional study was carried out among 183 nurses of oncology department of public sector tertiary care hospitals, Lahore, Pakistan. The nurses working in oncology departments of age ranges 20 years to 50 years and having at least six months’ experience in oncology units were included in the study. Results: The majority (56%) of the nurses reported “Good Practices” regarding safe handling of cytotoxic drugs followed by Fair practices (38%) and poor practices (6%). No significant association was reported among the level of practices and socio-demographic profile of the participants. Conclusions: Safe handling of cytotoxic drugs is very important aspect and the nurses can prevent their selves as well as the patients from complications. Overall, good practices were reported by the nurses regarding safe handling of cytotoxic drugs but still a large proportion of the nurses have fair and poor practices. Effective measures are needed to enhance the practices of nurse’s working in oncology nurses regarding safe handling of cytotoxic drugs


Asefa S, Aga F, Dinegde NG, Demie TG. Knowledge and practices on the safe handling of cytotoxic drugs among oncology nurses working at tertiary teaching hospitals in Addis Ababa, Ethiopia. Drug, Healthcare and Patient Safety. 2021 Mar; 13: 71-80. doi: 10.2147/DHPS.S289025.

Shamsi A, Azizzadeh Forouzi M, Iranmanesh S. Psychosocial risks among parents of children with cancer. Journal of Pediatric Nursing. 2016 Apr; 2(3): 44-55.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer Journal of Clinicians. 2020 Jan; 70(1): 7-30. doi: 10.3322/caac.21590.

Mirzadeh M, Mirzaei M, ShogaeiFar H. Years of life lost and childhood and adolescent cancer mortality in Yazd Province, Iran (2004-2009). Iranian Journal of Pediatric Hematology and Oncology. 2015 Jul; 5(3): 125-30.

Sattar S, Alibhai SM, Fitch M, Krzyzanowska M, Leighl N, Puts MT. Chemotherapy and radiation treatment decision-making experiences of older adults with cancer: a qualitative study. Journal of Geriatric Oncology. 2018 Jan; 9(1): 47-52. doi: 10.1016/j.jgo.2017.07.013.

Huang CY, Ju DT, Chang CF, Muralidhar Reddy P, Velmurugan BK. A review on the effects of current chemotherapy drugs and natural agents in treating non-small cell lung cancer. Biomedicine 2017 Dec; 7: 12-23. doi: 10.1051/bmdcn/2017070423.

Shirangi A, Bower C, Holman CDJ, Preen DB, Bruce N. A study of handling cytotoxic drugs and risk of birth defects in offspring of female veterinarians. International Journal of Environmental Research and Public Health 2014 Jun; 11(6): 6216-30. doi: 10.3390/ijerph110606216.

Falzone L, Salomone S, Libra M. Evolution of Cancer Pharmacological Treatments at the Turn of the Third Millennium. Frontiers in Pharmacology. 2018 Nov; 9: 1300. doi:10.3389/fphar.2018.01300.

Roe H and Lennan E. Role of nurses in the assessment and management of chemotherapy-related side effects in cancer patients. Nursing: Research and Reviews. 2014 Aug; 4: 103-15. doi: 10.2147/NRR.S41845.

Gallegos R, Kogelman A, Wagner M, Cloud A, Olson M, Robideau K, et al. Chemotherapy Education: An interprofessional approach to standardizing processes and improving nurse and patient satisfaction. Clinical Journal of Oncology Nursing. 2019 Jun; 23(3): 309-14. doi: 10.1188/19.CJON.309-314.

Sasaki M, Ishii N, Kikuchi Y, Kudoh Y, Sugiyama R, Hasebe M. Occupational exposures among nurses caring for chemotherapy patients-Quantitative analysis of cyclophosphamide and α-fluoro-β-alanine in urine. Sangyo Eiseigaku Zasshi= Journal of Occupational Health. 2016 Aug; 58(5): 164-72. doi: 10.1539/sangyoeisei.2016-005-E.

Simegn W, Dagnew B, Dagne H. Knowledge and associated factors towards cytotoxic drug handling among University of Gondar Comprehensive Specialized Hospital health professionals, institutional-based cross-sectional study. Environmental health and preventive medicine. 2020 Dec; 25(1): 1-8. doi: 10.1186/s12199-020-00850-z.

Komatsu H, Yagasaki K, Yoshimura K. Current nursing practice for patients on oral chemotherapy: A multicenter survey in Japan. BMC Research Notes. 2014 Dec; 7(1): 1-8. doi: 10.1186/1756-0500-7-259.

Boiano JM, Steege AL, Sweeney MH. Adherence to precautionary guidelines for compounding antineoplastic drugs: a survey of nurses and pharmacy practitioners. Journal of occupational and environmental hygiene. 2015 Sep; 12(9): 588-602. doi: 10.1080/15459624.2015.1029610.

Young AM, Charalambous A, Owen RI, Njodzeka B, Oldenmenger WH, Alqudimat MR, et al. Essential oncology nursing care along the cancer continuum. The Lancet Oncology. 2020 Dec; 21(12): e555-63. doi: 10.1016/S1470-2045(20)30612-4.

Sa B, Aa H, Sa EN, Mf Z. Role of occupational health and safety program in improving knowledge and practice among nurses exposed to chemotherapy at Zagazig university hospitals. Egyptian Journal of Occupational Medicine. 2016 Jul; 40(2): 219-35.doi: 10.21608/ejom.2016.842.

Sharour LA. Oncology nurses’ knowledge about exploring chemotherapy related-Extravasation care: A cross-sectional study. Clinical Epidemiology and Global Health. 2020 Sep; 8(3): 780-4. doi: 10.1016/j.cegh.2020.01.019.

Khan N, Khowaja KZ, Ali TS. Assessment of knowledge, skill and attitude of oncology nurses in chemotherapy administration in tertiary hospital Pakistan. Open journal of nursing. 2012 Jun; 2(2): 97. doi: 10.4236/ojn.2012.22015.

Folami FF and Onanuga KA. Perception of spirituality, spiritual care, and barriers to the provision of spiritual care among undergraduate nurses in the University of Lagos, Nigeria. Journal of Clinical Sciences. 2018 Jan; 15(1): 8-12. doi: 10.4103/jcls.jcls_66_17.

Easty AC, Coakley N, Cheng R, Cividino M, Savage P, Tozer R, et al. Safe handling of cytotoxics: guideline recommendations. Current Oncology. 2015 Feb; 22(1): 27-37. doi: 10.3747/co.21.2151.

Eedes DJ, Bailey B, Burger H. Chemotherapy administration standards and guidelines: the development of a resource document. SA Journal of Oncology. 2018 May; 2(1): 1-6. doi: 10.4102/sajo.v2i0.48.

Chaudhary R and Karn BK. Chemotherapy-Knowledge and Handling Practice of Nurses Working in a Medical University of Nepal. Scientific Research. 2012 Jan; 3(1): 17232. doi: 10.4236/jct.2012.31014.

Habiba AI, Eldin YK, Ibrahem EM. Oncology nurses’ knowledge and practices regarding handling hazardous drugs: developing procedure manual for safe handling of hazardous drugs. IOSR Journal of nursing and Health Science. 2018 Mar; 7(2):1-11. doi: 10.9790/1959-0702030111.

Hosen MS, Hasan M, Saiful Islam M, Raseduzzaman MM, Tanvirul Islam M, Tazbiul Islam M. Evaluation of knowledge and practice of handling chemotherapy agents by nurses: a multi-centre studies in Bangladesh. International Journal of Community Medicine and Public Health. 2019 Oct; 6(10): 4175-80. doi: 10.18203/2394-6040.ijcmph20194471.

Choudhary VS. Assessment of the Knowledge and Attitudes of Staff Nurses on Nursing Care of Cancer Patients Undergoing Chemotherapy at Selected Cancer Hospitals of Punjab. Nurse Care Open Access Journal. 2016 Nov; 1(2): 18-24. doi: 10.15406/ncoaj.2016.01.00009.

Alehashem M and Baniasadi S. Safe handling of anti-neoplastic drugs in the university hospitals: a descriptive survey study among oncology nurses. International Journal of Cancer Management. 2018 Feb; 11(2): e6482. doi: 10.5812/ijcm.6482.

Mamdouh Zakaria M, Mohamed Alaa S, Mohamed Desoky G. Oncology Nurses' Knowledge and Practices regarding Safe Administration of Intravenous Chemotherapy. Egyptian Journal of Health Care. 2022 Mar; 13(1): 1218-31. doi: 10.21608/ejhc.2022.225111.

Zayed HA, Saied SM, El-Sallamy RM, Shehata WM. Knowledge, attitudes and practices of safe handling of cytotoxic drugs among oncology nurses in tanta university hospitals. Egyptian Journal of Occupational Medicine. 2019 Jan; 43(1): 75-92. doi: 10.21608/ejom.2019.25119.

Turk M, Davas A, Çiçeklioglu M, Saçaklioglu F, Mercan T. Knowledge, attitude and safe behavior of nurses handling cytotoxic anticancer drugs in Ege University Hospital. Asian Pacific Journal of Cancer Prevention. 2004 Apr; 5(2): 164-8.

Rai DK, Lama S, Badu A, Mandal GN. Impact of educational intervention on knowledge regarding safe handling of cytotoxic drugs among the nursing personnel working in BPKIHS. Health Renaissance. 2015 Jan; 13(1): 13-22. doi: 10.3126/hren.v13i1.17943.

Jang KI, Yoo YS, Roh YS. Development and effectiveness of an oncology nursing standardized patient simulation program for nursing students. Korean Journal of Adult Nursing. 2019 Dec; 31(6): 595-604. doi: 10.7475/kjan.2019.31.6.595.

Mitema A, Maree L, Young A. Cancer treatment in Africa: the importance of the role of nursing. Ecancermedicalscience. 2019 Jul; 13: 944. doi: 10.3332/ecancer.2019.944.

Kumari D and Taksande V. Assess the practice regarding safety measures used by nurses while handling Chemotherapy drugs. International Journal of Advances in Nursing Management. 2016 Dec; 4(4): 349-54. doi: 10.5958/2454-2652.2016.00078.0



DOI: 10.54393/pjhs.v3i07.449
Published: 2022-12-31

How to Cite

Khalid, N., Masih, S. ., & Afzal, M. . (2022). Practices On Safe-Handling of Cytotoxic Drugs Among Oncology Nurses in Two Public Sector Hospitals: Safe-Handling of Cytotoxic Drugs Among Oncology Nurses. Pakistan Journal of Health Sciences, 3(07), 131–136.



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