Prayers, please

[Bill]

Hi everyone. My wife's awesome chemo. nurse, Ashley, and her husband, Tyler had a house built and moved into it 6 weeks ago. They are a young couple and last week Ashley told me that they were pregnant. (about 2 weeks or so) I had invited them to dinner tomorrow to celebrate, and yesterday, Ashley (nickname "Bubbles", always smiling always humming a happy tune) called me to let me know that they couldn't make it. Ashley had miscarried yesterday and had to undergo surgery today. We talked tonight, she said she's okay, but I'm asking you all for warm thoughts and prayers of comfort for her and her husband. Thanks in advance, Bill

[Lani]

Along with our prayers, let us resolve to bring attention to the following and endeavor to 1) inform others including the janatorial staff who work at facilities where there may be occupational exposure through the skin by those without enough education/ language abilities to know of the hazards and take appropriate precautions 2) make this another reason, among many, to push progress not only in research but in the EARLY ADOPTION of more targetted agents which are less toxic not only to patients but also to personnel caring for them 3) do what is possible in that regard by honoring those lost by redoubling the efforts to establish a registry/"lending library"
of her2+ tumor specimens 4) be certain we are appropriately thankful to those who may be putting their personal, reproductive and children's health at risk in caring for others:


Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists.

Valanis B, Vollmer WM, Steele P.
Kaiser Permanente Center for Health Research, Portland, OR 97227, USA.
Insult to the germ cells of an ovum or sperm prior to pregnancy as well as exposures to a fetus during pregnancy can affect the outcome of a pregnancy. Antineoplastic agents are mutagenic and teratogenic, so the potential effects of exposure on reproduction are of concern to the workers who handle them. This study investigates pregnancy loss associated with occupational exposures to antineoplastic drugs by comparing rates of spontaneous abortion and stillbirths for pregnancies without antineoplastic exposure and exposed pregnancies in which the pregnant woman or the father handled antineoplastic agents either before or during the pregnancy. A total of 7094 pregnancies of 2976 pharmacy and nursing staff were examined. After age during pregnancy, prior gravidity, maternal smoking during the pregnancy, and occurrence of a spontaneous abortion or stillbirth in a prior pregnancy were controlled for, exposure of the mother to or the handling of antineoplastic agents during the pregnancy was associated with a significantly increased risk of spontaneous abortion (odds ratio = 1.5; 95% confidence interval, 1.2 to 1.8) and combined risk of spontaneous abortion and stillbirth (odds ratio = 1.4; 95% confidence interval, 1.2 to 1.7) but not stillbirth alone. Among the wives of exposed men, too few stillbirths occurred to allow analysis. However, for spontaneous abortion and any loss, the patterns of increased risk were similar to those seen for women, although the odds ratios were not statistically significant.
PMID: 10457505 [PubMed - indexed for MEDLINE]



A study of occupational exposure to antineoplastic drugs and fetal loss in nurses.
[N Engl J Med. 1985]
Association of petrochemical exposure with spontaneous abortion.
[Occup Environ Med. 1998]
Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists.
[J Occup Environ Med. 1997]
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.
[J Oncol Pharm Pract. 2005]
Occupational paternal exposure to benzene and risk of spontaneous abortion.
[Occup Environ Med. 1994]

Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes.

Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D.
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. w.fransman@iras.uu.nl
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.
PMID: 17099323 [PubMed - indexed for MEDLINE]




Fransman W.




[Cytostatics: occupational exposure and health risks]
Tijdschr Diergeneeskd. 2007 Mar 1;132(5):168-71. Dutch. No abstract available.
PMID: 17378488 [PubMed - indexed for MEDLINE]
2:
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Fransman W, Peelen S, Hilhorst S, Roeleveld N, Heederik D, Kromhout H.




A pooled analysis to study trends in exposure to antineoplastic drugs among nurses.
Ann Occup Hyg. 2007 Apr;51(3):231-9. Epub 2007 Mar 2.
PMID: 17337460 [PubMed - indexed for MEDLINE]
3:
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Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D.




Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes.
Epidemiology. 2007 Jan;18(1):112-9.
PMID: 17099323 [PubMed - indexed for MEDLINE]
4:
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Fransman W, Huizer D, Tuerk J, Kromhout H.




Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility.
Int Arch Occup Environ Health. 2007 Apr;80(5):396-403. Epub 2006 Oct 5.
PMID: 17021843 [PubMed - indexed for MEDLINE]
5:
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Meijster T, Fransman W, Veldhof R, Kromhout H.




Exposure to antineoplastic drugs outside the hospital environment.
Ann Occup Hyg. 2006 Oct;50(7):657-64. Epub 2006 May 5.
PMID: 16679337 [PubMed - indexed for MEDLINE]
6:
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Meijster T, Fransman W, van Hemmen J, Kromhout H, Heederik D, Tielemans E.




A probabilistic assessment of the impact of interventions on oncology nurses' exposure to antineoplastic agents.
Occup Environ Med. 2006 Aug;63(8):530-7. Epub 2006 Mar 21.
PMID: 16551759 [PubMed - indexed for MEDLINE]
7:
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van Wendel de Joode B, Vermeulen R, van Hemmen JJ, Fransman W, Kromhout H.




Accuracy of a semiquantitative method for Dermal Exposure Assessment (DREAM).
Occup Environ Med. 2005 Sep;62(9):623-32.
PMID: 16109819 [PubMed - indexed for MEDLINE]
8:
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Fransman W, Vermeulen R, Kromhout H.




Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities.
Int Arch Occup Environ Health. 2005 Jun;78(5):403-12. Epub 2005 May 11.
PMID: 15887018 [PubMed - indexed for MEDLINE]
9:
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Rajan-Sithamparanadarajah R, Roff M, Delgado P, Eriksson K, Fransman W, Gijsbers JH, Hughson G, Mäkinen M, van Hemmen JJ.




Patterns of dermal exposure to hazardous substances in European union workplaces.
Ann Occup Hyg. 2004 Apr;48(3):285-97.
PMID: 15059805 [PubMed - indexed for MEDLINE]
10:
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Fransman W, Vermeulen R, Kromhout H.




Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study.
Ann Occup Hyg. 2004 Apr;48(3):237-44. Epub 2004 Mar 2.
PMID: 15059800 [PubMed - indexed for MEDLINE]

Hemminki K, Kyyrönen P, Lindbohm ML.




Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome.
J Epidemiol Community Health. 1985 Jun;39(2):141-7.
PMID: 3925060 [PubMed - indexed for MEDLINE]
9:
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Magnusson LL, Bodin L, Wennborg H.




Adverse pregnancy outcomes in offspring of fathers working in biomedical research laboratories.
Am J Ind Med. 2006 Jun;49(6):468-73.
PMID: 16691607 [PubMed - indexed for MEDLINE]
10:
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Kersemaekers WM, Roeleveld N, Zielhuis GA.







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.
J Oncol Pharm Pract. 2005 Jun;11(2):69-78. Review.
PMID: 16465719 [PubMed - indexed for MEDLINE]
12:
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Krstev S, Perunicić B, Vidaković A.




Work practice and some adverse health effects in nurses handling antineoplastic drugs.
Med Lav. 2003 Sep-Oct;94(5):432-9.
PMID: 14619181 [PubMed - indexed for MEDLINE]

14:
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Valanis B, Vollmer W, Labuhn K, Glass A.




Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists.
J Occup Environ Med. 1997 Jun;39(6):574-80.
PMID: 9211216 [PubMed - indexed for MEDLINE]
15:
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Fransman W, Peelen S, Hilhorst S, Roeleveld N, Heederik D, Kromhout H.




A pooled analysis to study trends in exposure to antineoplastic drugs among nurses.
Ann Occup Hyg. 2007 Apr;51(3):231-9. Epub 2007 Mar 2.
PMID: 17337460 [PubMed - indexed for MEDLINE]

17:
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Shortridge LA, Lemasters GK, Valanis B, Hertzberg V.




Menstrual cycles in nurses handling antineoplastic drugs.
Cancer Nurs. 1995 Dec;18(6):439-44.
PMID: 8564939 [PubMed - indexed for MEDLINE]
18:
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Xu SJ, Wang JX, Yang DP.




[An investigation on the chromosomal damage in nurses occupationally exposed to antineoplastic drugs]
Zhonghua Yu Fang Yi Xue Za Zhi. 2003 Mar;37(2):119-20. Chinese.
PMID: 12839665 [PubMed - indexed for MEDLINE]
19:
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Meijster T, Fransman W, van Hemmen J, Kromhout H, Heederik D, Tielemans E.




A probabilistic assessment of the impact of interventions on oncology nurses' exposure to antineoplastic agents.
Occup Environ Med. 2006 Aug;63(8):530-7. Epub 2006 Mar 21.
PMID: 16551759 [PubMed - indexed for MEDLINE]
20:
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Medková J.




Analysis of the health condition of the children born to the personnel exposed to cytostatics at an oncology unit.
Acta Univ Palacki Olomuc Fac Med. 1991;130:323-32.
PMID: 1838884 [PubMed - indexed for MEDLINE]

[tousled1]

Bill,

I will keep Ashley (Bubbles) in my prayers.

[Faith in Him]

I'm praying for Ashley and her husband during this difficult time. May God comfort them and bring them peace.

[Donna]

...for prayers. Bummer

Donna

[Mary Jo]

Dear Bill,

Prayers said for Ashley and her husband during this difficult, difficult time in the life. May God hold them close and give them some sort of peace as they greive their loss.

I'm so sorry this has happened to them. It's so very sad,

Mary Jo

[R.B.]

In my prayers and thoughts too.

Gosh Lani this is a subject you have been looking at in depth. You have been busy.

Thank you for highlighting the impact on those who have to administer these agents as well as those with fertility concerns who receive them.

RB

[Jackie07]

Ditto.

Everyone has said it so well. Thank you.

[Jean]

Hi Bill,

Very sad news - it is such a loss to a young new Mom to experience.
Also for her husband, so much concern and attention goes to the expecting Mom many forget the Dad has a major loss also.

Give her a big hug and please let her know how we are all praying for her.

Kind Regards,
jean

[charlotte]

I would also like to add my name to this list of folks praying for Ashley..

[Bill]

Good point, Jean. Thanks, I'll do just that. And thanks to everyone for your thoughts and prayers. Love, Bill

[Joan M]

Bill, Ashley and her husband are in my prayers during this difficult time. Joan

[Joanne S]

My heart goes out to your friends during this difficult time. You are a caring friend.

Jo

[kcherub]

Bill,

I tried to post the other day, but my computer locked up. I will say a big prayer for them! If they lean on each other, they will get through this! We had two ectopic pregnancies (one before our son was born and one after), and it was horrific and heartbreaking.

I hope that they go on to have lots of happy and healthy babies. I never would have wanted to hear that another pregnancy would lessen the pain, but it did. Don't tell them this, as it will seem insensitive at this stage, but once I was pregnant with my son, I had to be happy and hopeful, and it left little room for grief. I still think of both my losses very often, but with a wistful attitude now.

They can get through this with time, love, and prayers.

Take care,

[Bill]

Hi everyone, thanks for all of your thoughts and prayers for Ashley and Tyler. I saw Ashley today at the center, and she looked good and sounded good too. She said Tyler is good too. I know all of your prayers and well-wishes helped. Krista, my heart goes out to you, too, but I'm glad that you have found some peace and perspective. You have given good advice, as you all do. When the time is right, I'm sure that subject will come up. Thanks again for all the help. Love, Bill