What Is ONS’s Stance on Handling Chemotherapy While Pregnant, Breastfeeding, or Trying to Conceive?

One of the questions that ONS commonly receives in the clinical inbox (clinical@ons.org) is whether nurses who are pregnant, breastfeeding, or trying to conceive can safely administer or handle chemotherapy and other hazardous drugs. Because one of ONS’s strategic plan goals relates to patient and staff safety, we’ve aligned with organizations such as the National Institute for Occupational Safety and Health (NIOSH) and the American Society of Health-System Pharmacists (ASHP) in producing a position statement (ONS, 2016) and publication (Polovich, 2011) focusing on safe handling.

ONS Perspective

Handling antineoplastics may result in reproductive risk, including structural defects in a fetus because of occupational exposure during pregnancy; adverse reproductive outcomes, including fetal loss, miscarriage, or spontaneous abortions; infertility; and preterm births and learning disabilities in offspring of nurses exposed during pregnancy. Although consistent and thorough use of primary engineering controls and personal protective equipment when handling hazardous drugs minimizes risk of occupational exposure, it does not eliminate it (Polovich, 2011). Because of the increased susceptibility for harm, an added level of protection is needed for nurses who are pregnant, breastfeeding, or actively trying to conceive.

Because of the increased susceptibility for harm, an added level of protection is needed
for nurses who are pregnant, breastfeeding, or actively trying to conceive.

Male and female healthcare workers who handle chemotherapy, biotherapy, and other hazardous drugs are accountable to notify their employers about such situations or if they have other medical reasons to avoid exposure. Upon notification, employers should provide alternate duty that does not include the preparation or administration of hazardous drugs. Collaboration with the employee’s primary care and obstetrician/gynecologist should be part of the decision-making process (ASHP, 2006; Polovich, Olsen, & LeFebvre, 2014).

We often hear of concern with non-nursing personnel
such as ancillary staff. It is important to note that much of
the reproductive risk research has been done on healthcare personnel who prepare and/or administer chemotherapy. Although the risk of exposure appears to be lower with clinical activities not directly related to preparation and administration, risk still exists.

Ultimately, the responsibility lies with healthcare workers to inform their employer of their health condition and desire to perform alternate duties that do not involve handling hazardous drugs.

Do you have questions related to the clinical care of patients with cancer? Email clinical@ons.org to reach one of our clinical nurses on staff directly.

American Society of Health-System Pharmacists. (2006). ASHP guidelines on handling hazardous drugs. American Journal Health- System Pharmacy, 63, 1172–1193. Retrieved from http://www.ashp .org/DocLibrary/BestPractices/PrepGdlHazDrugs.aspx

ONS. (2016). Ensuring healthcare worker safety when handling hazardous drugs [position statement]. Retrieved from https://www .ons.org/advocacy-policy/positions/practice/hazardous-drugs

Polovich, M. (2011). Safe handling of hazardous drugs (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.

Polovich, M., Olsen, M., & LeFebvre, K.B. (2014). ONS chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society.

Copyright © 2023 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints.