Anemia and quality of life including anemia-related symptoms in patients with solid tumors in clinical practice.

The aim of this study was to explore in a clinical setting the association between hemoglobin (Hb) level and quality of life (QoL) including anemia-related symptoms in patients with cancer disease. The study was performed in the outpatient units at the Oncology Clinic, Karolinska University Hospital, during spring 2004. One hundred-sixty patients responded to the questionnaires and Hb levels were available in 133 of their medical files. Anemia was not a common problem as only 12 out of 133 patients had an Hb level below 110 g/L. The Hb level was not related to general QoL but to FACT-An Trial Outcome Index (rs = 0.186, p = 0.036), measuring anemia-related symptoms as well as functional and physical well-being. However, two patients with Hb < 110 g/L had minor anemia-related symptoms (FACT AnS > or = 40), while 22 patients with Hb > or = 110 g/L had more pronounced symptoms (FACT AnS < 40). There was no difference in anemia-related symptoms between patients with and without ongoing cancer treatment, but patients with ongoing cancer treatment had decreased physical (p = 0.025) and functional (p = 0.011) well-being as compared to those without ongoing treatment. Patients with lung cancer on cancer treatment had lower FACT-An Trial Outcome Index than patients with breast cancer on treatment (mean values 71.8 and 99.1 for patients with lung and breast cancer, respectively, p = 0.009), and also a tendency to lower Hb levels (mean values 119 and 127 for patients with lung and breast cancer, respectively, p = 0.052). Physical and functional aspects might be more important to consider than increasing the Hb level to reduce the fatigue.

Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden.

Workplaces, e.g. hospital pharmacies and hospital departments, where antineoplastic drugs are handled might be contaminated with these drugs, and pharmacy personnel and health care workers may be exposed. In this study potential sources for exposure of antineoplastic drugs were investigated. Unbroken drug vials and tablet blister packages, both containing cyclophosphamide (CP) and their outer packaging were wipe sampled. Analysis was performed by liquid chromatography combined with tandem mass spectrometry (LC-MS/MS). The result showed that almost every part of the primary packaging was contaminated with CP and ifosfamide (IF). However, the amounts of CP and IF were low, and most likely not harmful for the personnel handling these packaging in association with drug preparation. The contamination must originate from the pharmaceutical manufacturer. Different surfaces in the preparation unit of a Swedish hospital pharmacy were also investigated at two different occasions by wipe sampling. In the preparation unit CP and IF were found as contaminants on the majority of the investigated surfaces. After the first measurement the hospital pharmacy improved its routines. Lower amounts of CP and IF were detected at the second measurement. A low degree of contamination with CP and IF was also detected on the floor outside the preparation unit and this indicated a small distribution of antineoplastic drugs to the surroundings.