Knowledge, Attitude, and Practice of Nurses About Handling AntiNeoplastic Drugs at Hiwa Hospital in Sulaimaniyah, Iraq


  • Barzan Hassan Hussain Hiwa Hematology/Oncology Hospital, Ministry of Health, Sulaimani, Kurdistan Region, Iraq. & Department of Pediatric Nursing, College of Nursing, University of Sulaimani, Kurdistan Region, Iraq. Author
  • Awayi Ghazy Abdulkareem Department of Pediatric Nursing, College of Nursing, University of Sulaimani, Kurdistan Region, Iraq. Author



Handling anti-neoplastic drugs, knowledge, attitude, practices, nurses, cancer


Background: Anti-neoplastic drugs (ANDs) are a medical therapy utilized to fight cancer. Due to the possible health risks, safe handling and occupational exposure to anti-neoplastic agents have become significant concerns for oncology nursing staff.


Objective: To assess the knowledge, attitude, and practice of nurses in handling ANDs at Hiwa Hematology/Oncology Hospital in Sulaimaniyah, Iraq.


Materials and Methods: A quantitative-descriptive cross-sectional design was carried out on 91 nurses working in Hiwa Hematology/Oncology Hospital from March to June 2022. A questionnaire was designed and constructed by the researcher.


Results: The findings of this study showed that the higher percentages level of nurses' knowledge, attitude, and practice was 39.6%, 49.5%, and 51.6%, respectively, which indicated that the majority of participants in that hospital had a fair level of knowledge, attitude, and practice. A significant assertion was found between nurses' level of knowledge, attitude, and practice toward handling ANDs with age, employment status, years of experience in handling ANDs, receiving formal training, number of working hours per week, and exposure to an ANDs side effect. In addition, a highly significant association between nurses' level of knowledge, attitude, and practice toward handling ANDs (p=0.000) were found.


Conclusion: We concluded that most of the sample had fair knowledge, attitude, and practice about handling ANDs, with a highly significant association.


American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019. p:1. Available at cancer-factsfigures-2019.

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. DOI:

Orujlu, S., Habibzadeh, H., Zare, M. J., & Hajaghazadeh, M. (2016). Knowledge, Attitude, and Performance of Oncology Nurses Handling Antineoplastic Drugs in Hospitals of Urmia University, Iran. International Journal of Occupational Hygiene, 14–21.

CDC, Centers for Disease Control. Anti-neoplastic (Chemotherapy) Drugs–Reproductive Health. Available online: (accessed on 25th January 2022).

Graeve, C. U., McGovern, P. M., Alexander, B., Church, T., Ryan, A., & Polovich, M. (2017). Occupational Exposure to Antineoplastic Agents. Workplace Health and Safety, 65(1), 9–20. DOI:

Casciato, D.A., Territo, M.C. (2012). Manual of Clinical Oncology. Philadephia, PA. Lippincott, Williams & Wilkins.

Sadiq, Hiwa Sdiq. (2021). effectiveness of an educational health program on pediatric nurses’ knowledge and practice regarding chemotherapy administration at Hiwa cancer hospital in Sulaimani City-Iraq. JSMCVol.11.No.3-2021 (1st ed.). DOI:

Bolbol SA, Hassan AA, E.-N. S. and Z. M. (2016). 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, 40(2), 219–235. DOI:

Meade, E. (2014). Avoiding accidental exposure to intravenous cytotoxic drugs. British Journal of Nursing, 23(16), 2010–2015. DOI:

Friese, C. R., McArdle, C., Zhao, T., Sun, D., Spasojevic, I., Polovich, M., & McCullagh, M. C. (2015). Antineoplastic drug exposure in an ambulatory setting: A pilot study. Cancer Nursing, 38(2), 111–117. DOI:

Keat, C. H., Sooaid, N. S., Yun, C. Y., & Sriraman, M. (2013). Improving safety-related knowledge, attitude, and practices of nurses handling cytotoxic anticancer drug: Pharmacists’experience in a general hospital, Malaysia. Asian Pacific Journal of Cancer Prevention, 14(1), 69–73. DOI:

Lawson CC, Rocheleau CM, Whelan EA, et al. Occupational exposures among nurses and risk of spontaneous abortion. American Journal of Obstetrics and Gynecology. 2012;206. 327.e321-327. DOI:

Friese, C. R., Himes-Ferris, L., Frasier, M. N., McCullagh, M. C., & Griggs, J. J. (2012). Structures and care processes in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Quality and Safety, 21(9), 753–759. DOI:

Polovich, M., & Clark, P. C. (2012). Factors influencing oncology nurses’ use of hazardous drug safe-handling precautions. Oncology Nursing Forum. 39 (3), 299-309. Available at DOI:

Mahdy, N. E., Rahman, A. A. R. A., & Hassan, H. A. (2017). Cytotoxic Drugs Safety Guidelines: Its Effect on Awareness and Safe Handling Practices of Oncology Nurses. IOSR Journal of Nursing and Health Science, 06(03), 22–33. DOI:

Abbasi, K., Hazrati, M., Mohammadbeigi, A., Ansari, J., Sajadi, M., Hosseinnazzhad, A., & Moshiri, E. (2016). Protection behaviors for cytotoxic drugs in oncology nurses of chemotherapy centers in Shiraz hospitals, South of Iran. Indian Journal of Medical and Paediatric Oncology, 37(4), 227–231. DOI:

Dal Bello, F., Santoro, V., Scarpino, V., Martano, C., Aigotti, R., Chiappa, A., Davoli, E., & Medana, C. (2016). Anti-neoplastic drug determination by HPLC-HRMSn to monitor occupational exposure. Drug Testing and Analysis, 8(7), 730–737. DOI:

Al-Azzam, S. I., Awawdeh, B. T., Alzoubi, K. H., Khader, Y. S., & Alkafajei, A. M. (2015). Compliance with safe handling guidelines of anti-neoplastic drugs in Jordanian hospitals. Journal of Oncology Pharmacy Practice, 21(1), 3–9. DOI:

Al-Attar, W. M. A., Hassain, A., & Al-Gannem, M. (2015). Effectiveness of the nursing educational program upon nurses' knowledge and practices concerning chemotherapy precautions. IOSR Journal of Nursing and Health Science, 4(6), 2320–1940.

Boiano, J. M., Steege, A. L., & Sweeney, M. H. (2014). Adherence to safe handling guidelines by health care workers who administer anti-neoplastic drugs. Journal of Occupational and Environmental Hygiene, 11(11), 728–740. DOI:

Zhang, X., Zheng, Q., Lv, Y., An, M., Zhang, Y., Wei, Y., & Feng, W. (2016). Evaluation of adverse health risks associated with anti-neoplastic drug exposure in nurses at two Chinese hospitals: The effects of implementing a pharmacy intravenous admixture service. American Journal of Industrial Medicine, 59(4), 264–273. DOI:

Ivanova, K., & Avota, M. (2016). Anti-neoplastic Drugs: Occupational Exposure and Side Effects. Proceedings of the Latvian Academy of Sciences, Section B: Natural, Exact, and Applied Sciences, 70(5), 325–329. DOI:

Ramazani, M., Jaktaji, R. P., Shirazi, F. H., Tavakoli-ardakani, M., & Salimi, A. (2019). Analysis of apoptosisrelated genes in nurses exposed to anti-neoplastic drugs. 0, 1–9. DOI:

Preksha, S., & Shaminder, K. (2019). A study assesses the practices regarding safe handling of chemo Drugs among nursing personnel. International Journal of Current Research, 2(1), 6821–6827.

Sylvia E. Nwagbo, R. E. I., & , Beatrice M. Ohaeri1, A. O. O. (2017). Knowledge of chemotherapy and occupational safety measures among nurses in oncology units. Journal of Clinical Sciences, 14(1), 119–125.

Rizalar, S., Tural, E., & Altay, B. (2012). Nurses’ protective measures during chemotherapy preparation and administration in Turkey. International Journal of Nursing Practice, 18(1), 91–98. DOI:

Chaudhary, R., & Karn, B. K. (2012). Chemotherapy-Knowledge and Handling Practice of Nurses Working in a Medical University of Nepal. Journal of Cancer. DOI:

Gamal, G. A., Gamal, L. M., Eldessouki, K. H. M., & Abozied, A. M. (2019). Chemotherapy Health Hazards among Oncology Nurses and its Possible Relation to Malpractice and Workplace Environment. Evidence-Based Nursing Research, 1(3), 10. DOI:

Ibrahim, N., Al Mutairi, M., & Al Onazi, M. (2019). Assessment of Oral Chemotherapeutic Agents Safe Handling Among Healthcare Professionals in Saudi Arabia. Global Journal of Medical Therapeutics, 1(2), 14–19. DOI:

Chen, H. C., Lu, Z. Y. J., & Lee, S. H. (2016). Nurses' experiences in safely handling chemotherapeutic agents: The Taiwan case. Cancer Nursing, 39(5), E29–E38. DOI:

Sheikh, Y. A. (2016). knowledge and practice on safe handling of cytotoxic drugs among health care workers at Kenyatta national hospital. Dissertation.

Simegn, W., Dagnew, B., & Dagne, H. (2020). An institutional-based cross-sectional study is based on knowledge and associated factors towards cytotoxic drug handling among University of Gondar Comprehensive Specialized Hospital health professionals. Environmental Health and Preventive Medicine, 25(1), 1–8. DOI:

Constantinidis, T. C., Vagka, E., Dallidou, P., Basta, P., Drakopoulos, V., Kakolyris, S., & Chatzaki, E. (2011). Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals. European Journal of Cancer Care, 20(1), 123–131. DOI:

Borges, G. G., Silvino, Z. R., & Dos Santos, L. C. G. (2015). Proposal for best practice guidelines on chemical exposure risk for nurses of a chemotherapy unit. Revista de Pesquisa Cuidado é Fundamental Online, 7(4), 3506–3515. DOI:

Hanafi, S., Torkamandi, H., Bagheri, S., Tavakoli, M., Hadavand, N., & Javadi, M. (2015). Safe Handling of Cytotoxic Drugs and Risks of Occupational Exposure to Nursing Staffs. Journal of Pharmaceutical Care, 3(2), 11–15.

Gómez-Oliván, L. M., Miranda-Mendoza, G. D., Cabrera-Galeana, P. A., Galar-Martínez, M., Islas-Flores, H., Sanjuan-Reyes, N., Neri-Cruz, N., & García-Medina, S. (2014). Oxidative stress induced in nurses by exposure to preparation and handling of antineoplastic drugs in Mexican hospitals: A multicentric study. Oxidative Medicine and Cellular Longevity, 2014. DOI:

Kaur, R. (2017). Knowledge about Safety Measures for Handling Chemotherapeutic Agents among Staff Nurses in a Tertiary Care Teaching Hospital. AMEI's Current Trends in Diagnosis & Treatment, 1(2), 76–79. DOI:

Hosen, M. S., Hasan, M., Saiful Islam, M., Raseduzzaman, M. M., Tanvirul Islam, M., Tazbiul Islam, M., Motaher Hossain, M., Nafiujjaman, M., Nishat, T. R., & Jahidul Hasan, M. (2019). Evaluation of knowledge and practice of handling chemotherapy agents by nurses: a multi-center studies in Bangladesh. International Journal of Community Medicine and Public Health, 6(10), 4175. DOI:

Esmail D.H, Qadir C.S, Mahmood E.K, Osman G.a, Omer Y.B (2016). Safe Handling Knowledge and Practices of Chemotherapy among Oncology Nurses in Erbil City, Kufa Journal for Nursing Sciences, Vol.6 No. 1. DOI:

Crannell, C. (2012). Chemotherapy administration: Using simulation case-based scenarios to assess chemotherapy competency. Oncology Nursing Forum, 39(1), 19–22. DOI:

Zayed, H., Saied, S., El-Sallamy, R., & Shehata, W. (2019). Knowledge, Attitudes, and Practices of Safe Handling of Cytotoxic Drugs Among Oncology Nurses in Tanta University Hospitals. Egyptian Journal of Occupational Medicine, 43(1), 75–92. DOI:

Ali, F. B., 2, Shireen Arif, 3, & Pesnani, F. (2015). Association of Knowledge on the Attitude and Practice of Registered Nurses Regarding Handling of Cytotoxic Drugs in a Tertiary Care Hospital in. International Journal of Novel Research in Healthcare and Nursing, 2(3), 73–76.



How to Cite

Knowledge, Attitude, and Practice of Nurses About Handling AntiNeoplastic Drugs at Hiwa Hospital in Sulaimaniyah, Iraq. (2023). Journal of Zankoy Sulaimani - Part A, 25(1), 14.

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