A national survey investigating UK prescribers' opinions on chemotherapy dosing and 'dose-banding'.
OBJECTIVE
The primary purpose of dose-banding for cancer chemotherapy is to reduce patient waiting times, but dose-banding also has additional benefits, such as reduced drug wastage, reduced stress for staff, and prospective quality control of infusions. However, the uptake of dose-banding seems fairly low. Possible reasons for this are a reluctance to use dose-banding for clinical reasons or a lack of awareness. Despite the seemingly minor change from established practice of dose preparation, dose-banding has the potential to alter patient chemotherapy exposure. The aim of this study was to investigate prescribers' awareness of dose-banding and their opinions on the scope and limitations of dose-banding in the context of UK chemotherapy services.


METHODS
This survey was performed throughout the UK by use of a postal questionnaire, which was validated before national distribution to 1104 oncologists and haematologists. The questionnaire contained both quantitative and qualitative elements. A database was created for data entry and analysis.


RESULTS
The response from prescribers was encouraging for a postal questionnaire, with a 35% response rate (387 responses). Many were aware of the concept of dose-banding (>80%) and were also supportive of the system. The weakness around body surface area-based dosing was a commonly discussed topic. However, opinions on which is the maximum acceptable deviation from the prescribed dose with dose-banding were controversial, and there was a concern about the lack of evidence to support the use of dose-banding. The views on whether carboplatin and targeted therapies should be dose-banded were also divided.


CONCLUSIONS
There was general support for dose-banding, but concerns about the lack of an evidence base could be a barrier to the wider introduction of the system. Consequently, more clinical studies are required to justify the safety and efficacy of dose-banding, and also to evaluate whether dose-banding is acceptable within clinical trials.
Kaestner
S A
SA
NHS Plymouth/Plymouth Teaching PCT, Medicines Management Team, Plymouth, UK. s.kaestner@hotmail.co.uk
Sewell
G J
GJ
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage* / Q000627:therapeutic use; D019992:Databases as Topic; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000970:Antineoplastic Agents; D016190:Carboplatin