Description of current practices of empiric chemotherapy dose adjustment in obese adult patients.
OBJECTIVE
The literature is not clear on the best method to empirically dose chemotherapy in obese adult patients. The purpose of our study was to determine whether a standard of practice existed, characterize current practices of empiric dose adjustment (EDA) in obese adult patients, and identify factors affecting this decision.


METHODS
An electronic survey was distributed to oncologists and board-certified oncology pharmacists via the Association of Community Cancer Centers and Board of Pharmaceutical Specialties e-mail distribution lists. The survey contained patient scenarios assessing the impact of various factors on EDA of chemotherapy, demographic information, and details of institutional policies.


RESULTS
Responses were collected from 174 professionals. Pharmacists comprised 95% of respondents. Of these, 50% practiced in academic medical centers, and 19% practiced in institutions with a standard of practice regarding EDA for obesity. The most common methods of EDA were use of an adjusted body weight in the body-surface area (BSA) equation and capping BSA. Factors with the most impact on EDA were curative intent, degree of obesity, type of chemotherapy, and performance status.


CONCLUSIONS
There is no standard of practice regarding EDA of chemotherapy in obese adult patients. Although many factors affect this decision, intent of treatment, degree of obesity, performance status, age, and type of medication seem to carry the most weight.
Thompson
Lisa A
LA
University of Colorado Denver School of Pharmacy, Aurora, CO; University of Kentucky HealthCare; and Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY.
Lawson
Amber P
AP
Sutphin
Stephanie D
SD
Steinke
Douglas
D
Adams
Val R
VR
Am J Hosp Pharm. 1980 Apr;37(4):519-22
7377215
J Oncol Pract. 2008 May;4(3):108-13
20856612
Cancer. 2008 May 15;112(10):2159-65
18338813
J Clin Oncol. 2007 Oct 20;25(30):4707-13
17947717
J Natl Cancer Inst. 2006 Nov 15;98(22):1647-54
17105987
JAMA. 2006 Apr 5;295(13):1549-55
16595758
Gynecol Oncol. 2008 Jun;109(3):353-8
18407341
Oncogene. 2004 Aug 23;23(38):6365-78
15322511
Nephron. 1976;16(1):31-41
1244564
J Pharm Sci. 1999 Jan;88(1):1-7
9874695
Lancet. 2005 Sep 24-30;366(9491):1108-10
16182899
N Engl J Med. 2003 Apr 24;348(17):1625-38
12711737
Clin Pharmacokinet. 2000 Sep;39(3):215-31
11020136
Cancer. 2003 Aug 1;98(3):484-95
12879464
Clin Pharm. 1985 Jan-Feb;4(1):70-2
3971686
Eur J Cancer. 2007 Feb;43(3):544-8
17169553
Am J Med. 1988 Jun;84(6):1053-60
3376975
Clin Pharmacokinet. 2004;43(15):1127-56
15568891
J Clin Oncol. 1989 Nov;7(11):1748-56
2681557
Bone Marrow Transplant. 2003 Jun;31(11):961-6
12774045
Lancet. 1971 May 8;1(7706):975-6
4102307
Ann Oncol. 2008 May;19(5):898-902
18272913