Dosing of chemotherapy in obese and cachectic patients: results of a national survey.
BACKGROUND
It is not unusual to find obese and cachectic patients in the hematology oncology setting. However, information on dosage in these groups is scarce.


OBJECTIVE
The objectives of our study were to explore the dosing strategies applied in the treatment of obese and cachectic cancer patients and to determine whether these strategies are applied in clinical trials.


METHODS
Members of the Spanish Group for the Development of Hematology-Oncology Pharmacy (GEDEFO).


METHODS
We invited all cancer hospital pharmacists to participate in a survey.


METHODS
Descriptive statistics of the dosing strategies approaches.


RESULTS
We invited 159 eligible hospitals to participate, and 38 responded to the survey. A total of 50 surveys were received: different strategies were applied by different physicians from the same hospital and by hematology and oncology departments. Body mass index was used to define obesity and cachexia in 40 and 30 % of the cases, respectively. Capping the body surface area (BSA) was the approach most commonly followed (64.1 %) in obese patients, whereas no specific approach was adopted in cachectic patients. In hematology patients, the BSA calculation was based on ideal body weight or adjusted body weight in 16.0 % of cases (n = 2) and 50.0 % of cases (n = 6), respectively; in oncology patients, use of adjusted or ideal body weight was negligible. Actual body weight was the main approach in obese patients (35 surveys) and cachectic patients (48 surveys). Creatinine clearance was assessed mainly using the Cockcroft and Gault equation (around 76.0 % of responses). As for clinical trials, 64.1 % of the respondents (n = 25 hospitals) considered the criteria from each clinical trial individually.


CONCLUSIONS
Dose adjustments are more frequent in obese patients than in cachectic patients. In cancer oncology patients, dose is adjusted mainly by hematology and hematopoietic cell transplant teams. Capping BSA is the most frequent strategy, followed by calculating actual body weight.
Pharmacy Service, Hospital Clínic Barcelona, Villarroel, 170, 08036, Barcelona, Spain, hangladamartinez@gmail.com.
Helena
H
Anglada-Martínez
Gisela
G
Riu-Viladoms
Fernando
F
do Pazo-Oubiña
Gloria
G
Molas-Ferrer
Irene
I
Mangues-Bafalluy
Carles
C
Codina-Jané
Natàlia
N
Creus-Baró
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015992:Body Mass Index; D001830:Body Surface Area; D002100:Cachexia / Q000453:epidemiology*; D002173:Cancer Care Facilities; D003404:Creatinine / Q000378:metabolism; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D009765:Obesity / Q000453:epidemiology*; D010595:Pharmacists
D000970:Antineoplastic Agents; D003404:Creatinine