In 2012, this prompted the American Society of Clinical Oncology to release guidelines for dosing obese patients.4 Dr Lyman said that he thinks the guidelines have improved dosing practices for these patients.
“I know just from anecdotal experience that a lot of institutions changed their practice, which had previously been to cap the dose or use the ideal body weight instead of the actual body weight,” said Dr Lyman. “A lot of institutions and practices changed that practice and now they dose based on actual weight.”
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Dr Lyman said he believes that integrating dosing guidelines into electronic medical records could help mitigate the problem, and pointed out that this is already done for other conditions.
”These systems often incorporate standing orders,” he said. “Those orders should be based on full dosing. The clinician could modify it, of course, but I think to have an alert or an advisory come up on the screen to suggest the full dosing unless the patient has important co-morbidities would be useful.”
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He added that ”obviously if the patient develops a neutropenic complication or infection with the first course, then it may be appropriate to reduce the dose if they developed complications in spite of adequate supportive care.”
Dr Lyman noted that the importance of full chemotherapy dosing in curative settings is better recognized than it was even 5 years ago, but said he thinks there is still work to do. “I think we just need to get the message out further, particularly in these less-studied disease settings like ovarian cancer, lung cancer, and the lymphomas,” he said.
References
- Denduluri N, Patti DA, Wang Y, et al. Dose delays, dose reductions, and relative dose intensity in patients with cancer who received adjuvant or neoadjuvant chemotherapy in community oncology practices. J Natl Compr Netw. 2015;13(11):1383-1394.
- Griggs J, Sorbero M, Lyman, G. 2005. Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med. 2015;165(11):1267-1273.
- Lyman GH, Sparreboom A.Chemotherapy dosing in overweight and obese patients with cancer. Nat Rev Clin Oncol . 2013;10(8):451–459.
- Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 30(13):1553-1561.
