Background The dosing of chemotherapy according to the body surface area (BSA) in obese adult patients, who present a BSA above 2 m2, is usually set to an established BSA maximum limit of 2 m2. The recent publication (April 2012): ‘Appropriate chemotherapy dosing for obese adult patients with cancer’ in the American Society of Clinical Oncology Clinical Practice Guidelines (ASCO), considers the benefit of full dosing, without adjusting to a maximum BSA, especially when the goal of treatment is curative.
Purpose To suggest recommendations for adult obese people according to the current ASCO guidelines and evaluate the medical prescribers’ level of acceptance.
Materials and Methods Prospective observational study of all patients from the oncology, haematology and palliative care services receiving chemotherapy from April to June 2012. In those obese patients where the cytostatic dose was adjusted to BSA 2 m², it was recommended to dose according to their actual BSA. The article was disseminated in these services and a spreadsheet was created to record the level of acceptance from the medical prescriber in each of the clinic units.
Results 368 patients (56% female) were included: 82.3% from the oncology service, 16.6% from haematology and 1% from the palliative care service. The average ± standard deviation age was 61.2 ± 1.6 years, 69.3 ± 14.1 Kg and 1.7 ± 0.2 m². The number of patients with a BSA above 2 m² was 26 (7%): 50% were from the oncology service and none from the palliative service.
Recommendations were made in 17 (65%) of the patients with a BSA >2 m², of which the haematology service was the largest cohort (58%). The acceptance level was 53% (66.6% haematology service). Recommendations were not made to 35% (66.6% oncology service) because the treatments were started after the article had been disseminated and full doses were prescribed.
The use of full doses was well tolerated by all patients, no adverse outcomes were observed of the use of greater doses of chemotherapy.
Conclusions Following the recommendations, full dosing in patients commencing treatment was observed.
Those recommendations not followed were due to patients whose treatment was not curative or those where a dose increase would cause a degree of toxicity.
The involvement of the Pharmacist responsible for updating the cytostatic unit led to a change in chemotherapy dosing in obese adult patients.
No conflict of interest.
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