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Chemotherapy Dosing Strategies in the Obese, Elderly, and Thin Patient: Results of a Nationwide Survey

Department of Medical Oncology, Western Hospital, Footscray; Peter MacCallum Cancer Centre, East Melbourne; Royal Melbourne Hospital, Victoria; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia

Corresponding author: Peter Gibbs, MD, MBBS,Department of Oncology, Royal Melbourne Hospital Royal Parade, Parkville Victoria 3052, Australia Email: peter.gibbs{at}mh.org.au

Purpose: Determining the optimal starting dose of chemotherapy (CHT) presents a considerable challenge when using body-surface area (BSA)–based dosing, particularly in obese, elderly, or thin patients. We sought to document the range of approaches employed when administering CHT to these patients.

Methods: A questionnaire was developed by a panel of oncologists and mailed to all members of the Medical Oncology Group of Australia.

Results: From 315 oncologists, 188 responded (response rate 59.7%). BSA-based dosing is standard practice for 176 (97.2%) of the responding oncologists. In the adjuvant disease setting, 23 (12.7%) use ideal rather than actual body weight (BW) to calculate BSA, or choose whichever is less. When treating obese patients, only 6.1% of respondents routinely use actual BW. Of the remainder, 69.5% either cap the dose at 2 m² or use ideal BW. In underweight patients, 95% (n = 171) routinely calculate BSA using actual BW. Forty one respondents (22.7%) routinely reduce dose in the fit elderly.

Conclusion: This analysis of BSA-based CHT dosing methods demonstrates significant variability in practice. Based on evidence from adjuvant studies showing that actual BSA-based dosing is desirable, a substantial number of Australian patients are being underdosed. Further education, together with ongoing research, is required to optimize individualized dosing for efficacy and tolerability.

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