DOSING OF CHEMOTHERAPY IN OBESE ADULT PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES: A SURVEY OF PRACTICE IN THE UK.
(Abstract release date: 05/19/16)
EHA Library. Preston A. 06/09/16; 134599; PB1699
Mrs. Andrea Preston
Contributions
Contributions
Abstract
Abstract: PB1699
Type: Publication Only
Background
With obesity levels increasing to epidemic proportions, treating obese patients optimally with chemotherapy is a significant issue. There is accumulating evidence of increased cancer risk in obese patients and obesity related co-morbidities can compromise relative total dose intensity, resulting in poorer overall survival in some tumour types.In 2010 the American Society of Clinical Oncology (ASCO) convened an expert panel to review the literature on chemotherapy dosing in obesity. The panel concluded that up to 40% of obese patients received “capped” doses because of clinicians’ concerns regarding toxicity. They concluded that there was no evidence of increased toxicity in such patients and released a Clinical Practice Guideline recommending that obese patients should be dosed on their actual (full) body weight.
Aims
To investigate UK clinical practice in this area and establish whether it has changed as a result of the ASCO Clinical Practice Guideline.
Methods
A questionnaire was completed by 81 specialist cancer services pharmacists from the British Oncology Pharmacy Association. The questionnaire assessed: 1) criteria used for defining obesity, 2) if dose adjusting for obesity was undertaken at individual hospitals and if so what methodology it was based on, 3) if practice had been influenced by the ASCO guideline and 4) what formulae/ methods were being used to assess body surface area (BSA), ideal body weight (IBW) and glomerular filtration rate (GFR).Bone marrow transplant conditioning and treatment of leukaemia were excluded to reflect ASCO’s guideline; treatment of Non-Hodgkins and Hodgkins Lymphoma were included.
Results
Of the 73 pharmacists who fully responded, just less than half (47%) stated that their hospitals follow ASCO’s recommendations and dose on actual body weight. The most common reasons for non-adherence included the lack of robust evidence and a need for clinical teams to discuss the guidelines and reach a consensus of how to adapt locally. Of the 53% who confirmed that they reduce doses in obese patients, 30% dose reduced in all obese patients and 70% in selected patients where ‘capping’ decisions were based on treatment goal (100%) and the pharmacokinetics of the individual drugs (38%). There was no uniformity in formulae used for BSA, IBW or GFR calculations. Methodology varied for defining obesity, adjusting the dose, assessing GFR and some centres used IBW in GFR formulae, some actual body weight. This lack of uniformity is not unique to the UK and is likely to be a widespread issue.
Conclusion
Further research is needed to clarify chemotherapy dosing in obese patients to aid clinicians and pharmacists in these decisions. Pharmacokinetic and pharmacogenetic studies would provide a more personalised approach to treatment, and can be undertaken in the context of large prospective trials. Until evidence is available for specific cancers, a unified approach to dosing in obesity based on current guidance should be encouraged.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Obesity, Treatment
Type: Publication Only
Background
With obesity levels increasing to epidemic proportions, treating obese patients optimally with chemotherapy is a significant issue. There is accumulating evidence of increased cancer risk in obese patients and obesity related co-morbidities can compromise relative total dose intensity, resulting in poorer overall survival in some tumour types.In 2010 the American Society of Clinical Oncology (ASCO) convened an expert panel to review the literature on chemotherapy dosing in obesity. The panel concluded that up to 40% of obese patients received “capped” doses because of clinicians’ concerns regarding toxicity. They concluded that there was no evidence of increased toxicity in such patients and released a Clinical Practice Guideline recommending that obese patients should be dosed on their actual (full) body weight.
Aims
To investigate UK clinical practice in this area and establish whether it has changed as a result of the ASCO Clinical Practice Guideline.
Methods
A questionnaire was completed by 81 specialist cancer services pharmacists from the British Oncology Pharmacy Association. The questionnaire assessed: 1) criteria used for defining obesity, 2) if dose adjusting for obesity was undertaken at individual hospitals and if so what methodology it was based on, 3) if practice had been influenced by the ASCO guideline and 4) what formulae/ methods were being used to assess body surface area (BSA), ideal body weight (IBW) and glomerular filtration rate (GFR).Bone marrow transplant conditioning and treatment of leukaemia were excluded to reflect ASCO’s guideline; treatment of Non-Hodgkins and Hodgkins Lymphoma were included.
Results
Of the 73 pharmacists who fully responded, just less than half (47%) stated that their hospitals follow ASCO’s recommendations and dose on actual body weight. The most common reasons for non-adherence included the lack of robust evidence and a need for clinical teams to discuss the guidelines and reach a consensus of how to adapt locally. Of the 53% who confirmed that they reduce doses in obese patients, 30% dose reduced in all obese patients and 70% in selected patients where ‘capping’ decisions were based on treatment goal (100%) and the pharmacokinetics of the individual drugs (38%). There was no uniformity in formulae used for BSA, IBW or GFR calculations. Methodology varied for defining obesity, adjusting the dose, assessing GFR and some centres used IBW in GFR formulae, some actual body weight. This lack of uniformity is not unique to the UK and is likely to be a widespread issue.
Conclusion
Further research is needed to clarify chemotherapy dosing in obese patients to aid clinicians and pharmacists in these decisions. Pharmacokinetic and pharmacogenetic studies would provide a more personalised approach to treatment, and can be undertaken in the context of large prospective trials. Until evidence is available for specific cancers, a unified approach to dosing in obesity based on current guidance should be encouraged.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Obesity, Treatment
Abstract: PB1699
Type: Publication Only
Background
With obesity levels increasing to epidemic proportions, treating obese patients optimally with chemotherapy is a significant issue. There is accumulating evidence of increased cancer risk in obese patients and obesity related co-morbidities can compromise relative total dose intensity, resulting in poorer overall survival in some tumour types.In 2010 the American Society of Clinical Oncology (ASCO) convened an expert panel to review the literature on chemotherapy dosing in obesity. The panel concluded that up to 40% of obese patients received “capped” doses because of clinicians’ concerns regarding toxicity. They concluded that there was no evidence of increased toxicity in such patients and released a Clinical Practice Guideline recommending that obese patients should be dosed on their actual (full) body weight.
Aims
To investigate UK clinical practice in this area and establish whether it has changed as a result of the ASCO Clinical Practice Guideline.
Methods
A questionnaire was completed by 81 specialist cancer services pharmacists from the British Oncology Pharmacy Association. The questionnaire assessed: 1) criteria used for defining obesity, 2) if dose adjusting for obesity was undertaken at individual hospitals and if so what methodology it was based on, 3) if practice had been influenced by the ASCO guideline and 4) what formulae/ methods were being used to assess body surface area (BSA), ideal body weight (IBW) and glomerular filtration rate (GFR).Bone marrow transplant conditioning and treatment of leukaemia were excluded to reflect ASCO’s guideline; treatment of Non-Hodgkins and Hodgkins Lymphoma were included.
Results
Of the 73 pharmacists who fully responded, just less than half (47%) stated that their hospitals follow ASCO’s recommendations and dose on actual body weight. The most common reasons for non-adherence included the lack of robust evidence and a need for clinical teams to discuss the guidelines and reach a consensus of how to adapt locally. Of the 53% who confirmed that they reduce doses in obese patients, 30% dose reduced in all obese patients and 70% in selected patients where ‘capping’ decisions were based on treatment goal (100%) and the pharmacokinetics of the individual drugs (38%). There was no uniformity in formulae used for BSA, IBW or GFR calculations. Methodology varied for defining obesity, adjusting the dose, assessing GFR and some centres used IBW in GFR formulae, some actual body weight. This lack of uniformity is not unique to the UK and is likely to be a widespread issue.
Conclusion
Further research is needed to clarify chemotherapy dosing in obese patients to aid clinicians and pharmacists in these decisions. Pharmacokinetic and pharmacogenetic studies would provide a more personalised approach to treatment, and can be undertaken in the context of large prospective trials. Until evidence is available for specific cancers, a unified approach to dosing in obesity based on current guidance should be encouraged.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Obesity, Treatment
Type: Publication Only
Background
With obesity levels increasing to epidemic proportions, treating obese patients optimally with chemotherapy is a significant issue. There is accumulating evidence of increased cancer risk in obese patients and obesity related co-morbidities can compromise relative total dose intensity, resulting in poorer overall survival in some tumour types.In 2010 the American Society of Clinical Oncology (ASCO) convened an expert panel to review the literature on chemotherapy dosing in obesity. The panel concluded that up to 40% of obese patients received “capped” doses because of clinicians’ concerns regarding toxicity. They concluded that there was no evidence of increased toxicity in such patients and released a Clinical Practice Guideline recommending that obese patients should be dosed on their actual (full) body weight.
Aims
To investigate UK clinical practice in this area and establish whether it has changed as a result of the ASCO Clinical Practice Guideline.
Methods
A questionnaire was completed by 81 specialist cancer services pharmacists from the British Oncology Pharmacy Association. The questionnaire assessed: 1) criteria used for defining obesity, 2) if dose adjusting for obesity was undertaken at individual hospitals and if so what methodology it was based on, 3) if practice had been influenced by the ASCO guideline and 4) what formulae/ methods were being used to assess body surface area (BSA), ideal body weight (IBW) and glomerular filtration rate (GFR).Bone marrow transplant conditioning and treatment of leukaemia were excluded to reflect ASCO’s guideline; treatment of Non-Hodgkins and Hodgkins Lymphoma were included.
Results
Of the 73 pharmacists who fully responded, just less than half (47%) stated that their hospitals follow ASCO’s recommendations and dose on actual body weight. The most common reasons for non-adherence included the lack of robust evidence and a need for clinical teams to discuss the guidelines and reach a consensus of how to adapt locally. Of the 53% who confirmed that they reduce doses in obese patients, 30% dose reduced in all obese patients and 70% in selected patients where ‘capping’ decisions were based on treatment goal (100%) and the pharmacokinetics of the individual drugs (38%). There was no uniformity in formulae used for BSA, IBW or GFR calculations. Methodology varied for defining obesity, adjusting the dose, assessing GFR and some centres used IBW in GFR formulae, some actual body weight. This lack of uniformity is not unique to the UK and is likely to be a widespread issue.
Conclusion
Further research is needed to clarify chemotherapy dosing in obese patients to aid clinicians and pharmacists in these decisions. Pharmacokinetic and pharmacogenetic studies would provide a more personalised approach to treatment, and can be undertaken in the context of large prospective trials. Until evidence is available for specific cancers, a unified approach to dosing in obesity based on current guidance should be encouraged.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Obesity, Treatment
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