Description of current practices of empiric chemotherapy dose adjustment in obese adult patients

Purpose: The literature is not clear on the best method to empirically dose chemotherapy in obese adult patients. The purpose of our study was to determine whether a standard of practice existed, characterize current practices of empiric dose adjustment (EDA) in obese adult patients, and identify factors affecting this decision. Methods: An electronic survey was distributed to oncologists and board-certified oncology pharmacists via the Association of Community Cancer Centers and Board of Pharmaceutical Specialties e-mail distribution lists. The survey contained patient scenarios assessing the impact of various factors on EDA of chemotherapy, demographic information, and details of institutional policies. Results: Responses were collected from 174 professionals. Pharmacists comprised 95% of respondents. Of these, 50% practiced in academic medical centers, and19%practiced in institutions with a standard of practice regarding EDA for obesity. The most common methods of EDA were use of an adjusted body weight in the body-surface area (BSA) equation and capping BSA. Factors with the most impact on EDA were curative intent, degree of obesity, type of chemotherapy, and performance status. Conclusion: There is no standard of practice regarding EDA of chemotherapy in obese adult patients. Although many factors affect this decision, intent of treatment, degree of obesity, performance status, age, and type of medication seem to carry the most weight.