Monday, August 07, 2006

Medications Are Not One Size Fits All

If you are carrying excess pounds, finding clothes that fit may be the least of your problems. Besides the well-publicized increased risks of developing cardiovascular disease, diabetes and certain types of cancer, researchers now report that obese people may require different medication doses and are not necessarily getting them. This is leading to life-or-death consequences for some. According to a study published in the Archives of Internal Medicine, some overweight or obese women receiving chemotherapy for breast cancer aren't getting doses of chemo that are appropriate for their size. That's because some doctors fear that using full doses (based on body size) of powerful chemo drugs could cause toxic side effects in these patients. The researchers analyzed data from 9,672 breast cancer patients around the country who were treated with chemo after surgery. The heavier the woman, the greater the likelihood of receiving reduced chemotherapy doses, the researchers found. And the women who received inadequate doses of chemo were more likely to experience poor outcomes.

Dosing chemo
Jennifer Griggs, MD, MPH, lead author of the study and an associate professor at the University of Rochester School of Medicine and Dentistry, explained to me that doctors currently base chemo doses on body surface area, which is calculated using a person's height and weight. But some physicians reduce that amount when treating heavier patients. Other doctors may reduce the dose during chemo and then add one or two more cycles. In the heavier patients, the total chemo doses may be the same, but these women don't receive the intensity of full doses. This practice is not supported by oncology specialty societies, hospitals, pharmaceutical manufacturers or, most importantly, by the studies used to prove efficacy. If doctors underdose or alter recommended frequency of administration, they are providing substandard, actionable care. Part of the problem is that current medical literature includes no information on dosing heavy patients, says Dr. Griggs, who is a breast cancer specialist at the University's James P. Wilmot Cancer Center. Since doctors are trained to "do no harm," many err on the side of caution. However, in reality, underdosing may actually cause more harm than good. Full doses of chemo are safe, Dr. Grigg's study found. The severely obese women in her study who received a full chemo dose appropriate to their size were no more likely than leaner women to be hospitalized with side effects. "Sixty-three percent of the women studied got the right doses, so a lot of doctors are confident that it's safe to give full doses. But 37% did not," says Dr. Griggs. Women who are overweight would be smart to lose weight for a variety of health reasons. However, if you are overweight and you are beginning chemotherapy, Dr. Griggs advises you to be forthright and ask your doctor how he/she doses for heavy people, This issue applies to men with assorted cancers, as well.
Cancer treatment is traumatic enough. Be sure it is effective as well.


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