Undertreatment of Obese Women Receiving Breast Cancer Chemotherapy

Griggs, Jennifer J.; Sorbero, Melony E.; Lyman, Gary H.

doi:10.1001/archinte.165.11.1267

Cited by 250 publications

(192 citation statements)

References 35 publications

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“…29 Obese women may be given lower doses of chemotherapy because the ideal body surface area rather than true body surface area is used to estimate the dose of chemotherapy. [30][31][32] The fact that obese women experienced less toxicity than normal weight women supports that hypothesis, but we did not detect an interaction between obesity and toxicity on breast cancer-specific survival. Other proposed biological mechanisms include higher estrogen levels among obese women that counter the efficacy of tamoxifen and increase cell proliferation, elevated adipokine levels caused by obesity that may accelerate cancer progression, independent effects of insulin, altered immune responses, and oxidative stress.…”

Section: Discussionmentioning

confidence: 56%

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Maskarinec

Pagano

Lurie

et al. 2011

Journal of Women's Health

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Background: Given previous reports of ethnic differences in breast cancer survival among Hawaii's population, we investigated the role of adherence to treatment standards, treatment toxicity, preexisting chronic conditions, and obesity in the survival of 382 prospectively studied breast cancer patients representing six ethnic groups. Methods: Participants were recruited from several hospitals in Honolulu. Information on tumor characteristics and treatment was abstracted from medical records. Based on the Physicians Data Query (PDQ

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Section: Discussionmentioning

confidence: 56%

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Maskarinec

Pagano

Lurie

et al. 2011

Journal of Women's Health

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“…Obese postmenopausal breast cancer survivors have increased estrone, estradiol, free estradiol, levels and decreased sex-hormone-binding globulin levels [36]. Furthermore, it has been suggested that obese women with breast cancer may receive reduced doses of adjuvant chemotherapy [37]. Higher BMI has been related to more advanced stages of breast cancer at diagnosis in terms of tumour size [38].…”

Section: Biological Mechanismmentioning

confidence: 99%

Lifestyle changes and breast cancer prognosis: a review

Kellen

Vansant

Christiaens

et al. 2008

Breast Cancer Res Treat

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“…The ASCO guidelines recommend that obese adult patients with cancer should be treated with chemotherapy doses based on ABW, especially when the goal of treatment is cure. No evidence shows that obese patients receiving chemotherapy would experience increased toxicity if actual weight were used to calculate the dose [13][14][15][16][17][18][19][20][21]. Clinicians should address treatment-related toxicities in obese patients in the same manner that they would for nonobese patients.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Dose Adjustment for Obese Patients Undergoing Hematopoietic Stem Cell Transplantation: A Survey on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Shem‐Tov

Labopin²,

Moukhtari³

et al. 2014

The Oncologist

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Background. Appropriate chemotherapy dosing for obese patients with malignant diseases is a significant challenge because limiting chemotherapy doses in these patients may negatively influence outcome. There is a paucity of information addressing high‐dose chemotherapy in obese patients undergoing hematopoietic stem cell transplantation (HSCT). Methods. The Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) designed an electronic survey to assess current practice of dose adjustment of chemotherapy in obese patients undergoing HSCT. Results. A total of 56 EBMT centers from 27 countries responded to the online survey. Overall, 45 centers declared that they routinely adjust chemotherapy doses for obese patients (80.5%), and only 11 (19.5%) declared they do not adjust dose. Among the former group, most used body mass index as the parameter for defining obesity (28 centers, 62%). The method for determining the weight for chemotherapy calculation was actual body weight (ABW) in 16 centers, ideal body weight (IBW) in 10 centers, IBW plus 25% of the difference between IBW and ABW in 16 centers, and other methods for the rest. Among centers that used dose adjustment, 44% also capped the dose at 2 m2 for a chemotherapy dose based on body surface area (BSA), whereas 56% did not cap. Interestingly, most of the centers (9 of 11) that did not adjust dose for weight also did not cap the BSA at 2 m2. Conclusion. This EBMT survey revealed large diversity among transplant centers regarding dose‐adjustment practice for high‐dose conditioning chemotherapy. Our next step is to analyze outcomes of transplantation according to dose‐adjustment practice and, subsequently, to formulate a methodology for future prospective studies.

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Undertreatment of Obese Women Receiving Breast Cancer Chemotherapy

Abstract: Overweight and obese women with breast cancer often receive intentionally reduced doses of adjuvant chemotherapy. Administration of initial and overall full weight-based doses of adjuvant chemotherapy in overweight and obese women is likely to improve outcomes in this group of patients.

Cited by 250 publications

References 35 publications

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Factors Affecting Survival Among Women with Breast Cancer in Hawaii

Lifestyle changes and breast cancer prognosis: a review

Chemotherapy Dose Adjustment for Obese Patients Undergoing Hematopoietic Stem Cell Transplantation: A Survey on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

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