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Obese women not getting the right dose of chemotherapy? (x-post)
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PostPosted: Mon Jun 13, 2005 9:32 pm    Post subject: Obese women not getting the right dose of chemotherapy? (x-post) Reply with quote


AP Health
Obese Cancer Patients May Need More Chemo

AP Medical Writer

June 13, 2005, 4:01 PM EDT

CHICAGO -- A study suggests overweight breast cancer patients often do not
get enough chemotherapy -- and that might help explain why they tend to
fare worse than thinner women.

Doctors typically use weight, height and body-surface measurements to
determine the proper doses of the powerful cancer-fighting drugs.

But many doctors avoid that approach with overweight breast cancer
patients because they worry about the toxic side effects of very large
doses, said Dr. Jennifer Griggs, the study's lead author and a breast
cancer specialist at the University of Rochester.

The phenomenon has been reported in treating other kinds of cancer.

In her study of 9,672 women who received standard drugs for breast cancer,
overweight women were 20 percent more likely than thin women to receive
lower doses than a size-based formula would indicate they need; obese
women were more than twice as likely; and very obese women were almost six
times more likely.

Previous studies have suggested that overweight patients are more likely
than lean ones to suffer a recurrence of their breast cancer, partly
because excess fat increases the amount of circulating estrogen, which
fuels the growth of some tumors.

Griggs said insufficient chemotherapy is probably also to blame. "It
certainly seems like a plausible explanation," she said.

Her study appears in Monday's Archives of Internal Medicine.

Undertreatment occurred in 9 percent of normal-weight women, 11 percent of
overweight women, 20 percent of the obese women and 37 percent of the
severely obese women.

Doctors worry about such side effects as fevers and a dangerous reduction
in disease-fighting white blood cells. But relatively new drugs to boost
white cell counts have probably helped ease those concerns, said Dr. Lydia
Usha, a breast cancer specialist at Chicago's Rush University Medical

In Griggs' study, 462 women were hospitalized for treatment of low white
counts with fevers. The problem was not more common in overweight women
who had received size-based doses.

Chemotherapy also sometimes increases the risk of longer-term
complications such as heart damage and other types of cancer -- concerns
that Usha said have led her to give obese patients lower doses than their
size dictated.

The participants in the study were not followed long enough to compare
long-term outcomes, but Griggs noted that a previous study found that
overweight breast cancer patients given chemotherapy based on their size
were as likely as lean women to survive without a recurrence.

Both studies raise concerns that doctors "are falsely thinking they're
making chemotherapy easier in them by giving them less," but are actually
doing obese women a disservice, said Dr. William Gradishar, a breast
cancer specialist at Northwestern University.

Amgen Inc., a maker of white cell-boosting drugs, funded early data
collection for Griggs' research, and a co-author has served on an Amgen
speakers' bureau, but the researchers said the company had no role in the
study design or analysis.

* __

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