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Chemo by your individual weight?

Rague
Posts: 3277
Joined: Aug 2009

Saw something on TV a little while ago that there is a new study that says that many do not get the right amount of their chemo.  What it said basically, was that chemo is/has been administered not based on actual weight but rather on 'ideal' weight.

I was surprised at the info as when I did chemo 4 yrs ago, I was weighed everytime on the way back to my cubicle and was told (I asked 'Why?") it was so the pharmacist could properly prepare what was right for me.  Made sense to me.  (They had checked my height the first time, height seldom changes LOL.)

Anyone 'hear/see/read' this or were you weighed?  Thoughts?

Winyan - The Power Within

Susan

SIROD's picture
SIROD
Posts: 2121
Joined: Jun 2010

I asked the same question and was told the same answer as they gave you.  The pharmacist went by my weight and it's been adjusted, so I could tolerated it better.

Doris

New Flower
Posts: 3944
Joined: Aug 2009

Hi Ssusan, interesting discussion, this topic eventually was brought to the general public. I came across of this original publication last June when I was looking at Xeloda dose. The paper said that about 50% patients have gotten a correctt dose per their weight, the other 50% is split between those who over treated and under treated. Well it left me wonder about my past (Taxotere/Cytoxan) and upcoming Xeloda. I remember my first order for Taxotere/Cytoxan had number of mg of the drug per kilogram of (my weight).

My initial prescription for Xeloda was 3000 mg a day, that seemed a lot to me. I did a little survey on the CSN board and found that many people were given a similar dose, despite of the weight. when I asked my oncologist why I was getting the same dose as person who is 30 lb heavier , she showed me a table for calculating Xeloda dose and explained that height plays a significant role too, and Xeloda dose for me was function of both my weight and my height.

ComfortablyNumb
Posts: 39
Joined: May 2013

I'm weighed before every treatment and the dose is adjusted accordingly.

desertgirl947's picture
desertgirl947
Posts: 408
Joined: Oct 2012

Went by weight -- sometimes I thought they got carried away with weighing though . . . I got weighed chemo day; got weighed the next day, which was shot day; got weighed Friday the following week when it was blood draw time; got weighed chemo day.  It made sense to me that they would weigh me every chemo day, though.  The concoction was made up according to my weight.

TraciInLA's picture
TraciInLA
Posts: 1836
Joined: Jul 2009

My oncologist takes the issue of height/weight very seriously when calculating chemo dosages.  Like desertgirl, during chemo, I was weighed every time I walked into the office...but especially on chemo day, and then my doctor would come in and verify the chemo nurse's calculations before anything was started.

I even once heard a patient loudly arguing with the nurse as they were weighing her...your scale isn't right, I had a big lunch, I don't weigh that much, etc.  My doctor intervened and gently but firmly stood his ground, telling her how critical it was for calculating chemo dosage, and that they regularly have their scale calibrated for just this reason.

Believe me...I sure WANTED to tell them their scale was whacked, I didn't weigh that much, write down a smaller number, please....but this is one time when you just have to be out and proud about your weight!

Traci

SIROD's picture
SIROD
Posts: 2121
Joined: Jun 2010

but this is one time when you just have to be out and proud about your weight!

I agree with you Traci.

SIROD's picture
SIROD
Posts: 2121
Joined: Jun 2010

I will have to ask my new oncologist about the reductions and it's effects.  I won't see him until October.  The amount I receive has been reduced several times, due to my anemia and low iron.  My  oncologist said, if I continued with the same amount, I soon would not be able to take it at all.  My body wasn't handling it that well.  Better some than none.  I feel better this time around but I wonder if it is to low.

Doris

Article I found on another board:

Are obese people with cancer getting chemotherapy doses too small for them?

excerpt: 
A paper Gary Lyman at Duke University published in the journal Nature in August said that a 20 percent reduction in chemo doses lowered remission and cure rates by half in animal experiments and helped the tumors develop resistance to the drugs. Other research in people found lower survival among those getting less chemo as well.

Even if a patient develops a problem from a chemo treatment and doctors have to dial it back, it's important to try a full dose the next time around so the patient gets all the treatment intended, Lyman said.

That happened to Tracy Smith, a 46-year-old Durham, N.C., woman treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight, which at 285 pounds classified her as obese.

Three times, high fevers put her in the hospital, and one treatment was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment and has been cancer-free since then.

After hearing you have cancer, "you're just kind of in a fog" and don't think to ask about doses of the drugs you need, she said. "I trusted my doctor. Doctors should be well aware of what you can tolerate. You should do whatever you can to fight this beast."

Smith's tumor was fueled by estrogen - a hormone made in abundance by fat tissue. Robin McRath, a floral designer who helps run a women's shelter in Ludington, Mich., had the same type.

"It's like a playground, an amusement park, for cancer cells when you're fat," she said. She was only was 41 when her cancer was diagnosed five years ago, and her oncologist, Dr. Carol Peterson, treated her with full doses based on her weight - about 240 pounds, which put her in the obese category.

"We didn't discuss dosage. That didn't matter to me - I just wanted to get it out of my system," she said of the cancer, and praised the treatments to prevent one of chemo's most feared side effects. "There are fantastic anti-nausea medicines. I was never sick one day."

McRath is active in the Obesity Action Coalition, an education and advocacy group. A spokesman said the group was unaware of the dosing issue for obese patients.

Not all doctors are aware either. Luckily for McRath, hers was. Peterson said she uses full doses unless a patient has other health issues.

"If that's their only problem - if they're just overweight or obese - they can do quite well" with full weight-based doses, she said.

Duke's Lyman agreed, and offered this advice to patients: "Ask your doctor how they plan to treat you and whether you're going to get the full dosing. The doctor may have a good reason not to, but you should have that discussion."

Story at: 
http://www.cbsnews.com/8301-204_162-57603715/are-obese-people-with-cancer-getting-chemotherapy-doses-too-small-for-them/

 

camul's picture
camul
Posts: 2017
Joined: Dec 2010

if everyone got the same dose. He just said no. Size, type of cancer, and what I was able to tolerate would determine what my dose was. I know the initial in 2002, he changed my dosing of cytoxin and then we stopped it after 3 treatments. But he started at a high dose, I was a stage 1 with one onco and stage 2 wth another, It was my current one that said 2 bcuz the main tumor was 1.97 cm, but it had broken out of the initial tumor spead to the nip. Both agreed with grade 3. Other onco said just a lumpectomy would be ok that I would never have recurrance, my onco treated me with higherndose and said due to quantity of hrt and being treated for endometriosis for many years with high doses of estrogen, that I was most likely looking at a recurrance. He felt from the beginning that I was high risk for mets. She flat out told me that she would not do chemo or a mastectomy.
I went with him and still respect hom and am so thankful that he was aggressive wih dose and treatment.

About weight and dose. In deciding on internal rads even
They weighed me 2 days in a row. Had I decded on that. The dose for ir is completely based on wright and height. It is made up especially for each patient. With tye start of each chemo, i was weighed and during treatment when my weight dropped 30 lbs at one point so did the dose of Halavan.
There was another article on weight/chemo dose this last week on Yahoo news.com (or I think it was yahoo).

Good topic. I dont believe all doctors do this

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