Abstract
The majority of chemotherapy drugs are dosed based on body surface area (BSA). No standard BSA values for patients being treated in the United Kingdom are available on which to base dose and cost calculations. We therefore retrospectively assessed the BSA of patients receiving chemotherapy treatment at three oncology centres in the UK between 1st January 2005 and 31st December 2005.A total of 3613 patients receiving chemotherapy for head and neck, ovarian, lung, upper GI/pancreas, breast or colorectal cancers were included. The overall mean BSA was 1.79 m2 (95% CI 1.78–1.80) with a mean BSA for men of 1.91 m2 (1.90–1.92) and 1.71 m2 (1.70–1.72) for women. Results were consistent across the three centres. No significant differences were noted between treatment in the adjuvant or palliative setting in patients with breast or colorectal cancer. However, statistically significant, albeit small, differences were detected between some tumour groups.In view of the consistency of results between three geographically distinct UK cancer centres, we believe the results of this study may be generalised and used in future costings and budgeting for new chemotherapy agents in the UK.
Highlights
Body surface area (BSA), despite well-documented limitations, remains the most frequently used measure for calculating the dose of cytotoxic drugs in chemotherapy regimens[1,2]
Recent media coverage continues to highlight the problems of introducing new, costly cancer chemotherapy agents into the National Health Service (NHS)
Evaluation of cost effectiveness as carried out by the National Institute for Health and Clinical Excellence (NICE) technology appraisal process[19] requires estimating the drug costs for the average patient, which for most chemotherapy drugs involves calculations based on expected BSA values
Summary
Body surface area (BSA), despite well-documented limitations, remains the most frequently used measure for calculating the dose of cytotoxic drugs in chemotherapy regimens[1,2]. The dosing of cytotoxic drugs has been based on the observation that physiologic variables related to drug metabolism and elimination, such as basal metabolic rate, renal function and hepatic function, vary between individuals according to surface area[3]. This type of dosing calculation has traditionally been thought to reduce the variability in drug exposure between patients. Each individual’s body/skin surface area was calculated and Du Bois and Du Bois determined that BSA was related to height and weight by the formula: weight (kg) 0.4256 height (cm) 0.7256 0.007184[7]. Several other formulae have since been put forward[8,9,10], none of these has gained widespread acceptance
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