Poor women apt to
get less chemotherapy

The less affluent, less educated, and less lean a breast cancer patient is, the more likely she is to receive lower doses of chemotherapy, reports a new study from the University of Rochester (N.Y.) Medical School.

Researchers examined data from 764 women in the Awareness of Neutropenia in Cancer Study Group Registry who have breast cancer and are just beginning chemotherapy. The standard chemotherapy dose was determined for each woman's height and weight and compared with the actual initial dose given. Receiving 85% or less of the expected amount was considered reduced. Actual education data and U.S. Census Bureau statistics were used to assign each woman a household income, poverty status, and level of schooling.

According to findings, published in a recent issue of the Journal of Clinical Oncology, doctors were more likely to lower the dose of chemotherapy for poor women. Severely obese patients were four times more likely to receive less and those without a high school diploma were three times more likely.

Researchers explain that, in the case of overweight women, doctors may be trying to avoid the side effects that stem from a high dose. Oncologists may also be anticipating treatment attitudes of patients from a lower socioeconomic class.

"We speculate that physicians have concerns about a patient's ability to tolerate the side effects of chemotherapy and that the physician's uncertainty about a patient's tolerance increases with increasing social distance," lead study author Jennifer Griggs, MD, MPH, now an associate professor of internal medicine at the University of Michigan Medical School, says in the article. "One might just as well ask why we are willing to give full doses to someone with more education. It may be that negotiating side effects and continued doses of treatment is easier when there is more shared culture."

Griggs's work is the first to look at chemotherapy and socioeconomic status. Reduced doses may impede the effectiveness of chemotherapy to prevent recurrence.

"I do not think it is the responsibility of the patient to ensure that she receives full weight-based doses, but physicians may be more comfortable dosing a patient fully when they are assured the patient is committed to her treatment," Griggs says. (The Advocate)