Toxicity and tolerability of adjuvant breast cancer chemotherapy in obese women.

The purpose of this study was to compare toxicity rates and types between obese and non-obese women during adjuvant chemotherapy for breast cancer, adjusting for regimen type and received dose. We conducted a retrospective cohort study of 537 women receiving chemotherapy, initially treated between 2007 and 2010 at two tertiary hospitals in Brisbane, Australia. Demographic, chemotherapy and toxicity data were extracted from patient charts and analyzed using multivariate logistic regression. Three hundred and seventy-four women were eligible for inclusion. Obese women (body mass index (BMI) > 30 kg/m(2); mean age 52.58 ± 9.49) were older than non-obese women (BMI ≤ 29.9 kg/m(2); mean age 50.19 ± 11.15, P = 0.05) and had more comorbidities (P < 0.01). After adjustment for potential confounders, obesity was not statistically related to chemotherapy-related admission risk (OR 1.27; 95 % CI 0.78-2.09) or febrile neutropenia risk (OR 0.56; 95% CI 0.28-1.21). However, obese women received chemotherapy with proportionally lower mean relative dose intensity than non-obese women (94 vs. 97% of reference dose, P = 0.03). Eighteen (15.8%) obese and zero non-obese women (P < 0.01) had their chemotherapy dose capped at an arbitrary body surface area. Compared with non-obese women, obese women receive different chemotherapy regimens and relatively lower chemotherapy doses. There was no significant evidence of increased toxicity among obese women with either full or adjusted chemotherapy doses. Full body surface areas-based dosing appears to be tolerated as well in obese as in lean women.

Active intravascular rewarming for hypothermia associated with traumatic injury: early experience with a new technique.

Hypothermia is a significant contributor to mortality in severely injured patients. Rewarming is an enormous challenge, especially in those who require operative or angiographic intervention. In this patient population, external warming methods are only capable of reducing further heat loss, whereas active rewarming adds heat to the body's core but is invasive. This article analyzes our initial experience with a minimally invasive, continuous, automated, and easily portable intravascular rewarming technique using the Alsius Corporation's CoolGard system. The records of 11 hypothermic critically injured patients presenting to our level 1 trauma center over a 6-month period were reviewed. The patients' mean age was 39 +/- 22 years, 7 (64%) were male, and 7 (64%) had blunt mechanisms of injury. The mean injury severity score was 40 +/- 16, and the mean initial systolic blood pressure was 91 +/- 60 mm Hg. The mean core temperature at the initiation of rewarming was 33.6 +/- 1.0 degrees C, and the mean rewarming rate was 1.5 +/- 1.0 degrees C/h. Six patients died (55%), two of acute exsanguination and four of unsurvivable traumatic brain injuries. One patient developed a deep vein thrombosis at the femoral catheter site and experienced a nonfatal pulmonary embolus. Our experience demonstrates that active intravascular balloon-catheter rewarming represents a practical, automated technique for the immediate and continuous treatment of hypothermia in all phases of the acute care of trauma patients.