Jan. 5th, 2009

susanstinson: (Default)
According to reports on a recent study published in Gynecologic Oncology , fat women have the same survival rates for ovarian cancer as thinner women when their chemotherapy dosage is based on their actual weight, rather than on ideal weight.

Here's a quote from the MedPage Today summary:

All patients received chemotherapy administered according to their actual body weight. Often, chemotherapy is administered based on ideal weight, which may lead to insufficient doses for obese patients, according to the researchers. Emphasis mine.

I'm sitting here, breathing into my hands for a minute. Women, I don't know how many, have died because their treatment was based on the body that the culture insists they are supposed to have, rather than the bodies that they actually have. Fat women in our millions have been told that we bring a higher risk of death from ovarian cancer upon ourselves by being fat when that higher risk of death has been and is being caused by a failure to adjust treatment to the size that our bodies actually are.

And note that the action points in this article, addressed to doctors, involve two suggestions about explaining the study, but not the obvious suggestion that chemotherapy be administered based on actual body weight rather than on ideal weight.

Yes, of course, I absolutely would get on the scale at a doctor's office if it actually resulted in treatment that would benefit me rather than another follow-the-pointing-finger-dance-through the flamier regions of the BMI chart. The last time I was scheduled for minor surgery, the anesthesiologist called me the night before because he hadn't been given my file, and wanted to know if there was anything about me that he might need to know. That he thought to call me up made me respect him a lot. I gave him an accurate estimate of my weight. He was noticeably surprised, but made appropriate adjustments, and the surgery went well.

This seems so obvious and matter of course, but now it also seems that it doesn't routinely happen for patients receiving chemotherapy, and so more fat patients are dying.

And so more fat patients are dying.

I am so angry.

[livejournal.com profile] bearsir posted the first link I saw about this. ETA: There is also now a response from [livejournal.com profile] foamcore to bear's post that gives some useful medical context, and suggests a way to advocate for more research about the specific effects of drugs on fat people.

We have to advocate for ourselves and our loved ones. What else? What would change this practice? What would help?

ETA: [livejournal.com profile] nerd_dog pointed out that Kate Harding wrote a post about this today at salon.com. Although there is plenty of vituperation, some of the responses raise the point that fat sometimes responds to drugs differently than other tissue, and so sometimes it might be appropriate to dose based on "ideal" weight (although, to me, the use of this term is a pretty clear marker for bias), or on other things, such as skin surface, rather than weight. The news in this article seems to be that this is not the case with ovarian cancer. I don't have the skill or time to try to tease out bias from science here (although past experience would suggest that often there may be some of both in operation), but one point is clear: in terms of ovarian cancer, this study suggests that dosing should be based on actual weight. And, to this point, it often has not been.

And me, I feel reminded to ask careful, insistent questions about body size and dosing in relationship to healthcare.

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susanstinson

May 2009

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