herapy dose because they do not want to give those patients the large dose that their weight would indicate. The motivation is to avoid potential severe and harmful side effects in their patients. For those patients of lower socioeconomic status, doctors may be anticipating the patient’s attitude toward treatment, the researchers suspect.

“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. 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,” says lead study author Jennifer Griggs, M.D., MPH, associate professor of internal medicine at the U-M Medical School. Griggs was at the University of Rochester in Rochester, N.Y., when she completed this research.

Previous studies have shown a connection between obesity and reduced chemotherapy doses. Griggs’ work is the first to look at socioeconomic status.

Reduced doses of chemotherapy may reduce its effectiveness in preventing breast cancer from returning. Women seeking treatment for breast cancer can advocate for full doses by indicating their commitment to treatment, Griggs suggests.

“A patient might say to her physician that she is fully committed to her treatment, and in particular, to full doses of chemotherapy. 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,” says Griggs, a member of the U-M Comprehensive Cancer Center.

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