Calculating and preparing chemotherapy can be a time-consuming task for the oncology pharmacist. In addition, administration of drugs based on the current standard of precise dosing can lead to the incomplete use of vials resulting in unused drug. Dose banding, or the standardization of injectable chemotherapy doses into a defined set of dose ranges or bands, has been suggested as an alternative approach to precise dosing. Rather than precise doses being based on body surface area (BSA) or other factors (eg, weight, age, contraindications), dose banding determines a standard, preprepared dose of chemotherapy based on predefined ranges.
The table of prdefined ranges, validated by prescribers or pharmacists, can either be drug-centered or BSA-centered.1 For example, if a patient’s dose falls between 1550 and 1700 mg (an example of a drug-centered dose band), the patient would receive a preprepared dose of 1625 mg. Alternatively, BSA-centered dose banding bases doses on BSA ranges rather than drug-dose ranges. Regardless of whether a drug-centered or BSA-centered table is used, the preprepared dose is usually within 5% of the precise dose. This preprepared dose of chemotherapy can either be purchased directly from the manufacturer or prepared by the hospital.2
Although dose banding has not been implemented in the United States, the practice is currently used abroad. Potential benefits include decreased outpatient waiting time and reduced drug waste, medication errors, and preparation time for administration.1,2 In addition, decreasing drug waste may help conserve drugs during times of shortages. Despite these potential benefits, however, questions remain regarding the safety and efficacy of drug doses determined by dose banding. To gain a better perspective on the potential use of dose banding, NCCN asked Audrea Szabatura, PharmD, BCOP, from Dana-Farber/Brigham and Women’s Cancer Center, her thoughts on dose banding and its potential implementation.
WilliamsonSfor the North of England Cancer Network. Guidelines for the dose banding of cancer chemotherapy: quality and safety for every patient every time. June2011. Available at http://cancernorth.nicktoye.co.uk/wp-content/uploads/2012/11/NECNdosebandingguidelinesversion1.41.pdf. Accessed February 19 2013.
SewellJ. The clinical impact of dose-banding. From the 2006 GERPAC conference. Available at http://www.gerpac.eu/spip.php?article289. Accessed February 19 2013.