Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002–2008

Tarlov, Elizabeth; Stroupe, Kevin T.; Lee, Todd A.; Weichle, Thomas W.; Zhang, Qiuying L.; Michaelis, Laura C.; Ozer, Howard; Browning, Margaret M.; Hynes, Denise M.

doi:10.1007/s00520-011-1255-0

Cited by 15 publications

(17 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Our results are consistent with prior studies showing decreases in ESA use [25][26][27][28][29][30] and increases in transfusion use 25,[27][28][29] following the ESA label change and subsequent NCD. Henry et al 27 showed that the number of ESA administrations per patient decreased from a mean of 4.6 to 2.9 following the NCD, nearly identical to our results.…”

Section: Discussionsupporting

confidence: 92%

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Gawade

Berlin

Henry

et al. 2017

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 92%

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Gawade

Berlin

Henry

et al. 2017

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…Insights from our study show the result of many potential causal changes in ESA use across a variety of insurance and patient types. A prior review of cancer patients with CIA identified decreased darbepoetin use following the 2006 Cochrane report of a 67% increase in VTE rate among patients who received an ESA 7 in Medicaid 16 and the Department of Veterans Affairs data 23 . Examination of the merged Surveillance Epidemiology and End Results‐Medicare databases attributed changes in ESA use for CIA to the 2007 Black Box warning, which occurred at a similar time to the decrease in darbepoetin use we report 15 .…”

Section: Discussionsupporting

confidence: 53%

“…A prior review of cancer patients with CIA identified decreased darbepoetin use following the 2006 Cochrane report of a 67% increase in VTE rate among patients who (a) ( c) received an ESA 7 in Medicaid 16 and the Department of Veterans Affairs data. 23 Examination of the merged Surveillance Epidemiology and End Results-Medicare databases attributed changes in ESA use for CIA to the 2007 Black Box warning, which occurred at a similar time to the decrease in darbepoetin use we report. 15 Analyses of Medicare data after the 2008 CMS decision restricting ESA use to cancer patients with hemoglobin levels less than 10 mg/dl showed increased risk of VTE.…”

Section: Resultsmentioning

confidence: 53%

End of an era for erythropoiesis‐stimulating agents in oncology

Schoen

Hoque

Witherspoon

et al. 2020

Intl Journal of Cancer

View full text Add to dashboard Cite

Erythropoiesis‐stimulating agents (ESAs) are available to treat chemotherapy‐induced anemia (CIA). In 2007–2008, regulatory notifications advised of venous thromboembolism and mortality risks while the Center for Medicare and Medicaid Services' restricted ESA initiation to patients with hemoglobin <10 g/dl. In 2010, a Risk Evaluation and Mitigation Strategies required consent prior to administration. We evaluated ESA utilization from 2003 to 2012 and obtained private health insurer claims data for persons with lung, colorectal, or breast cancer from 2001 to 2012. ESA use for CIA was determined by an ESA claim after chemotherapy, up to 6 months after treatment. We identified 839,948 commercially insured patients, including 24,785 patients with ESA‐treated CIA (3.2%). Darbepoetin use increased 3.9‐fold from 2003 to 2007 (12.3% to 48.7%) and then decreased 95% to 2.6% by 2012. Epoetin use decreased 90% from 2003 to 2012 (30.3% to 3.1%). Between 2003 and 2012, mean epoetin dosing decreased 0.8‐fold (244,979 in 2003 vs. 196,216 units in 2012), but increased 1.8‐fold for darbepoetin‐treated CIA (262 in 2003 to 467 μg in 2012). Among CIA patients, transfusions were low (4.5%) in 2002–2007, then increased 2.2‐fold between 2008 and 2012. Safety initiatives between 2007 and 2010 facilitated reductions in ESA use combined with changes in coverage. These data show the efficacy of regulatory efforts, publication of adverse events and changes in reimbursement in reducing use of ESAs. Future studies are warranted to optimize deimplementation strategies to improve patient safety.

show abstract

“…Among VA cancer patients, ESA use plateaued in late 2003 and sharply declined from 38% (2006) to 12% (2008) among colon cancer patients and from 23% (2006) to 5% (2008) among lung cancer patients. 10 Another study of cancer patients undergoing chemotherapy across 39 sites in seven states reported a decline from 41% to 30% between 10-month intervals before and after the 2007 FDA black-box warning. 12 Two studies of cancer patients treated at MD Anderson Comprehensive Cancer Center reported decreases in ESA use between 2006 and 2008 of 17% to 5% and 4% to 1%.…”

Section: Discussionmentioning

confidence: 99%

“…10–18 However, no information exists regarding trends in anemia treatment among patients with both ESRD and cancer.…”

Section: Introductionmentioning

confidence: 99%

Trends in Anemia Management in Hemodialysis Patients with Cancer

Butler

Kshirsagar²,

Olshan³

et al. 2015

Am J Nephrol

View full text Add to dashboard Cite

Background: Erythropoiesis-stimulating agents (ESAs), intravenous iron, and blood transfusion are used to treat anemia in both end-stage renal disease (ESRD) and cancer. However, anemia treatment patterns have not been described among ESRD patients undergoing hemodialysis with concurrent cancer, especially in the recent era of ESA-related safety concerns. Methods: We analyzed Medicare data from a cohort of hemodialysis patients diagnosed with incident cancer. We used multivariable generalized linear models to estimate trends and patterns in ESA use, iron use, transfusion use, epoetin alfa (EPO) dose, iron dose, and resulting hemoglobin levels (2000-2011). Results: Of 43,760 eligible patients, quarterly ESA use declined slightly from a peak of 94.1 to 90.0%. Quarterly EPO dose increased from 2000 to 2004, then declined; quarterly hemoglobin levels followed a similar pattern. Iron use increased rapidly from 46.9 to 79.3%. Iron dose increased until 2010 and then declined. There was an increase in the quarterly transfusion use (6.3-11.7%) and in the mean number of transfusion days per year (1.4-1.8). Anemia treatment patterns varied by demographic/clinical subgroups, especially among patients receiving chemotherapy, who required higher ESA use, EPO dose, and frequency of transfusions. Conclusions: Despite safety concerns about ESAs in both the ESRD and cancer populations, the proportion of hemodialysis patients with cancer who used ESAs between 2000 and 2011 remained extremely high. EPO dose and hemoglobin levels increased and then decreased. Iron use, iron dose, and transfusions increased substantially. Future research examining the risk-benefit profile of different anemia management strategies in the dialysis population with cancer is needed.

show abstract

Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002–2008

Abstract: Use of ESA treatment for anemia in VA cancer care declined markedly after 2005, well before the 2007 changes in product labeling and clinical guidelines. This suggests that earlier dissemination of research results had marked impacts on practice patterns with these agents.

Cited by 15 publications

References 32 publications

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

End of an era for erythropoiesis‐stimulating agents in oncology

Trends in Anemia Management in Hemodialysis Patients with Cancer

Contact Info

Product

Resources

About