Usage of erythropoiesis-stimulating agents in cancer patients at an academic cancer center and experience with specific care management tools for anemia

Backkground: In 2007, the US Food and Drug Administration (FDA) issued regulatory alerts for use of erythropoiesis-stimulating agents (ESAs) in cancer patients with anemia after clinical trials and meta-analysis data found that high ESA doses were associated with adverse outcomes in patients. In response to these findings, specific patient management tools for anemia (consisting in an algorithm and prescribing order set) were developed by a multidisciplinary team at The University of Texas MD Anderson Cancer Center. Methods: A retrospective study consisted of 7117 patients aged 18 years and older with cancer malignancies who had received an ESA between January 2006 and December 2008 at MD Anderson. Changes in utilization of ESAs and packed red blood cells (PRBCs) were evaluated. Results: The number of ESA doses dispensed each month decreased by 83% from January 2006 to December 2008 (P <.01), and the number of patients who received ESAs decreased by 80% (P <.01). The number of dispensed ESA doses for hemoglobin (Hb) levels ≥ 12 g/dL decreased significantly from 4% to 0% (P <.01), and the number for ≥ 10 g/dL decreased from 44% to 12% (P <.01). The PRBC transfusion rate remained stable in solid tumor patients (P >.05) but increased from 7% to 9% (P <.05) in patients with hematologic malignancies. Conclusions: The authors summarized their experience with use of ESAs in a tertiary oncology center. The implementation of their patient management tools for anemia might have facilitated the observed change at MD Anderson Cancer Center.