Faculty Collaboration Database

Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002-2008. Support Care Cancer 2012 Aug;20(8):1649-57

Date

09/22/2011

Pubmed ID

21935718

DOI

10.1007/s00520-011-1255-0

Scopus ID

2-s2.0-84863989608 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

PURPOSE: In 2007, growing concerns about adverse impacts of erythropoiesis-stimulating agents (ESAs) in cancer patients led to an FDA-mandated black box warning on product labeling, publication of revised clinical guidelines, and a Medicare coverage decision limiting ESA coverage. We examined ESA therapy in lung and colon cancer patients receiving chemotherapy in the VA from 2002 to 2008 to ascertain trends in and predictors of ESA use.

METHODS: A retrospective study employed national VA databases to "observe" treatment for a 12-month period following diagnosis. Multivariable logistic regression analyses evaluated changes in ESA use following the FDA-mandated black box warning in March 2007 and examined trends in ESA administration between 2002 and 2008.

RESULTS: Among 17,014 lung and 4,225 colon cancer patients, those treated after the March 2007 FDA decision had 65% (lung OR 0.35, CI(95%) 0.30-0.42) and 53% (colon OR 0.47, CI(95%) 0.36-0.63) reduced odds of ESA treatment compared to those treated before. Declines in predicted probabilities of ESA use began in 2006. The magnitude of the declines differed across age groups among colon patients (p = 0.01) and levels of hemoglobin among lung cancer patients (p = 0.04).

CONCLUSIONS: 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.

Author List

Tarlov E, Stroupe KT, Lee TA, Weichle TW, Zhang QL, Michaelis LC, Ozer H, Browning MM, Hynes DM

Author

Laura Michaelis MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Anemia
Chi-Square Distribution
Colonic Neoplasms
Female
Hematinics
Hemoglobins
Humans
Logistic Models
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Product Labeling
Registries
Retrospective Studies
United States
United States Food and Drug Administration
Veterans