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Patterns of Care in Community-Based Oncology Practices for Anemia Associated With Myelosuppressive Chemotherapy

University of California Los Angeles, Los Angeles; McKesson Specialty Care Solutions, San Rafael; ICON Clinical Research, Lifecycle Sciences Group, San Francisco; and Amgen, Thousand Oaks, CA

Corresponding author: Arash Naeim, MD,UCLA Medical Center, 10945 LeComte Ave, Ste 2333, Los Angeles, CA 90095; e-mail: anaeim{at}mednet.ucla.edu.

Purpose: Adherence to anemia guidelines may improve patient outcomes. The objectives of this retrospective analysis were to examine baseline guideline adherence and patient characteristics associated with receiving treatment for chemotherapy-induced anemia (CIA) in community-based oncology practices.

Methods: National guidelines at time of data collection, including those from ASCO, National Comprehensive Cancer Network, and McKesson Corporation (San Francisco, CA), were used to measure adherence. Guidelines recommended treatment with erythropoiesis-stimulating agents (ESAs) or transfusions when hemoglobin (Hb) levels were less than 11 g/dL or from 11 to 12 g/dL with presence of anemia symptoms or risk factors for development of symptomatic anemia. Medical records of patients age 18 years or older receiving myelosuppressive chemotherapy between June 2005 and August 2006 for multiple solid tumors, Hodgkin's lymphoma, or non-Hodgkin's lymphoma at 47 oncology practices were abstracted.

Results: There were 2,874 patients receiving chemotherapy (mean age, 62 years; 66% female). The most common malignancies were breast cancer (36.5%), non–small-cell lung cancer (19%), and colorectal cancer (18%). Treatment patterns in 2,175 (75.7%) of 2,874 patients followed guideline recommendations. In 310 patients (10.8%), treatment was not initiated when guidelines recommended it, and in 389 patients (13.5%), treatment initiated was inconsistent with guideline recommendations. Among patients for whom treatment was recommended, prior chemotherapy and lower Hb levels were associated with higher likelihood of receiving treatment. Patients with colorectal, breast, and head and neck cancer and non-Hodgkin's lymphoma were less likely than patients with other cancers to receive CIA treatment.

Conclusion: The majority of patients received treatment consistent with guidelines. Cancer type, prior chemotherapy, and lower Hb levels were associated with receiving CIA treatment among patients for whom treatment was recommended.

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Commentary: Do Guidelines Influence Physician Practice Behavior? The Experience With Erythropoiesis-Stimulating Agents

Marcus Neubauer, Roy A. Beveridge, and Michael Kolodziej
JOP 2009 5: 243-244. [Extract] [Full Text]  

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				M. Neubauer, R. A. Beveridge, and M. Kolodziej Commentary: Do Guidelines Influence Physician Practice Behavior? The Experience With Erythropoiesis-Stimulating Agents J. Oncol. Pract, September 1, 2009; 5(5): 243 - 244. [Full Text] [PDF]