Luo Weixiu, Nordstrom Beth L, Fraeman Kathy, Nordyke Robert, Ranganathan Gayatri, Linz Heather E, Winterkorn Anna, Stokes Michael, Ross Susan D, Knopf Kevin
United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington Office Park, Lexington, MA 02420, USA.
Clin Ther. 2008 Dec;30(12):2423-35. doi: 10.1016/j.clinthera.2008.12.022.
Chemotherapy-induced anemia (CIA) commonly occurs in cancer patients receiving conventional myelosuppressive chemotherapy. Two national guidelines regarding the use of erythropoiesis-stimulating agents (ESAs) in CIA were released in 2002. Because of poorer disease outcomes and increased risk of adverse events associated with ESAs in recent studies, the use of ESAs has been increasingly restricted in practice guidelines in the years 2007 and 2008.
The aim of this study was to provide a baseline for adherence to national guidelines in the use of ESAs for CIA between 2002 and 2006.
This retrospective study used the Varian Medical Oncology database (Varian Medical Systems, Inc., Palo Alto, California) of electronic medical records, representing 17 outpatient oncology organizations at 71 clinic locations in the United States. Adults diagnosed with any malignant neoplasm who started conventional cytotoxic chemotherapy between January 1, 2002, and September 30, 2006, were included. The proportion of patients receiving an ESA was calculated by hemoglobin (Hb) level during each chemotherapy cycle, stratified by line of chemotherapy and year. Logistic regression modeling identified predictors of ESA use in anemic patients during the first chemotherapy cycle.
The records of 17,731 cancer patients were evaluated. Median (SD) age was 61 (13) years, and 58.9% were female. Most patients (84.1%) had a solid tumor. Many patients (41.3%) received platinum containing chemotherapy and 74.4% received combination chemotherapy. During the first 5 cycles of first-line chemotherapy among patients with CIA (Hb <11 g/dL), ESAs were used by 55.8% of patients at cycle 1 and 68.9% at cycle 5. ESA use in CIA patients increased across lines of chemotherapy and time. Few patients (2.8%) received an ESA at Hb >13 g/dL. The statistically significant predictors of ESA use included age >65 years, eastern US residence, private health insurance, community-based care, and solid tumors, especially lung cancer.
The patterns we observed were generally consistent with prevailing ESA labels and national guidelines during 2002 through 2006. Although ESA use in patients with CIA increased over chemotherapy cycles, lines of chemotherapy, and time, <70% of CIA episodes were treated with ESAs during the initial 5 chemotherapy cycles.
化疗所致贫血（CIA）常见于接受传统骨髓抑制性化疗的癌症患者。2002年发布了两项关于在CIA中使用促红细胞生成素（ESA）的国家指南。由于近期研究中疾病预后较差以及与ESA相关的不良事件风险增加，在2007年和2008年的实践指南中，ESA的使用受到越来越多的限制。
本研究的目的是为2002年至2006年期间CIA患者使用ESA时遵循国家指南情况提供基线数据。
这项回顾性研究使用了Varian医疗肿瘤学数据库（Varian医疗系统公司，加利福尼亚州帕洛阿尔托）中的电子病历，该数据库代表了美国71个诊所地点的17个门诊肿瘤学机构。纳入2002年1月1日至2006年9月30日期间开始接受传统细胞毒性化疗的成年恶性肿瘤患者。按化疗疗程和年份分层，计算每个化疗周期中根据血红蛋白（Hb）水平接受ESA治疗的患者比例。逻辑回归模型确定了首次化疗周期中贫血患者使用ESA的预测因素。
对17731例癌症患者的记录进行了评估。中位（标准差）年龄为61（13）岁，58.9%为女性。大多数患者（84.1%）患有实体瘤。许多患者（41.3%）接受含铂化疗，74.4%接受联合化疗。在CIA患者（Hb<11g/dL）的一线化疗的前5个周期中，第1周期55.8%的患者使用了ESA，第5周期为68.9%。CIA患者中ESA的使用随着化疗疗程和时间的推移而增加。很少有患者（2.8%）在Hb>13g/dL时接受ESA治疗。使用ESA的统计学显著预测因素包括年龄>65岁、居住在美国东部、拥有私人医疗保险、社区护理以及实体瘤，尤其是肺癌。
我们观察到的模式总体上与2002年至2006年期间现行的ESA标签和国家指南一致。尽管CIA患者中ESA的使用在化疗周期、化疗疗程和时间上有所增加，但在最初的5个化疗周期中，<70%的CIA发作接受了ESA治疗。
