abstract
Trends in anemia treatment among patients with five non-myeloid
malignancies treated with chemotherapy in a large integrated health care
delivery system in California, 2000-2013
PURPOSE:
The
aim of this study is to examine treatment patterns for
chemotherapy-induced anemia (CIA) between calendar periods when the
changes in the US prescribing information, for
erythropoiesis-stimulating agents (ESAs) took place.
METHODS:
Patients diagnosed with breast, lung, colorectal,
ovarian, or gastric
cancer
(2000-2012) who developed grade 2+ CIA (hemoglobin (Hb) <10 g/dl)
were identified from Kaiser Permanente Southern California Health Plan.
We estimated the proportions of CIA episodes with ESA use, red blood
cell (RBC) transfusion, or prescription nutritional supplements in three
calendar periods: January 1, 2000-December 31, 2006 (P1), January 1,
2007-March 24, 2010 (P2), and March 25, 2010-June 30, 2013 (P3).....
RESULTS:
The
proportions of CIA episodes with ESA use were 28 % in P1, 21 % in P2,
and 3 % in P3. For RBC transfusion, they were 8 % in P1, 14 % in P2 and
16 % in P3. The trend of decreasing ESA use and increasing transfusion
use were statistically significant. Relative to P1, the odds ratio (OR)
was 0.69 (95% CI: 0.55, 0.86) for P2 and 0.08 (0.30, 0.88) for P3 for
ESA use. For RBC transfusion, OR was 2.00 (1.56, 2.56) for P2 and 2.37
(1.88, 3.00) for P3. Use of prescription nutritional supplement was rare
across calendar periods. There was a decreasing trend of Hb
concentration prior to ESA use (p value <0.01), but no difference in
Hb concentrations prior to transfusion.
CONCLUSION:
In the management of CIA, use of ESA has decreased over time, while use of RBC transfusion has increased.
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