Abstract
Introduction: Patients undergoing chemotherapy frequently experience chemotherapy induced anemia, which is commonly treated with erythropoiesis stimulating agents (ESAs). However, patients undergoing chemotherapy may also have anemia due to other factors. This study describes how often a proper anemia workup was performed to ensure that the patient’s anemia is due to chemotherapy and not renal insufficiency or iron, B12, or folate deficiency, before administering ESAs in a community hematology-oncology practice of 8 physicians.
Patients and Methods: Medical charts of 278 cancer patients receiving chemotherapy between January and June 2007 who were also given injections of either darbepoetin alfa (Aranesp) or epoetin alfa (Procrit) during the same time period were reviewed. Abnormal levels for each measure were defined as follows: ferritin (under 100ng/mL), B12 (under 200pg/mL), folate (under 5ng/mL), creatinine (over 1.4mg/dL), reticulocyte count percentage (over 5%), C-reactive protein (over 5mg/dL), erythrocyte sedimentation rate (over 20mm), and erythropoietin (over 20mU/dL).
Results: N=278 Patients
| Test . | Performed . | Not Performed . | |
|---|---|---|---|
| . | Normal* . | Abnormal* . | . |
| *Percentages shown in these two columns indicate the percentage of patients in which the test result was normal or abnormal out of the patients who had the test performed. | |||
| Ferritin | 85.5% (136) | 14.5% (23) | 42.8% (119) |
| B12 | 96.4% (132) | 3.6% (5) | 50.7% (141) |
| Folate | 94.7% (126) | 5.4% (7) | 52.2% (145) |
| Reticulocyte count | 91.9% (125) | 8.1% (11) | 51.1% (142) |
| Creatinine | 89.1% (246) | 10.9% (30) | 0.7% (2) |
| C-reactive protein | 20.8% (5) | 79.2% (19) | 91.4% (254) |
| Erythrocyte sedimentation rate | 75% (3) | 25% (1) | 98.6% (274) |
| Erythropoietin | 28.9% (13) | 71.1% (32) | 83.8% (233) |
| Test . | Performed . | Not Performed . | |
|---|---|---|---|
| . | Normal* . | Abnormal* . | . |
| *Percentages shown in these two columns indicate the percentage of patients in which the test result was normal or abnormal out of the patients who had the test performed. | |||
| Ferritin | 85.5% (136) | 14.5% (23) | 42.8% (119) |
| B12 | 96.4% (132) | 3.6% (5) | 50.7% (141) |
| Folate | 94.7% (126) | 5.4% (7) | 52.2% (145) |
| Reticulocyte count | 91.9% (125) | 8.1% (11) | 51.1% (142) |
| Creatinine | 89.1% (246) | 10.9% (30) | 0.7% (2) |
| C-reactive protein | 20.8% (5) | 79.2% (19) | 91.4% (254) |
| Erythrocyte sedimentation rate | 75% (3) | 25% (1) | 98.6% (274) |
| Erythropoietin | 28.9% (13) | 71.1% (32) | 83.8% (233) |
Conclusion: We conclude that a significant number of patients do not have a proper anemia workup prior to ESA use (or before continued ESA after the first dose). In those patients who did, some laboratory results indicate that there may be another cause for the anemia, in addition to chemotherapy such as iron, B12, or folate deficiency, or renal insufficiency. Given the recent controversy over ESA use, it is particularly important to consider other treatment options prior to administering ESAs, especially given the cost-effectiveness of some of these treatments (FDA Alert: Erythropoietin Stimulating Agents 2006). Oncologists may want to consider identifying and treating other causes of anemia in their cancer patients on chemotherapy prior to, or in conjunction with, ESA use.
Disclosures: No relevant conflicts of interest to declare
Author notes
Corresponding author
