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Clinicians Face Challenges in the Management of Cancer-Related Anemia

By Edward C. Li, PharmD, BCOP, Manager, Oncology Pharmacy

The management of anemia in patients with cancer presents challenges from a clinical, operational, and economic perspective.  Over the past several years, new paradigms have emerged for the treatment of cancer- and chemotherapy-induced anemia, specifically regarding the use of blood transfusions, erythropoiesis stimulating agents (ESAs), and iron supplementation.  In a recent report by NCCN, which will be featured this fall in a Special Pharmacy Edition of JNCCN — Journal of the National Comprehensive Cancer Network, these clinical and operational issues are examined and recommendations and best practices to address these areas are considered.

The management of blood products is a priority for NCCN Member Institutions (as well as other institutions), as they are associated with risks and significant monetary cost. The report details an NCCN Member Institution’s initiative to reduce the use of blood products, which resulted in a decrease in the total cost of blood products from $12.2 million to $9.8 million, a savings of $2.4 million over the course of three years.  Results from a survey of NCCN Member Institutions regarding practice patterns and policies for the use of blood products are also included in the report. 

The use of ESAs in the management of cancer-related anemia is a major challenge for clinicians in this changing landscape.  Recent modifications to both clinical and reimbursement models have limited the use of these agents in the United States and ultimately lead to the Food and Drug Administration (FDA) requiring ESAs to have a Risk Evaluation and Mitigation Strategy(REMS).  According to a recent NCCN Trends™ Survey, clinicians in the United States report an overall decrease in the use of ESAs over the past two years; conversely, international respondents report an overall increase or no change in ESA use during that same time period.  NCCN previously reported a more detailed summary of these results.  An interesting finding, further described in the report, is that utilization of supplemental iron and blood products appears to have increased in light of recent restrictions on ESA use. 

A survey of NCCN Member Institutions Pharmacy Directors intended to identify patterns and challenges for the use of ESAs and blood products is detailed in the report.  Further, the NCCN Pharmacy Directors provide their insights on the current practice of iron supplementation in patients with cancer-related anemia and barriers to adequate supplementation. 

The first issue of the Special Pharmacy Edition of JNCCN will contain a clinical case study, an update on the status of managed care in oncology, the NCCN Risk Evaluation and Mitigation Strategies (REMS) white paper, and additional articles.  To ensure receipt of this special edition of JNCCN, please contact us