title: Use of erythropoietin in cancer patients: assessment of oncologists' practice patterns in the United States and other countries.
abstract: OBJECTIVE
  To assess physician use of erythropoietin in cancer patients before publication of the American Society of Clinical Oncology/American Society of Hematology guidelines.
  
  
  METHODS
  Questionnaires about erythropoietin use in practice and 12 hypothetical clinical scenarios involving patients with cancer were mailed to 2000 oncologists/hematologists in the United States and 19 other countries. Response rates were 30% in the United States and 25% internationally. Data on erythropoietin use for ovarian cancer were obtained from one clinical trial. Multivariate regression models assessed predictors of erythropoietin prescription.
  
  
  RESULTS
  Most physicians selected a hemoglobin level < or =10 g/dL as an upper threshold for erythropoietin use (36% to 51% of U.S. physicians and 21% to 32% of foreign physicians). Frequent erythropoietin use (defined as use in at least 10% of cancer patients) was higher in the United States than elsewhere (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5 to 13.4). Among U.S. physicians, those who said they used erythropoietin frequently were more likely to be in fee-for-service than managed care settings (OR = 2.2; 95% CI: 1.3 to 3.7). Those who reported never using erythropoietin practiced in countries that had lower annual per capita health care expenditures, lower proportions of privately funded health care, and a national health service (P <0.05 for all comparisons). Of 235 ovarian cancer patients who received topotecan, 38% (45/118) of U.S. patients and 2% (2/117) of European patients who developed grade 1 anemia (hemoglobin level between 10 and 12 g/dL) were treated with erythropoietin (P <0.01).
  
  
  CONCLUSIONS
  Financial considerations and a hemoglobin level <10 g/dL appear to influence erythropoietin use in the United States, whereas financial considerations alone determine erythropoietin use abroad.
authors.affiliation: Department of Veterans Affairs, the MidWest Center for Health Services and Policy Research and the Veterans Affairs Chicago Healthcare System/Lakeside Division, Chicago, Illinois, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Adams
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: James N
authors.initials: JN
authors.lastname: George
authors.forename: Barry C
authors.initials: BC
authors.lastname: Lembersky
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.forename: George D
authors.initials: GD
authors.lastname: Demetri
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016001:Confidence Intervals; D017046:Cost Savings / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D004363:Drug Utilization / Q000706:statistics & numerical data; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006452:Hemoglobinometry / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data; D008495:Medical Oncology / Q000191:economics / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000191:economics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis; D019772:Topotecan / Q000009:adverse effects / Q000627:therapeutic use; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D004921:Erythropoietin; D019772:Topotecan