European guidelines for the management of chemotherapy-induced anaemia and health economic aspects of treatment.
Patients with cancer receiving myelosuppressive chemotherapy frequently develop anaemia; platinum-based chemotherapy, in particular, leads to reduced production of the bone marrow-stimulating hormone erythropoietin. The European Cancer Anaemia Survey showed that many patients do not receive erythropoiesis-stimulating agent (ESA) therapy and highlighted the need for clear guidelines for the diagnosis and treatment of anaemia in cancer patients. In response to a fast-moving therapeutic environment and guidelines produced in the USA, the European Organisation for Research and Treatment of Cancer established an independent task force to develop evidence-based guidelines for the use of ESAs in European anaemic cancer patients that were first published in 2004. The guidelines recommend that, in patients receiving chemotherapy/radiotherapy, ESA therapy should be initiated at haemoglobin levels of 9-11 g/dL based on the severity of symptoms (target haemoglobin concentration: 12-13 g/dL) to improve quality of life and prevent the need for red blood cell transfusions. Treatment should be maintained as long as Hb levels remain <12-13 g/dL and patients continue to show symptomatic improvement, and should be discontinued, due to marginally elevated risks of thromboembolic events, when haemoglobin levels exceed 14 g/dL. Treatment of anaemia with ESAs is cost-effective and is associated with long-term gains in quality-adjusted life years.
Repetto
Lazzaro
L
Istituto Nazionale di Riposo e Cura per Anziani, Unita Operativa di Oncologia, Via Cassia 1167, Rome 00189, Italy. l.repetto@inrca.it
Moeremans
Karen
K
Annemans
Lieven
L
D026683:Advisory Committees; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D005060:Europe; D019317:Evidence-Based Medicine; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D014481:United States
D000970:Antineoplastic Agents; D006397:Hematinics; D006454:Hemoglobins