title: Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002-2008.
abstract: OBJECTIVE
  In 2007, growing concerns about adverse impacts of erythropoiesis-stimulating agents (ESAs) in cancer patients led to an FDA-mandated black box warning on product labeling, publication of revised clinical guidelines, and a Medicare coverage decision limiting ESA coverage. We examined ESA therapy in lung and colon cancer patients receiving chemotherapy in the VA from 2002 to 2008 to ascertain trends in and predictors of ESA use.
  
  
  METHODS
  A retrospective study employed national VA databases to "observe" treatment for a 12-month period following diagnosis. Multivariable logistic regression analyses evaluated changes in ESA use following the FDA-mandated black box warning in March 2007 and examined trends in ESA administration between 2002 and 2008.
  
  
  RESULTS
  Among 17,014 lung and 4,225 colon cancer patients, those treated after the March 2007 FDA decision had 65% (lung OR 0.35, CI(95%) 0.30-0.42) and 53% (colon OR 0.47, CI(95%) 0.36-0.63) reduced odds of ESA treatment compared to those treated before. Declines in predicted probabilities of ESA use began in 2006. The magnitude of the declines differed across age groups among colon patients (p = 0.01) and levels of hemoglobin among lung cancer patients (p = 0.04).
  
  
  CONCLUSIONS
  Use of ESA treatment for anemia in VA cancer care declined markedly after 2005, well before the 2007 changes in product labeling and clinical guidelines. This suggests that earlier dissemination of research results had marked impacts on practice patterns with these agents.
authors.affiliation: Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave. (151H), Hines, IL 60141, USA. Elizabeth.Tarlov@va.gov
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tarlov
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Weichle
authors.forename: Qiuying L
authors.initials: QL
authors.lastname: Zhang
authors.forename: Laura C
authors.initials: LC
authors.lastname: Michaelis
authors.forename: Howard
authors.initials: H
authors.lastname: Ozer
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Browning
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006397:Hematinics / Q000009:adverse effects*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011356:Product Labeling; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D014728:Veterans
chemical_list: D006397:Hematinics; D006454:Hemoglobins