title: Hemoglobin decline in chemotherapy patients prior to and after policy changes affecting use of erythropoiesis-stimulating agents: 2006-2009.
abstract: OBJECTIVE
  Since 2007, the use of erythropoiesis-stimulating agents (ESAs) to treat anemia in cancer patients receiving chemotherapy has been increasingly restricted in the USA. This study assessed hemoglobin (Hb) decline over time among chemotherapy patients.
  
  
  METHODS
  Episodes of chemotherapy care were identified in a large US-oncology electronic medical record database; weekly Hb levels were computed in the first 8 weeks. Unadjusted and adjusted proportions of patient-weeks with Hb decline>1 g/dl (i.e. representing clinically significant decline) within 1 or 2 weeks were analyzed.
  
  
  RESULTS
  Between 2006 and 2009, unadjusted proportions of patient-weeks with Hb decline>1 g/dl increased (1-week, from 12.7% to 14.9%; 2-week, from 19.3% to 26.3%). Adjusted 1-week proportions in 2007 were similar to 2006, but increased in 2008 (odds ratio [OR] 1.135; 95% confidence intervals [CI] 1.067, 1.208) and in 2009 (OR 1.235; 95% CI 1.094, 1.395). Adjusted 2-week proportions had the same pattern.
  
  
  CONCLUSIONS
  Since restrictions on ESA use were introduced in the USA, more patients have experienced a clinically significant Hb decline after chemotherapy initiation. Initiating anemia therapy at the earliest indicated opportunity may help reduce the risk of such declines.
authors.affiliation: IMS Health, 1 IMS Drive, Plymouth Meeting, PA 19462, USA. j.hill@us.imshealth.com
authors.forename: J W
authors.initials: JW
authors.lastname: Hill
authors.forename: Z
authors.initials: Z
authors.lastname: Cong
authors.forename: G
authors.initials: G
authors.lastname: Hess
authors.forename: N
authors.initials: N
authors.lastname: McGarvey
authors.forename: R J
authors.initials: RJ
authors.lastname: Nordyke
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics; D006454:Hemoglobins