title: Trends in anemia treatment among patients with five non-myeloid malignancies treated with chemotherapy in a large integrated health care delivery system in California, 2000-2013.
abstract: The aim of this study is to examine treatment patterns for chemotherapy-induced anemia (CIA) between calendar periods when the changes in the US prescribing information, for erythropoiesis-stimulating agents (ESAs) took place.
  
  
  
  Patients diagnosed with breast, lung, colorectal, ovarian, or gastric cancer (2000-2012) who developed grade 2+ CIA (hemoglobin (Hb) <10 g/dl) were identified from Kaiser Permanente Southern California Health Plan. We estimated the proportions of CIA episodes with ESA use, red blood cell (RBC) transfusion, or prescription nutritional supplements in three calendar periods: January 1, 2000-December 31, 2006 (P1), January 1, 2007-March 24, 2010 (P2), and March 25, 2010-June 30, 2013 (P3). Multivariable regressions were used to test the differences of CIA treatment approaches and Hb concentration prior to CIA treatment across these calendar periods.
  
  
  
  The proportions of CIA episodes with ESA use were 28 % in P1, 21 % in P2, and 3 % in P3. For RBC transfusion, they were 8 % in P1, 14 % in P2 and 16 % in P3. The trend of decreasing ESA use and increasing transfusion use were statistically significant. Relative to P1, the odds ratio (OR) was 0.69 (95% CI: 0.55, 0.86) for P2 and 0.08 (0.30, 0.88) for P3 for ESA use. For RBC transfusion, OR was 2.00 (1.56, 2.56) for P2 and 2.37 (1.88, 3.00) for P3. Use of prescription nutritional supplement was rare across calendar periods. There was a decreasing trend of Hb concentration prior to ESA use (p value <0.01), but no difference in Hb concentrations prior to transfusion.
  
  
  
  In the management of CIA, use of ESA has decreased over time, while use of RBC transfusion has increased.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd floor, Pasadena, CA, 91101, USA.
authors.forename: Lanfang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Hairong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd floor, Pasadena, CA, 91101, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cannavale
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd floor, Pasadena, CA, 91101, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Sattayapiwat
authors.affiliation: Department of Hematology Oncology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Page
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd floor, Pasadena, CA, 91101, USA. chun.r.chao@kp.org.
authors.forename: Chun
authors.identifier: 0000-0002-6072-4954
authors.initials: C
authors.lastname: Chao
mesh_terms: D000328:Adult; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002140:California; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics
keywords: Chemotherapy-induced anemia (CIA); Erythropoiesis-stimulating agents (ESA); Supportive care; Transfusion