Use of Epoetin in Patients With Cancer: Evidence-Based Clinical Practice Guidelines of the American Society of Clinical Oncology and the American Society of Hematology
Anemia resulting from cancer, or its treatment, is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin. To address uncertainties regarding indications and efficacy, the American Society of Clinical Oncology and the American Society of Hematology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. The guideline panel found good evidence to recommend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin level less than 10 g/dL. Use of epoetin for patients with less severe anemia (hemoglobin < 12 g/dL but never below 10 g/dL) should be determined by clinical circumstances. Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly (150 U/kg tiw) for a minimum of 4 weeks. Less strong evidence supports an alternative weekly (40,000 U/wk) dosing regimen, based on common clinical practice. With either administration schedule, dose escalation should be considered for those not responding to the initial dose. In the absence of response, continuing epoetin beyond 6 to 8 weeks does not appear to be beneficial. Epoetin should be titrated once the hemoglobin concentration reaches 12 g/dL. Evidence from one randomized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodysplasia not receiving chemotherapy; however, there are no published high-quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy. Therefore, for anemic patients with hematologic malignancies, it is recommended that physicians initiate conventional therapy and observe hematologic response before considering use of epoetin.
About the book;
After reading the chapters in the book, I felt a sense of satisfaction. I felt that a lot of the things that the author outlined as points of interest were things that I did already. Myself as a student nurse though is different than a floor nurse with 5-6 other patients. I realize that the strain of workload may interfere with spending more time at the bedside and less behind a stack of paperwork. I do think one area I would change would be to place more emphasis on empathy. It can be hard sometimes to put yourself in other peoples shoes but it remains a corner stone of nursing. Sometimes you must slow down and take a more human, holistic approach to patients and their needs. This is a touching story and really makes you feel a sense of pride to be able to help those who need it most.
1. References for evidence based article: J. Douglas Rizzo,
2. Alan E. Lichtin,
3. Steven H. Woolf,
4. Jerome Seidenfeld,
5. Charles L. Bennett,
6. David Cella,
7. Benjamin Djulbegovic,
8. Matthew J. Goode,
9. Ann A. Jakubowski,
10. Stephanie J. Lee,
11. Carole B. Miller,
12. Mark U. Rarick,
13. David H. Regan,
14. George P. Browman and
15. Michael S. Gordon
+ Author Affiliations
1. From the Medical College of Wisconsin, Milwaukee, WI; Cleveland Clinic Foundation, Cleveland, OH; Virginia Commonwealth University, Richmond, VA; Blue Cross and Blue Shield Association Technology Evaluation Center and Veterans Affairs Chicago Health Care System, Chicago; Evanston Northwestern Healthcare, Evanston, IL; H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL; patient representative, Mesa; University of Arizona Health Sciences Center, Phoenix, AZ; Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Saint Agnes Hospital, Baltimore, MD; NW Kaiser Permanente and Northwest Cancer Specialists, Portland, OR; and Hamilton Regional Cancer Center, Hamilton, Ontario, Canada.
Address reprint requests to American Society of Clinical Oncology, Health Services Research Department, 1900 Duke St, Suite 200, Alexandria, VA 22314; email: guidelines@asco.org.
Anemia resulting from cancer, or its treatment, is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin. To address uncertainties regarding indications and efficacy, the American Society of Clinical Oncology and the American Society of Hematology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. The guideline panel found good evidence to recommend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin level less than 10 g/dL. Use of epoetin for patients with less severe anemia (hemoglobin < 12 g/dL but never below 10 g/dL) should be determined by clinical circumstances. Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly (150 U/kg tiw) for a minimum of 4 weeks. Less strong evidence supports an alternative weekly (40,000 U/wk) dosing regimen, based on common clinical practice. With either administration schedule, dose escalation should be considered for those not responding to the initial dose. In the absence of response, continuing epoetin beyond 6 to 8 weeks does not appear to be beneficial. Epoetin should be titrated once the hemoglobin concentration reaches 12 g/dL. Evidence from one randomized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodysplasia not receiving chemotherapy; however, there are no published high-quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy. Therefore, for anemic patients with hematologic malignancies, it is recommended that physicians initiate conventional therapy and observe hematologic response before considering use of epoetin.
About the book;
After reading the chapters in the book, I felt a sense of satisfaction. I felt that a lot of the things that the author outlined as points of interest were things that I did already. Myself as a student nurse though is different than a floor nurse with 5-6 other patients. I realize that the strain of workload may interfere with spending more time at the bedside and less behind a stack of paperwork. I do think one area I would change would be to place more emphasis on empathy. It can be hard sometimes to put yourself in other peoples shoes but it remains a corner stone of nursing. Sometimes you must slow down and take a more human, holistic approach to patients and their needs. This is a touching story and really makes you feel a sense of pride to be able to help those who need it most.
1. References for evidence based article: J. Douglas Rizzo,
2. Alan E. Lichtin,
3. Steven H. Woolf,
4. Jerome Seidenfeld,
5. Charles L. Bennett,
6. David Cella,
7. Benjamin Djulbegovic,
8. Matthew J. Goode,
9. Ann A. Jakubowski,
10. Stephanie J. Lee,
11. Carole B. Miller,
12. Mark U. Rarick,
13. David H. Regan,
14. George P. Browman and
15. Michael S. Gordon
+ Author Affiliations
1. From the Medical College of Wisconsin, Milwaukee, WI; Cleveland Clinic Foundation, Cleveland, OH; Virginia Commonwealth University, Richmond, VA; Blue Cross and Blue Shield Association Technology Evaluation Center and Veterans Affairs Chicago Health Care System, Chicago; Evanston Northwestern Healthcare, Evanston, IL; H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL; patient representative, Mesa; University of Arizona Health Sciences Center, Phoenix, AZ; Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Saint Agnes Hospital, Baltimore, MD; NW Kaiser Permanente and Northwest Cancer Specialists, Portland, OR; and Hamilton Regional Cancer Center, Hamilton, Ontario, Canada.
Address reprint requests to American Society of Clinical Oncology, Health Services Research Department, 1900 Duke St, Suite 200, Alexandria, VA 22314; email: guidelines@asco.org.
