Anemia is a widely prevalent complication among
cancer patients. At the time of diagnosis, 30% to 40% of patients with
non-Hodgkin lymphoma or
Hodgkin lymphoma and up to 70% of patients with
multiple myeloma are anemic; rates are higher among persons with
myelodysplastic syndromes. Among patients with solid
cancers or
lymphomas, up to half develop
anemia following
chemotherapy. For almost 2 decades,
erythropoiesis-stimulating agents (ESAs) were the primary treatment for
cancer-related
anemia. However, reassessments of benefits and risks of ESAs for
cancer-associated
anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the
cancer and
chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from
cancer patients seeking cure. Reimbursement is limited to
hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic
cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among
cancer patients.