Shared decision-making stressed, with deeper understanding of risks-- Monica Smith
Wednesday, October 27, 2010 (Last Updated: 10/28/2010)
WEDNESDAY, Oct. 27 (HealthDay News) -- A joint committee of the American Society of Hematology and the American Society of Clinical Oncology has published an updated guideline for the use of erythropoiesis-stimulating agents (ESAs) in cancer patients with chemotherapy-induced anemia. The guideline was published online Oct. 25 in both Blood and the Journal of Clinical Oncology.
J. Douglas Rizzo, M.D., of the Medical College of Wisconsin in Milwaukee, and colleagues analyzed all relevant literature published since the guideline was last updated in 2007. Their objective was to guide physicians in the use of the drugs, which are associated with risk of blood clots and shorter survival, but also to reduce the need for red blood cell transfusions.
The update recommends that clinicians discuss the potential harms and benefits of ESAs compared with the potential harms and benefits of red blood cell transfusions with patients undergoing myelosuppressive chemotherapy who have a hemoglobin level of less than 10 g/dL. The researchers did not find evidence to support hemoglobin levels equal to or greater than 10 g/dL as a threshold of initiation of treatment or as targets for ESA therapy, and recommend that if they must be used, to start at the lowest dose possible. Recommendations for initiation and modification of the drugs are consistent with U.S. Food and Drug Administration-approved labeling.
"This updated guideline offers clinicians the latest synthesis of the medical evidence surrounding use of ESAs in patients with cancer, including appropriate cautions where evidence is lacking or where risks may outweigh the use of ESAs," Rizzo said in a press release.
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