Treatment patterns and outcomes in the management of anaemia in cancer patients in Europe: Findings from the Anaemia Cancer Treatment (ACT) study☆
Introduction
Anaemia is among the most prevalent side-effects of cancer and cancer treatment,1, 2 is associated with poor prognosis and outcomes3, 4, 5 and significantly impacts quality of life.6 According to the European Cancer Anaemia Survey (ECAS),2 in 2001 67.9% of cancer patients had haemoglobin [Hb] levels ⩽ 12 g/dl during a 6-month period. Only 38.9% of them were treated: 17.4% received an erythropoiesis-stimulating agent (ESA) (either alone or in combination with blood transfusion or iron supplementation), 14.9% were given blood transfusion (alone or in combination with iron) and 6.5% were treated with iron alone. In a recent French survey, physicians reported to treat 64% of patients with Hb ⩽ 12 g/dl with ESAs, yet 22% of patients did not receive any anaemia treatment at all.7
Given the benefits of ESAs but also the variability in treatment and outcomes, evidence-based guidelines have been proposed.8, 9, 10, 11, 12 These guidelines and the ECAS findings may explain the recent attention to anaemia in cancer patients. Whether this has translated into improved outcomes remains unknown.
ECAS was an epidemiological study of the epidemiology and treatment of anaemia in cancer patients. The Anaemia Cancer and Treatment (ACT) study13 focused on anaemic cancer patients treated with any ESA, treatment patterns, outcomes and response rates. ACT used the EORTC-recommended definition of anaemia of <11 g/dl, whereas in ECAS the threshold was <12 g/dl.
Section snippets
Methods
The background and methodology of ACT have been described in a separate background and methodology paper.13 Key points and deviations from the original methodology are reviewed below.
Patients
A total of 2807 patients were enrolled in the study and constituted the enrolment sample. To be considered evaluable, patients had to be of age 18 or older, with a type of cancer specified in the inclusion criteria, and ESA initiation at Hb ⩽ 11 g/dl. Only those with valid Hb values at visits 1 through 3 were retained in the analysis sample (see Fig. 1). Data reported here are for the European analysis subsample (N = 2192).
Table 1 presents patient demographics and clinical status at enrolment. The
Discussion
ECAS2 raised awareness about the issue of anaemia in cancer patients. Coupled with the subsequent publication of evidence-based guidelines8, 9, 10, 11, 12, there seems to have been an impact on ‘real world’ clinical practice in cancer in Europe. The low ESA treatment rate in 2001 (17.4%) increased almost fourfold (62.2%) over 4–6 years; though with the caveat that these rates were calculated at the patient level in ECAS but at the centre level in ACT. This article is the first report of
Contributions
Study design: H. Ludwig, M. Aapro, K. MacDonald, P. Soubeyran, M. Turner, I. Abraham.
Study implementation: K. MacDonald, M. Turner, T. Albrecht, I. Abraham.
Data management: K. MacDonald, T. Albrecht, I. Abraham.
Statistical analysis: H. Ludwig, M. Aapro, C. Bokemeyer, K. MacDonald, I. Abraham.
Interpretation of results: H. Ludwig, M. Aapro, C. Bokemeyer, K. MacDonald, P. Soubeyran, M. Turner, T. Albrecht, I. Abraham.
Critical review of manuscript: C. Bokemeyer, P. Soubeyran, M. Turner.
Writing
Conflict of interest statement
H.L., M.A., C.B., and P.S. have received compensation from F. Hoffmann-La Roche AG for professional and scientific services. M.T. is an employee of F. Hoffmann-La Roche AG. I.A., K.M., and T.A. are employees of Matrix45. By company policy, they are prohibited from owning equity in client organisations and performing independent duties for client companies. Matrix45 received consulting and research contracts from F. Hoffmann-La Roche AG to conduct the study. Matrix45 provides similar services to
Acknowledgements
This study was supported by research funding from F. Hoffmann-La Roche. We thank physicians, nurses and other staff for implementing the study; and Matthew Abraham and Kevin Jones for editorial, proofreading and manuscript preparation support.
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Support: The ACT study was supported by F. Hoffmann-La Roche AG (Basel, Switzerland).