Supportive Care in Cancer

, Volume 20, Issue 9, pp 2089–2096 | Cite as

Hematologic outcomes and blood utilization in cancer patients with chemotherapy-induced anemia (CIA) pre- and post-national coverage determination (NCD): results from a multicenter chart review

  • David H. HenryEmail author
  • Corey J. Langer
  • R. Scott McKenzie
  • Catherine Tak Piech
  • Mekré Senbetta
  • Kathy L. Schulman
  • Edward J. Stepanski
Original Article



In July 2007, the Centers for Medicare and Medicaid Services (CMS) limited coverage of erythropoiesis-stimulating agents (ESAs) in cancer patients with chemotherapy-induced anemia (CIA) through a National Coverage Determination (NCD). The primary objective of this study was to compare transfusion rates in patients with CIA with lung, breast, or colorectal cancer before and after the NCD.


Adult Medicare patients with CIA treated at 49 community oncology clinics were selected from two time periods based on clinics' NCD implementation date. Chart data were abstracted for 12 weeks post-CIA episode start, defined as hemoglobin (Hb) level <11 g/dL while receiving chemotherapy or within 60 days of the last chemotherapy dose. Multivariate analyses were used to calculate the odds of transfusion and to assess the units of blood transfused, controlling for differences in demographics, clinical history, and chemotherapy.


Eight hundred pre-NCD and 994 post-NCD patients from 49 sites were selected. Of the patients, 56% used ESAs post-NCD vs. 88% pre-NCD (p < 0.0001). The duration of ESA use decreased in the post-NCD (32.1 days) vs. pre-NCD (48.4 days, p < 0.0001) group. The post-NCD group reported significantly lower Hb levels, higher odds of receiving a transfusion (odds ratio: 1.41, 95% CI 1.05–1.89, p = 0.0238) and increased blood utilization of 53% (units transfused: OR 1.53, 95% CI 1.15–2.04, p = 0.0034).


Decreased frequency and duration of ESA administration were reported in the post-NCD vs. pre-NCD period. Findings were accompanied by a modest but statistically significant increase in transfusions and a decrease in Hb values.


Chemotherapy-induced anemia Erythropoiesis-stimulating agents Transfusions Hemoglobin 


Sources of support

This was an industry-sponsored study supported by Janssen Scientific Affairs, LLC.

Financial disclosures

David H. Henry: consulting and research support from Janssen Biotech, Inc.; Corey J. Langer: no conflicts; R. Scott McKenzie, Catherine Tak Piech, and Mekré Senbetta: employees of Janssen Scientific Affairs, LLC; Kathy L. Schulman: consulting support from Janssen Scientific Affairs, LLC; Edward J. Stepanski: no conflicts.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • David H. Henry
    • 1
    Email author
  • Corey J. Langer
    • 2
  • R. Scott McKenzie
    • 3
  • Catherine Tak Piech
    • 3
  • Mekré Senbetta
    • 3
  • Kathy L. Schulman
    • 4
  • Edward J. Stepanski
    • 5
  1. 1.Joan Karnell Cancer CenterPennsylvania HospitalPhiladelphiaUSA
  2. 2.University of PennsylvaniaPhiladelphiaUSA
  3. 3.Health Economics & Outcomes ResearchJanssen Scientific Affairs, LLCHorshamUSA
  4. 4.HealthcareThomson ReutersCambridgeUSA
  5. 5.ACORN Research, LLCMemphisUSA

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