Community Oncology Explores Pitched Debate Over Anemia-Fighting Drugs

Scientists, oncologists, and critics explore whether ESA's are critical to quality of life or over-prescribed for profit.

Huntington, New York, 26 June 2007 — The June issue of Elsevier’s Community Oncology takes an in-depth look at the charge that ESAs, generally considered vital to cancer patients’ quality of life, are overprescribed for profit. Scientists, oncologists, and critics of oncologists are in a heated debate now over the use of ESAs, or erythropoiesis-stimulating agents—drugs that fight anemia by boosting levels of oxygen-carrying red blood cells and the protein hemoglobin.

Many cancer patients, suffering from fatigue and symptomatic anemia as side effects of their disease and its treatment, are prescribed ESAs—also known as EPO (epoetin alfa, or Procrit) and DARB (darbepoetin alfa, or Aranesp). New data—mostly from studies of off-label uses—on potentially dangerous side effects such as blood clots, and on survival rates, are prompting some scientists to recommend that the US Food and Drug Administration effectively curtail the use of ESAs. Adding fuel to this debate is the fact that the drugs are costly, and some critics have accused oncologists of overprescribing them, swayed by drug company rebates.

“The question is whether trained oncologists will be allowed to make the best clinical decision for each patient, or whether rationing—which isn’t based on scientific evidence but on an economic policy tug-of-war—becomes the standard,” says Lee S. Schwartzberg, MD, Editor-in-Chief of Community Oncology. “The current issue of the journal puts the debate in clear focus.”

ESAs are intensively studied medications. “After 15 years of well-designed clinical trials, we know that ESAs decrease the need for blood transfusions in cancer patients, increase hemoglobin, and improve quality of life in most patients with chemotherapy-induced anemia,” says David H. Henry, MD, an editor of Community Oncology. He adds, “It’s clear that these drugs cost too much and that any profit from reimbursement should be corrected. But when used on-label, ESAs are safe. Still, the recent studies give us pause. They suggest we need to review all the data in a fair and balanced way. There has been too much emotional distraction.”

The June issue of Community Oncology, which serves private practice-based clinicians, contains a point-counterpoint debate, an economic analysis of the cost of ESAs to practices, a report on toxicities from the RADAR project (Research on Adverse Drug Events And Reports) which closely monitors reports to the FDA on drug side effects, a review of ESA clinical studies, the point of view of a payer who plays a key role in ESA prescribing patterns, and a community oncology advocate who says that if insurers jump the gun on policy, both patients and practices could suffer. “It’s not an exaggeration to say that this controversy has serious implications for the future of cancer care in the United States,” notes Dr. Schwartzberg.

For more information on the June issue of Community Oncology, please visit

# # #

About Community Oncology
Community Oncology is a peer-reviewed journal distributed to 30,000 private practice-based oncologists, hematologists, oncology nurses, pharmacists, and practice administrators. Our mission is to provide practical information that enhances readers’ ability to deliver quality care. More than 80 percent of cancer patients today are treated by private practice community oncologists, and more than 60 percent of adult patients in clinical trials participate through their community oncologist’s office.

About Elsevier Oncology
Elsevier Oncology, a full-service publishing division of Elsevier, Inc., is dedicated to the advancement of cancer care by providing up-to-date information and educational resources to physicians, nurses, allied health professionals, and patients in the fight against cancer.Elsevier Oncology currently publishes the medical journals The Journal of Supportive Oncology (Medline Listed), Community Oncology, and The Oncology Report. Each publication circulates to 30,000 oncology professionals. Elsevier Oncology also publishes custom supplements to the journals.

In partnership with its sister company, Reed Medical Education, Elsevier Oncology develops and manages two annual conferences for oncology professionals: the Chicago Supportive Oncology Conference and the Community Oncology Conference.

Notes for Editors:
In the June issue of Community Oncology, see especially:

  • Having Your Say (an opinion column) Brian R. Klepper, PhD, founder of the Center for Practical Health Reform, writes that when oncologists accept rebates they’re in danger of compromising their medical judgment. (page 367)

  • In reply to this editorial, Linda D. Bosserman, MD, an editor of Community Oncology and a private practitioner in La Verne, California, along with her practice’s COO, Steve Balalian, explains that rebates are in fact subsumed by Medicare’s skewed reimbursement. (page 369)

  • Washington Update, In his column, Steve Coplon, of the advocacy group Community Oncology Alliance, explains in detail the economics of rebates and reimbursement by “running the numbers.” (page 419)

  • Controversies in Patient Care Dr. Henry reviews the data on ESAs and the fallout from Medicare and its proposed restrictions. (page 389)

  • Charles Bennett, MD, PhD, and his Northwestern University colleague Kara J. Gleason, outline the history of the controversy and its implications for the future. Dr. Bennett is the force behind the RADAR project: Research on Adverse Drug Events And Reports which closely monitors reports to the FDA on drug side effects. (page 390)

  • Ralph Boccia, MD, of Georgetown University in Washington, DC, and the Center for Cancer and Blood Disorders in Bethesda, Maryland, reviews several recent ESA studies. (page 392)

  • Lee Newcomer, MD, the oncology services leader at UnitedHealthcare in Minneapolis, explains how his insurance company plays a key role in ESA prescribing patterns. (page 393)

  • If insurers jump the gun on policy, patients and practices could suffer, says Dawn G. Holcombe, of Supportive Oncology Services and the Connecticut Oncology Association. (page 394)

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media Contact:
Randi Londer Gould , Managing Editor Community Oncology
+1 631-424-8900, X312