Survey: Patients harmed by anemia drug policy

But the Centers for Medicare & Medicaid Services is skeptical of the poll and is sticking by its Medicare coverage decision.

By Dave Hansen, AMNews staff. Feb. 25, 2008.

Washington -- A new Medicare coverage policy on drug treatment for anemic cancer patients is hurting care, according to a survey of doctors released last month.

Ninety-one percent of oncologists and hematologists reported adverse patient events in the 12 weeks after the July 30 implementation of the national coverage determination on erythropoiesis-stimulating agents. The poll was sponsored by U.S. Oncology, which funds, develops, and helps manage 443 cancer centers in 39 states. It surveyed 307 physicians from Nov. 26, 2007, to Dec. 11, 2007. The organization limited the number of affiliated physicians involved in the poll to 20% of all respondents.

The most common event reported by doctors was a transfusion that could have been avoided if Medicare's old ESA coverage rules were still in place. Seventy-three percent of those surveyed said this problem had occurred. Sixty-five percent said they had a patient remain symptomatic for anemia despite sticking to the new ESA policy.

The Centers for Medicare & Medicaid Services decision limits ESA treatment to a maximum of eight weeks after a chemotherapy session. It also requires physicians to wait until hemoglobin levels drop below 10 g/dL before starting therapy.

The decision was prompted by preliminary evidence that use of the drugs, known as epoetin and darbepoetin, may result in strokes and heart attacks if used too readily in cancer patients with anemia from chemotherapy. The drugs also may make tumors worse, CMS concluded.