The issues of supportive care with hematopoietic colony stimulating factors are among the most controversial for hematologists and oncologists today. The major questions that have been identified previously for the hematopoietic colony stimulating factors (CSFs) G-CSF and GM-CSF (granulocyte colony stimulating factor and granulocyte macrophage colony stimulating factor) apply directly to erythropoietin. These questions include: under what conditions should erythropoietin be given prophylactically to prevent the development of anemia i.e. prior to chemotherapy and/or radiation therapy treatments that are likely to have high incidences of anemia; which regimens and agents are the most likely to require erythropoetin? If erythropoietin is given, what is the appropriate dose and schedule? Under what conditions should erythropoietin be given therapeutically among cancer patients who are anemic? What dose and schedule is optimal? What are the appropriate outcomes measures to be used in evaluating erythropoietin use? Are there predictive factors that can be used to identify a clinical situation or patient population that are most likely to benefit from erythropoietin use? How does EPO use vary according to patient factors (age, comorbidity, diagnosis, and prognosis) and physician factors (fee-for-service setting, managed care, or academic practice). While some of these issues will be addressed with the recently funded AHCPR effort carried out by the BC/BSA TEC program, others can only be addressed by reviewing medical records. Indirect evidence for physician responses to these queries can be obtained from physician responses to a mailed survey, an effort that is described in this small grant proposal to the AHCPR.
