The use of drugs to encourage red blood cell formation (erythropoiesis-stimulating agents) in cancer patients with anemia increases the risk of death and serious adverse events such as blood clots, found a new study in CMAJ.

While the relative increased risk of death was only 15 -16%, because of the high mortality rates in cancer patients this increase might translate into significant numbers of people.

"These findings suggest that erythropoiesis-stimulating agents should not be routinely used as an alternative to blood transfusion in patients with chemotherapy-induced anemia unless future studies document safety and clinical benefits in this population," write Dr. Marcello Tonelli from the University of Alberta and coauthors.

Anemia in cancer patients can develop because of the cancer itself or because of treatments such as chemotherapy. Treatment with agents to stimulate red blood cell formation has been widely used to improve quality of life for many patients and as an alternative to blood transfusions. However, these agents are expensive and reimbursement policies in Canada vary across provinces and territories.

The study, a meta-analysis of 52 clinical trials with 12,006 participants, was based on work done for the Canadian Agency for Drugs and Technologies in Health (CADTH) to summarize the benefits and harms of these agents in adults with cancer-related anemia.

The findings, which are consistent with studies from the United States and the United Kingdom, provide important information for clinicians treating cancer patients and for Canadian policy makers regarding drug reimbursement plans.

"Our findings suggest that existing practice guidelines should be revised to recommend against the routine use of erythropoiesis-stimulating agents as an alternative to blood transfusion in patients with cancer," conclude the authors. The authors add that erythropoiesis-stimulating agents may be warranted in situations where blood transfusions are not possible or practical.