Resource Utilisation and Time Commitment Associated with Correction of Anaemia in Cancer Patients Using Epoetin Alfa
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Resource Utilisation and Time Commitment Associated with Correction of Anaemia in Cancer Patients Using Epoetin Alfa The Editor Meehan and colleagues[1] set out to identify the resource use and time commitment associated with treatment of chemotherapy-induced anaemia with epoetin alfa therapy. Unfortunately, we believe that the authors failed to address this exact objective for the following reasons. The authors claimed that epoetin alfa is a resource-intensive treatment; however, the results of the study indicated that only about 12% of the total time commitment was directly related to the preparation, administration and documentation of epoetin alfa injection (tables II and III: anaemia correction injection total – mean 12.7 minutes; phlebotomy – mean 12.8 minutes; patients’ time involvement – mean 82.7 minutes); phlebotomy and patient traveling and waiting time, accounting for 88% of the time burden, were likely to be associated with cancer care, independent of epoetin alfa therapy. Medical visits for patients with cancer are primarily for the purposes of receiving chemotherapies and other oncology-related evaluations and treatments (e.g. immunosuppressive complications, marrow, liver and renal function check). For example, based on a national survey of over 15 000 cancer patients, Fortner et al.[2] reported that 29.7% of patients received chemotherapy once a week, 13.2% once every 2 weeks, and 36.8% once every 3 weeks. The authors also noted that a month prior to the survey, 60% of patients received colony-stimulating factors for chemotherapy-induced neutropenia. In other words, patients and clinics may have incurred some or all of this time burden even in the absence of epoetin alfa administration. Consequently, to validly evaluate
the time burden attributable to epoetin alfa treatment, one ought to focus on the proportion of clinic visits solely for receiving epoetin alfa. Furthermore, there are other important limitations of the study worthy of note. First, the authors described an office visit as a burden or unnecessary use of resource, but in fact a face-to-face interaction during an office visit can prove beneficial to the patient and caregiver by allowing for a review of physical findings and providing emotional support as patients progress through their treatment plans. A recent article further substantiated this notion, demonstrating that the effectiveness of an erythropoietic agent is valued far more importantly by both patients and clinicians than the frequency of office visits.[3] Second, the patient eligibility criteria were not described. Two patients were reportedly excluded from the study because they self-injected epoetin, which shows they still need to be seen in the clinic for other services with zero clinic time attributable to epoetin alfa injection. By excluding these patients, the authors overestimated the time commitment due to epoetin alfa therapy. Second, no data on darbepoetin alfa treatment was provided, thus, th
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