Erythropoietic Agents in the
Management of Anemia in Patients
With Cancer:
Achievements and Challenges

CME Credit: Release Date—October 2003
Expiration Date—October 31, 2004

Lillian Nail, PhD, RN, FAAN
Professor and Senior Scientist
Oregon Health & Science University School of Nursing
Portland, Oregon
James Prudden


Anemia in people with cancer is not well understood and continues to be suboptimally treated. Anemia has a direct impact on patient-perceived quality of life (QOL), and diminished QOL can ultimately affect a patient’s willingness to continue cancer therapy. Conversely, studies show that a rise in hemoglobin level correlates with improved QOL. The management of anemia in patients with cancer has shifted dramatically over the past 2 decades. Transfusion, with its attendant risks for infection and transfusion reactions, is used less frequently, and clinical practice guidelines emphasize the importance of anemia correction with erythropoietic agents. Increasing evidence indicates a benefit of earlier intervention with erythropoietic agents and more flexible dosing regimens. In addition, a growing body of evidence suggests that erythropoietic agents may potentially reduce cognitive dysfunction related to chemotherapy and/or anemia, provide neuroprotection, and improve cancer treatment outcomes. This article reviews current data supporting the optimal use of erythropoietic agents, ie, epoetin alfa and darbepoetin alfa, in managing chemotherapy-induced anemia—an issue of utmost importance to patients experiencing the debilitating effects of this condition.

This educational activity is intended for physicians, pharmacists, and nurses involved in the management of patients with cancer.

Upon completion of this activity, the participant should be able to:

Discuss the evolution of management strategies for chemotherapy-induced anemia over the last 20 years
Assess the relationships between anemia, fatigue, and quality of life in cancer patients
Evaluate the role that erythropoietic agents play in the treatment of anemia
Incorporate appropriate assessment and treatment strategies for patients with chemotherapy-induced anemia into clinical practice

This activity should take approximately 1 hour to complete. The participant should, in order, read the objectives and monograph, answer the online multiple-choice post-test, and complete the online answer form, registration, and evaluation at the end of this activity. This credit is valid through October 31, 2004.


This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and McMahon Publishing Group. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.


This educational activity contains discussion of published and/or investigational uses of darbepoetin alfa and epoetin alfa; some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


All faculty members participating in continuing medical education programs jointly sponsored by the University of Kentucky Colleges of Pharmacy and Medicine Continuing Education Office are expected to disclose any real or perceived conflict of interest related to the content of their presentations.

Dr. Nail is a member of the speaker’s bureau for Ortho Biotech Products, LP. She is a member of the DOSE Study Advisory Committee for Ortho Biotech Products, LP, and is on the Board of the National Anemia Council (grant funding from Amgen Inc).

This monograph was drafted by James Prudden, who has no relationships to disclose. The content of this activity was controlled and approved by the faculty.

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Jointly sponsored by the University of Kentucky College of Medicine and McMahon Publishing Group.

This activity is supported through an unrestricted educational grant from Ortho Biotech Products, LP.

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