The group of drugs known as ESAs are apparently being used inappropriately in cancer patients, suggesting that the expensive treatments are being wasted and exposing patients unnecessarily to serious side effects, according to a new study in the Journal of Clinical Oncology.

Specifically, the meds were administered for no more than one week in 24 percent of patients, which is an insufficient amount of time to offer a useful benefit, according to the researchers (read the abstract). Moreover, nearly eight percent of the patients received one of the drugs for more than 14 weeks, while almost 14 percent were getting the drugs when they weren’t on chemotherapy.”

The meds are approved for cancer patients who are getting chemotherapy, and recommended treatment is between two and 14 weeks. The Center for Medicare & Medicaid Services spends more than $1 billion dollars annually on ESAs, which include Epogen and Aranesp, which are sold by Amgen; Procrit, which is sold by Johnson & Johnson, and Roche’s NeoRecormon.

“These are very expensive drugs and there are a fair number of side effects,” lead author Jason Wright of Columbia University Medical Center in New York tells Reuters. “You’re subjecting patients to potential toxicity for very little clinical benefit, so it is wasted resources.”

But as Reuters notes, benefits may be uncertain and could be mitigated by such side effects as blood clots and heart problems. In some cases, the drugs might even fuel tumor growth. “Over the last five years, we have been seeing many side effects that weren’t seen in the early clinical trials,” Wright says, noting the FDA issued a warning in 2007.

In reaching their conclusion, the researchers reviewed data on 21,000 Medicare beneficiaries who were 65 years or older with breast, lung, or colon cancer diagnosed between 1995 and 2005, and who had one ESA and chemotherapy claim.

Interestingly, they found that ESA misuse was associated with MD degree, female sex of physician, and earlier year of medical school graduation. Private practice physicians and high-volume physicians were less likely to use one week or less of ESA treatment. Treatment by high-volume oncologists and by oncologists who graduated from US medical schools predicted prolonged-duration ESA use, whereas female oncologists were less likely to prescribe prolonged ESA treatment. Private practice physicians and high-volume providers were more likely to prescribe more than 24 weeks of ESA treatment.

“The really important question now is whether it is still being used routinely, because that would be a real public health concern,” Thomas George, a cancer researcher at the University of Florida who was not involved in the study, tells Reuters. “There needs to be a fairly rigorous educational program that accompanies the use of these medications so doctors know who is going to benefit.”

benjamins pic thx to amagill on flickr