Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 20573
© 2008 American Society of Clinical Oncology

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Abstract

Evidence-based management of anemia in cancer patients: Validity of RESPOND, a web-based clinical guidance system based on the EORTC guidelines

Algemeen Stedelijk Ziekenhuis, Aalst, Belgium; Clinique de Genolier, Genolier, Switzerland; Matrix45, Earlysville, VA; Institut Bergonie & Universite Victor Segalen, Bordeaux, France; F. Hoffmann-La Roche, Basel, Switzerland; University of Virginia, Earlysville, VA; Roche, Brussel, Belgium; University of Arizona, University of Pennsylvania, Earlysville, VA

20573

Background: The EORTC has published evidence-based guidelines for the management of anemia using erythropoiesis- stimulating agents (ESA). We previously described background/validation methodology (Van Erps et al, ASCO 2007 abstr 19633) and content validity results (Foubert et al, ASCO 2007 abstr 19676) for the RESPOND system. Concurrent, discriminant, and predictive validity are reported here. Methods: 68 patients (2x34) matched by gender, cancer type, and treatment, and managed prior to (pre-cohort) and after introduction of the EORTC guidelines (post-cohort). Endpoint: congruence score (CS) with EORTC guidelines. Results: See Table 1 for CS results. Mean CS for the pre-cohort was 3.0 (SD=1.5; 95% CI 2.5–3.5), for the post-cohort 8.2 (SD=1.4, 95% CI 7.7–8.7). Concurrent validity was inferred from the high mean CS for post-cohort. Discriminant validity was inferred from the statistically significant difference between M±SD CSs for both cohorts (p<.00001) and higher likelihood of the post-cohort to have Hb 11g/dL (OR=3.6, 95% CI 1.1–11.8) and 12g/dL (OR=2.9, 95% CI 1.1–8.1). Predictive validity was inferred from significant Hb differences at each of the 4 visits and Hb from visit 1 to 4 (all at least p<.03), interaction effect for time and cohort (p=.006), regression slope coefficient of 0.3g/dL Hb increase for every 1 CS point increase, and CS predicting likelihood of Hb 11g/dL (OR=1.5, 95% CI 1.2–2.0) and 12g/dL (OR=1.5, 95% CI 1.2–1.8). Conclusions: RESPOND has now been shown to have content, concurrent, discriminant, and predictive validity. This validation study identified areas where web-based clinical guidance can improve guideline-adherent anemia management: ruling out or treating other causes of anemia, initiating ESA treatment, setting Hb target range, fixed initial dosing per ESA evidence, and achieving target range at 4–8wks; and where good practice is reinforced in terms of managing starting Hb levels at <9g/dL or between 11.0–11.9g/dL.

Author Disclosure

Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Roche Roche Roche