To help mark the 10th volume of JNCCN, I was asked to comment on the evolution of anemia management for patients with cancer over the past decade. I joined the panel for the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer- and Chemotherapy-Induced Anemia during its early years and have chaired it since 2004. Major changes in the NCCN Guidelines on anemia over the years have focused on 2 topics: erythropoiesis-stimulating agent (ESA) safety and the increasing use of intravenous iron therapy to treat the functional iron deficiency of these patients.
The latter half of the past decade was a turbulent time for the management of anemia from cancer and chemotherapy. A review of the published versions of the NCCN Guidelines for Cancer- and Chemotherapy-Induced Anemia from 2002 to 2012 reveals reasonably consistent recommendations from 2002 to 2006 (to view the most recent version of these guidelines, visit the NCCN Web site at NCCN.org). During those 5 years, 8 versions of the NCCN Guidelines were published on NCCN.org, with no more than 2 updates in any year. Over the next 5 to 6 years, however, significant controversy about ESA safety and restrictions on ESA use led to 12 Guidelines versions between 2007 and 2011. Figure 1 presents a timeline of significant events as chronicled by the NCCN Guidelines on anemia related to ESA safety and intravenous iron therapy.
I thank the numerous members of the NCCN Guidelines Panel for Cancer- and Chemotherapy-Induced Anemia over the past decade who contributed to writing and improving the NCCN Guidelines. I gratefully acknowledge the assistance of the NCCN staff who were invaluable in producing the NCCN Guidelines, and thank Jeff Gilreath for reviewing this manuscript.
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