Updating 1999 of Standards, Options and Recommendations (SOR) for the clinical use of erythropoietin in oncology

Context: The "Standard, Options and Recommandations" (SOR), started in 1993 , are a collaborative project between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve the qualit y of health care and outcomes for cancer patients. The methodology is based an literature review and critical appraisal by a multidisciplinary, expert s group, with feedback from specialits in cancer care delivery. The initial guidelines are bring updated in case of new evidence. Objectives: To updat e the clinical practice guideline [39] with definitions of new Standards, O ptions and Recommendations for the use of recombinant human erythropoietin (rHuEPO) in oncology. Methods: Data have been identified by literature sear ch using Medline. Current Contents. Embase, Cancerlit (march 1996-march 199 9). The main end points considered were hemoglobin level haematocrit, quali ty of life, transfusion requirements, incidence and length of hospital stay s, efficacy of cancer treatment, safety and costs. Once the guideline tons updated and defined, the document was submitted to 42 reviewers for peer re view, and to the medical committees of the 20 French Cancer Centres for rev iew and agreement. Results: The new key recommendations are: 1) The use of recombinant human erythropoietin in oncology is an alternative to treat che motherapy-induced anemia when the chemotherapeutic regimen contains platinu m; 2) Cancer-induced anemia reduces patients' quality of life. Treatment of anemia by tranfusions of erythropoietin may improve quality of life; 3) We recommend assessment of haemoglobin levels during radiation therapy and th e possible use of erythropoietin to optimise the efficacy of radiation ther apy; 4) Erythropoietin is effective in others pathologies (multiple myeloma , non-Hodgkin lymphoma, non-platinum based chemotherapy...) and also in ped iatric patients bur the risk/benefit ratio for anemia therapy (i.e. transfu sion or erythropoietin therapy) must be analysed for each individual; 5) We recommend an economic analysis of the need of erythropoietin within the co ntext of the french health care system.