Last Monday, the Centers for Medicare and Medicaid Services relaxed some of the limits that it had proposed in May for the use of anemia drugs in cancer patients, in the face of an outcry from cancer patients and their physicians.

However, CMS said it is still going to deny payment for drugs like Aranesp and Epogen from Amgen and Procrit from Johnson & Johnson if a patient's hemoglobin level is greater than 10 grams per deciliter. Physicians generally aim for a hemoglobin level of 10 to 12 g/deciliter in their cancer patients. Normal range is 12 to 18 g/deciliter.

Amgen is challenging this new limit, saying that such a limit will increase the need for blood transfusions. The company also noted such limits contradict the FDA's approved labeling for the drugs.

June's issue of Community Oncology explores the debate over the use of ESAs (erythropoiesis-stimulating agents).

ESAs are anemia drugs that increase the level of oxygen-carrying red blood cells and the protein hemoglobin. They are used by many cancer patients to fight fatigue and anemia, which occur either as a direct result of their disease or their treatments. The ESAs include EPO (epoetin alfa, or Procrit) and DARB (darbepoetin alfa, or Aranesp).

New data has come out on potentially dangerous side effects of these drugs including blood clots. These drugs are also very costly and some critics have accused oncologists of overprescribing them, swayed by rebates from pharmaceutical companies.

Medicare is currently reviewing their reimbursement policy for the use of these drugs to possibly limit coverage. According to David H. Henry, MD, FACP, and editor of Commmunity Oncology, if this new reimbursement policy is enacted, it would eliminate the use of almost 90% of ESAs in oncology.

Doctors prescribing anemia drugs for patients with kidney disease and cancer were urged by the Food and Drug Administration (FDA) on Friday to carefully dispense of these drugs due to an increased risk of death and other serious problems, such as blood clots, strokes, and heart attacks in patients with chronic kidney failure and rapid tumor growth in patients with head and neck cancer who receive doses higher than recommended.

The potentially harmful drugs, sold under than brand names Procrit, Epogen, and Aranesp, are genetically engineered versions of a natural protein -- called erythropoietin -- that increases the number of red blood cells. The drugs, with combined 2006 U.S. sales of $10 billion, are commonly used for patients with certain forms of kidney disease and for those receiving chemotherapy for cancer.

The FDA is adding warnings to the drugs' labels that will strongly instruct doctors to use the lowest possible dose needed to help patients avoid blood transfusions.

The FDA will also take a close look at how the drugs are marketed, including claims the drugs can improve the quality of life.

A meeting of FDA officials to further discuss this issue, believed to stem from drug overuse by dialysis centers and oncologists who make more money by using more of the drugs. is scheduled for May 10. Recommendations could lead to additional revisions of the drugs' labels.

Kim Taylor is a 45-year-old single mother who lives in Suwannee County, Florida and is proud to have successfully raised one daughter -- a graduate of the University of Florida. Kim enjoys outdoor activities like camping as well as sewing, crafting, and carpentry projects. She is most at peace spending time with her family, working as a youth volunteer -- and raising awareness for breast cancer. It's a interest she acquired just two years ago, compliments of a personal encounter with the disease that has taught her to let the little things go, to appreciate every sunrise, to make every moment matter.

Chemotherapy can cause anemia. Anemia is characterized by low levels of circulating red blood cells. These red blood cells are responsible for bringing oxygen to the tissues throughout our body.

I saw a commercial during my chemotherapy treatments for Procrit, a drug that can increase the body's red blood cell count. It showed an older woman running in an open area towards her grandson. I immediately thought to myself "I want some of that stuff!" I was getting worn down from my treatments and feeling very tired and had hardly any energy.

During a chemotherapy session I met a woman who said that she gets the Procrit shots. I asked her "how does it make you feel?" She answered "Well, I'm not running through any fields like that lady on the commercial." It was SO funny! I was LUCKY enough that my red blood cell count got low enough so I could try it. She was right. It didn't give me that boost of energy that I thought I would get but I think it just made me feel a bit more like my normal self.

Here I was looking for some fun! jeez.