Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Abstract

Anaemia is a common occurrence in patients with cancer and contributes to the clinical symptomatology and reduced quality of life (QOL) seen in cancer patients. Many aspects of reduced QOL, including fatigue, are known to be associated with suboptimally low levels of haemoglobin. Even mild-to-moderate anaemia adversely affects patient-reported QOL parameters. Red blood cell transfusions are associated with many real and perceived risks, inconveniences, costs, and only temporary benefits. Recombinant human erythropoietin (rHuEPO) is an effective therapy to increase haemoglobin values in over half of anaemic cancer patients receiving concurrent chemotherapy. These increased haemoglobin values are closely correlated with improvements in QOL. Despite these objectively defined benefits, less than 50% of anaemic patients undergoing cytotoxic chemotherapy receive rHuEPO, in contrast to patients with chronic renal failure on dialysis, where anaemia is universally and aggressively treated to more optimal haemoglobin values. However, there are several barriers that may limit more widespread use of rHuEPO. These include inconvenience associated with frequent dosing; failure of a large proportion (40 to 50%) of patients to respond; relatively slow time to response; absence of reliable early indicators of response; and current lack of rigorous pharmacoeconomic data demonstrating cost-effectiveness. Darbepoetin alfa is a novel erythropoiesis stimulating protein (NESP) that is biochemically distinct from rHuEPO, and which has been proven to stimulate red blood cell production. The molecule has a 3-fold longer half-life and increased biological activity that will allow less frequent dosing, facilitating improved management of the anaemia of cancer. With this new option for therapy, further avenues of investigation should lead to renewed interest in the clinical benefits of optimal haemoglobin levels for patients with cancer. © 2001 Cance Cancer Research Campaign

Kinetics of haematopoietic recovery after dose‐intensive chemo/radiotherapy in mice: optimized erythroid support with darbepoetin alpha

“…The maintenance of normal or near-normal Hb concentrations in patients undergoing chemotherapy and/or radiotherapy may not only significantly improve the patient's quality of life (Demetri, 2001), but may also improve the probability of a successful outcome from their therapy (Dusenbery et al, 1994;Tarnawski et al, 1997;Lee et al, 1998;Warde et al, 1998;Canaday et al, 1999;Grogan et al, 1999;Obermair et al, 2000;Phan et al, 2001;Pangalis et al, 2002). Several options exist to support Hb levels during cancer treatment, including blood transfusions and the administration of rHuEPO.…”

Cancer Patients’ Morbidity (II): Anemia-related Quality of Life in Relation to Personality

“…The typological analysis to identify patients' characteristics, receiving major surgery or chemotherapy, who experience chronic emotional distress and need immediate attention, psychological care or support, may lead to more accurate risk estimate in clinical practice, leading to appropriate recognition and management of their morbidity and QOL. Pre-treatment patients' condition, Hb level, anemia-proneness or debility as well as immunological or nutritional status 3,10,12,13,20,21) may influence survival or relapsing in certain types of tumor 5,43,45) , and such an influence and the proneness to specific morbidity could be predicted by the personality types, such as intolerant, melancholic or high-anxious, which were found to be directly associated with anemia-related QOL deficits (Tables 6 and 7).…”

“…Impaired QOL, or anemiaspecific QOL deficit, includes reduced energy level, fatigue, debilitating tiredness, inability to carry out normal daily functions or activities, mood deterioration, poor feeling, dyspnoea (suffocating), lack of interest in social relations (social interaction deficit), etc. [1][2][3][4][5][6][7][8][9] . Although it is common in cancer patients, reported in 20% to more than 90% depending on malignancy of disease and treatment regimen 9) , anemia is still overlooked and seriously under-treated.…”

“…A number of factors have been investigated which may influence anemia, anemiarelated morbidity and related complications, including type of tumor, stage, pre-treatment Hb level, response to chemotherapy (type, status), treatment for anemia (blood transfusion and recombinant human erythropoietin or rHuEPO), related Hb level, erythropoietin (EPO) level status, etc. However, most of these factors were examined individually or in separate studies, and there is no universally accepted guidelines for the patient selection or reliable single prognostic indicator for the treatment of anemia, anemia-related complications or QOL deterioration 5,8,10,11) . Hence, patients with cancer will benefit most by appropriate recognition and management of these factors, before the treatment, which will influence severity of the disease, related complications and impaired QOL.…”

“…Significant differences have been noted among cancer patients in the relationships between rHuEPO dosing schedule and improvement of the level of EPO, Hb and QOL. In about 50% of the patients, rHuEPO was effective in enhancing the levels of Hb and QOL, when dose was increased 5,13) . These studies suggested that patient characteristics are important parameters involved in the management of anemia and QOL deterioration.…”