Current trends in the management of anaemia in solid tumours and haematological malignancies

Eeden, Ronwyn van; Rapoport, Bernardo

doi:10.1097/spc.0000000000000209

Cited by 15 publications

(8 citation statements)

References 28 publications

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“…Cancer anemia may be associated with a broad spectrum of symptoms, depending on its severity and rapidity of development. Fatigue is the most debilitating symptom [8,9], followed by impaired mental capacity, confusion and depression, especially in elderly people. Nausea, loss of appetite, dyspnea, syncope and falls can also occur, particularly in patients with comorbidities such as cardio-pulmonary and renal dysfunctions.…”

Section: Anemia In Cancer: Prevalence Pathophysiology and Prognosmentioning

confidence: 99%

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

et al. 2018

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Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (ID) often being a major and potentially treatable contributor. In turn, ID in cancer patients can be due to multiple concurring mechanisms, including bleeding (e.g., in gastrointestinal cancers or after surgery), malnutrition, medications, and hepcidin-driven iron sequestration into macrophages with subsequent iron-restricted erythropoiesis. Indeed, either absolute or functional iron deficiency (AID or FID) can occur. While for absolute ID there is a general consensus regarding the laboratory definition (that is ferritin levels <100 ng/mL ± transferrin saturation (TSAT) <20%), a shared definition of functional ID is still lacking. Current therapeutic options in cancer anemia include iron replacement, erythropoietic stimulating agents (ESAs), and blood transfusions. The latter should be kept to a minimum, because of concerns regarding risks, costs, and limited resources. Iron therapy has proved to be a valid approach to enhance efficacy of ESAs and to reduce transfusion need. Available guidelines focus mainly on patients with chemotherapy-associated anemia, and generally suggest intravenous (IV) iron when AID or FID is present. However, in the case of FID, the upper limit of ferritin in association with TSAT <20% at which iron should be prescribed is a matter of controversy, ranging up to 800 ng/mL. An increasingly recognized indication to IV iron in cancer patients is represented by preoperative anemia in elective oncologic surgery. In this setting, the primary goal of treatment is to decrease the need of blood transfusions in the perioperative period, rather than improving anemia-related symptoms as in chemotherapy-associated anemia. Protocols are mainly based on experiences of Patient Blood Management (PBM) in non-oncologic surgery, but no specific guidelines are available for oncologic surgery. Here we discuss some possible approaches to the management of ID in cancer patients in different clinical settings, based on current guidelines and recommendations, emphasizing the need for further research in the field.

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Section: Anemia In Cancer: Prevalence Pathophysiology and Prognosmentioning

confidence: 99%

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

et al. 2018

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“…Subsequently, multivariable adjustment was performed, accounting for sociodemographic and clinical characteristics at the index PCI. Predictors were selected based on a priori knowledge if they were: (a) well-established cancer risk factors (including sex, smoking status and Arab/Jewish ethnicity 30 ); (b) variables previously shown to be associated both with TRAP exposure as well as cancer incidence (including nSES, 31,32 diabetes mellitus, 33,34 chronic heart failure 1,35 and haemoglobin levels 36,37 ); and (c) other clinical variables previously shown to have a prognostic importance in our cohort (including hypertension and renal failure). 21 The proportional hazards assumption was tested through the Schoenfeld residuals, and was met in all models.…”

Section: Methodsmentioning

confidence: 99%

Chronic exposure to traffic-related air pollution and cancer incidence among 10,000 patients undergoing percutaneous coronary interventions: A historical prospective study

Cohen

Levy

Yuval

et al. 2018

Eur J Prev Cardiolog

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Background Exposure to traffic-related air pollution (TRAP) is considered to have a carcinogenic effect. The authors previously reported a nonsignificant association between TRAP and cancer risk in a relatively small cohort of myocardial infarction survivors. This study assessed whether TRAP exposure is associated with subsequent cancer in a large cohort of coronary patients. Methods & results Consecutive patients undergoing percutaneous coronary interventions in a major medical centre in central Israel from 2004 to 2014 were followed for cancer through 2015. Residential levels of nitrogen oxides (NO) - a proxy for TRAP - were estimated based on a high-resolution national land use regression model. Cox proportional hazards models were constructed to study relationships with cancer. Among 12,784 candidate patients, 9816 had available exposure data and no history of cancer (mean age, 68 years; 77% men). During a median (25th-75th percentiles) follow-up of 7.0 (3.9-9.3) years, 773 incident cases of cancer (8%) were diagnosed. In a multivariable-adjusted model, a 10-ppb increase in mean NO exposure was associated with hazard ratios (HRs) of 1.07 (95% confidence interval [CI] 1.00-1.15) for all-site cancer and 1.16 (95% CI 1.05-1.28) for cancers previously linked to TRAP (lung, breast, prostate, kidney and bladder). A stronger association was observed for breast cancer (HR = 1.43; 95% CI 1.12-1.83). Associations were slightly strengthened after limiting the cohort to patients with more precise exposure assessment. Conclusion Coronary patients exposed to TRAP are at increased risk of several types of cancer, particularly lung, prostate and breast. As these cancers are amenable to prevention strategies, identifying highly exposed patients may provide an opportunity to improve clinical care.

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“…Anemia is associated with reduced survival in many cancer types. 53,54 In a case like this, anemia should be addressed as the patient is optimized to start neoadjuvant chemotherapy.…”

Section: Postoperative Anemia Assessmentmentioning

confidence: 99%

How I treat anemia in the perisurgical setting

Shander

Kaufman²,

Goodnough

2020

Blood

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Anemia is a common finding in perioperative setting with significant untoward consequences including worsening of outcomes and diminished quality of life as well as increased risk of allogeneic blood transfusions. Here we present three cases that illustrate how anemia can be perioperatively managed in patients undergoing cardiac, orthopedic and oncology surgeries. Timely detection of anemia prior to high-blood loss surgeries can allow clinicians to manage it and optimize hemoglobin level, making patients better prepared for the surgery. Treatment of anemia should be guided by the etiology and may include erythropoietic agents, folic acid, B12 and iron preparations. Other blood management strategies geared toward reducing surgical blood loss such as autologous transfusion techniques and agents to optimize hemostasis are employed during surgery and in the immediate post-operative period. Patients should be closely monitored following the surgery for signs of ongoing bleeding in need of control. Finally, screening for and management of anemia should continue in the post-operative and post-discharge period, as persistence and recurrence of anemia can further undermine patient's outcomes.

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Current trends in the management of anaemia in solid tumours and haematological malignancies

Abstract: This review is aimed at guiding treating physicians to make the best evidence-based treatment choices according to the product label and according to current guidelines for patients with cancer-related anaemia.

Cited by 15 publications

References 28 publications

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

Chronic exposure to traffic-related air pollution and cancer incidence among 10,000 patients undergoing percutaneous coronary interventions: A historical prospective study

How I treat anemia in the perisurgical setting

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