Independent Risk Factors for Anemia in Cancer Patients Receiving Chemotherapy: Results from the European Cancer Anaemia Survey

Abstract

Objectives: To develop a hitherto unavailable risk factor model for accurately predicting anemia development in cancer patients before chemotherapy (CT) administration. Methods: 2,070 nonanemic patients from the European Cancer Anaemia Survey (ECAS) with hemoglobin (Hb) ≧12 g/dl at enrollment who received their first CT during ECAS and underwent at least two CT cycles were divided randomly into split half (SH) 1 and SH2 (n = 1,035 each). The model was developed on SH1 using logistic regression to simultaneously evaluate predictive factors, and was validated using SH2 and an additional similar subpopulation of 5,901 ECAS patients. Anemia risk values were assigned to the predictive factors and the sum of the predictive factors gave the total anemia risk score; lower-, higher-, and highest-risk cutoff points of the total anemia risk score were determined. Results: Variables ultimately identified as significant predictive factors for anemia were: lower initial Hb (≤12.9 g/dl in females, and ≤13.4 g/dl in males); having lung or gynecologic cancer versus gastrointestinal (GI)/colorectal cancer; cancer at any other site versus GI/colorectal cancer; treatment with platinum CT, and female gender. Conclusion: Using this evidence-based risk model, nonanemic patients who are at the highest risk of develop ing anemia prior to receiving CT can be identified clinically, allowing appropriate anemia management to be planned.

Anemia Management in Oncology and Hematology

“…From various studies over the years, it is now possible to predict which cancer patients receiving chemotherapy are most likely to develop anemia [13]. Significant predictive factors for the risk of developing anemia include: a low initial hemoglobin (Hb) level (Յ12.9 g/dl in females and Յ13.4 g/dl in males), having lung or gynecologic cancers versus gastrointestinal (GI) or colorectal cancers, cancer at any site other than the GI tract or colon/rectum, treatment with platinum chemotherapy, and female gender [13].…”

“…Significant predictive factors for the risk of developing anemia include: a low initial hemoglobin (Hb) level (Յ12.9 g/dl in females and Յ13.4 g/dl in males), having lung or gynecologic cancers versus gastrointestinal (GI) or colorectal cancers, cancer at any site other than the GI tract or colon/rectum, treatment with platinum chemotherapy, and female gender [13]. In lymphoma and multiple myeloma patients, factors found to significantly increase anemia risk were a low initial Hb level, persistent or resistant disease, platinum chemotherapy, and female gender [3].…”

Supportive and Palliative Care in Solid Cancer Patients

“…It has been found by the European Cancer Anaemia Survey (ECAS) that the incidence of anemia after the first cycle is 19.5% and after second cycle is 34.3% while after the third the incidence was more than 40%. Also single or combination chemotherapy play a serious and major role in anemia incidence and severity since the use of combination chemotherapy regimen will leads to severe anemia more than the use of single chemotherapy drug [48][49][50]. Besides chemotherapy myelosuppression, anemia can take place as a result of direct destruction of the RBC (i.e., direct effect on the erythropoiesis in the bone marrow) or reduced erythropoietin production (i.e., impact on EPO production).…”

The Role Of Erythropoietin In The Treatment Of Anemia In Patients With Malignant Lymphoma

“…Th is may be due to the reduction of erythropoesis, manifested by reduction of erythrocyte half-life, poor iron reutilization by the bone marrow and inadequate response to erythropoetin with reduced endogenous erythropoetin levels [4,5,6]. Anemia may have a signifi cantly negative eff ect on the quality of life of patients suff ering from malignant lymphoma, producing symptoms such as dizziness, fatigue, weakness, nausea, headache and depression [7].…”

“…Tissue hypoxia triggers the synthesis and the release of erythropoietin into the blood. Erythropoietin is the primary regulator of human erythropoiesis and has two major functions: stimulating proliferation of erythroid progenitor cells and maintaining their viability by inhibiting their apoptosis [5,9]. In 1993, the use of erythropoietin was approved by the FDA for the treatment of anemia in cancer patients.…”