Iron Deficiency Anemia in Cancer Patients

Abstract

Anemia is defined by the World Health Organization as a hemoglobin (Hb) level <13 g/dl for men and <12 g/dl for women, 1 and can be further subcategorized into mild (>10 g/dl), moderate (8-10 g/dl), severe (6.5-8 g/dl), and life-threatening (<6.5 g/dl) ranges. Anemia is a common comorbidity in cancer patients. In the previously mentioned ECAS study, cancer-related anemia was most frequently reported in patients with gynecological cancer (81.4 %), lung cancer (77 %), and lymphoma/myeloma (72.9 %). 2 In addition, this study indicated that the longer patients received chemotherapy, the higher their risk of becoming anemic. Anemia is also a recognized complication of myelosuppressive chemotherapy in cancer patients. AbstractAnemia is highly prevalent, affecting approximately 40 % of cancer patients, and results in a significant decrease in health-related quality of life while also being associated with shorter cancer survival times. A recent survey of 15,000 cancer patients in Europe found that 39 % were anemic at the time of enrolment. In addition, anemia is a recognized complication of myelosuppressive chemotherapy, and it has been estimated that, in the US, around 1.3 million cancer patients who are not anemic at the time of diagnosis will develop anemia during the course of their disease. The etiology of anemia in cancer patients is variable and often multifactorial, and may be the result of an absolute or a functional iron deficiency. Cancer produces an enhanced inflammatory state within the body-causing hepcidin levels to increase and erythropoietin production to decrease-and results in a reduction in erythropoiesis due to impaired iron transport. This type of anemia is known as functional iron deficiency, where the body has adequate iron stores but there are problems with mobilization and transport of the iron. Absolute iron deficiency is when both iron stores and iron transport are low. The National Comprehensive Cancer Network (NCCN) treatment guidelines for cancer-related anemia recommend intravenous (IV) iron products alone for iron repletion in cancer patients with absolute iron deficiency, and erythropoiesis-stimulating agents (ESAs) in combination with IV iron in cancer patients (currently undergoing palliative chemotherapy) with functional iron deficiency. Although IV iron has been demonstrated to enhance the hematopoietic response to ESA therapy, the use of supplemental iron has not yet been optimized in oncology. Here we discuss the significance of iron deficiency anemia in cancer patients and the need to implement tools to properly diagnose this condition, and we provide an overview of the management strategies and recommendations for patients with iron deficiency anemia as outlined in the NCCN guidelines.

Pattern of Anaemia among Non-haematological Malignant Patients in a Tertiary Care Hospital: A Cross-sectional Study

“…11 In addition, anaemia is a recognized complication of myelosuppressive chemotherapy, and it has been estimated that around 1.3 million cancer patients who are not anemic at the time of diagnosis may acquire anaemia during the course of their disease in the United States. 12 Most studies have found that pretreatment anaemia is an important predictor of prognosis, survival, and disease free period. 13 Grigieneet al and Zhang et al, in their study found that the hemoglobin (Hb) level before treatment had a significant influence on overall survival, disease-free survival and local relapse-free survival in uterine cervical carcinoma treated with irradiation 14 and Breast Cancer 13 , respectively.…”