Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx.

Fein, Douglas A.; Lee, William R.; Hanlon, Alexandra L.; Ridge, John A.; Langer, Corey J.; Curran, Walter J.; Coia, Lawrence R.

doi:10.1200/jco.1995.13.8.2077

Cited by 177 publications

(93 citation statements)

References 35 publications

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“…Anemia was significantly related to decreased survival and increased relapse rates. A strong correlation between hemoglobin levels, local control, and survival was also observed in a study of 109 patients with T1-T2 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy [9]. Patients who presented with hemoglobin values >13.0 g/dl had significantly higher two-year rates of locoregional tumor control (95% versus 66%, p = 0.0018) and survival (88% versus 46%, p < 0.001) as compared with patients with hemoglobin values <13.0 g/dl.…”

Section: Understanding the Impact Of Anemiamentioning

confidence: 56%

“…The association between anemia and tumor hypoxia is not fully understood, but it is well established that low hemoglobin levels independently predict poorer survival and relapse [8][9][10]. However, it is not clear whether low hemoglobin levels are associated with poor survival because they indicate advanced disease or because they indicate poor tumor oxygenation.…”

Section: Understanding the Impact Of Anemiamentioning

confidence: 99%

“…Current thinking, however, recognizes anemia as a likely contributor to tumor hypoxia [8,11] with a focus on anemia and locoregional failure. The impact of anemia on survival and relapse after radiotherapy has been investigated for a number of tumor types [8,9]. A recent study looked at the association between anemia and overall survival and local tumor control in patients with locally advanced head and neck cancer undergoing radiation therapy.…”

Section: Understanding the Impact Of Anemiamentioning

confidence: 99%

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Radiotherapy-Associated Anemia: The Scope of the Problem

Harrison

2000

The Oncologist

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The impact of anemia on cancer patients undergoing chemotherapy is well established, but only recently has the prevalence of anemia in patients receiving radiotherapy received much attention. Many cancer patients present with anemia prior to radiotherapy, and even more experience anemia or a worsening of anemia at some point during treatment. However, the problem of anemia is often ignored because patients may experience only functional anemia, defined as a hemoglobin level less than 12 g/dl. Unless physiologic anemia (hemoglobin = 8 g/dl) is discovered, efforts to correct anemia are often not made. Because hemoglobin levels <12 g/dl seem to be associated with tumor hypoxia and poorer outcomes of radiotherapy in a number of patient populations, ignoring even modest anemia can result in decreased locoregional control, overall survival, and quality of life (QOL). Because increasing hemoglobin levels 1-2 g/dl is usually easily accomplished, there exists the potential for improving outcomes by paying greater attention to this problem. This article focuses on the prevalence of anemia, particularly functional anemia, and discusses the impact of anemia on locoregional control, overall survival, and QOL. INTRODUCTIONContinuing advances in oncology care, including new radiotherapy technologies and recent developments with multimodal therapies, have significantly improved clinical outcomes and quality of life (QOL) for many patients with cancer. However, the prevalence and impact of cancer-associated anemia is not widely appreciated. Emerging data demonstrate that cancer-related anemia is unexpectedly common in cancer patients receiving radiotherapy and/or chemotherapy and that even modest anemia (hemoglobin <12 g/dl) substantially impairs QOL. In addition, a growing body of literature suggests that hemoglobin concentrations of less than 12-13 g/dl during cancer therapy are associated with reduced local tumor control and decreased survival [1,2]. Although anemia of this magnitude can be easily managed, it is often overlooked or considered clinically insignificant. However, restoration of normal hemoglobin concentrations in patients undergoing radiotherapy has the potential to improve local tumor control and survival and produce sizable improvements in patient QOL.

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Section: Understanding the Impact Of Anemiamentioning

confidence: 56%

Section: Understanding the Impact Of Anemiamentioning

confidence: 99%

Section: Understanding the Impact Of Anemiamentioning

confidence: 99%

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Radiotherapy-Associated Anemia: The Scope of the Problem

Harrison

2000

The Oncologist

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“…Other studies have shown a statistically significant association between anaemia and reduced local control or survival in cervical cancer or head and neck cancer (Fein et al, 1995;Dubray et al, 1996;Warde et al, 1998;Grogan et al, 1999). Dubray et al (1996) found that even moderate anaemia significantly correlated with a worse treatment outcome in squamous cell carcinoma of the head and neck (Figure 2).…”

Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 89%

“…Many studies have found that inadequate oxygenation at the tumour site and/or low haemoglobin values are associated with poor treatment outcome after curative radiotherapy (Fein et al, 1995;Dubray et al, 1996;Fyles et al, 1998;Grogan et al, 1999). Adequate tumour oxygenation is known to be necessary for an optimal response to radiotherapy (Glaspy and Cavill, 1999), thus it is theoretically possible that decreased haemoglobin (which may contribute to lowered oxygenation at the tumour site) may also have an effect on the success of therapy.…”

Section: Possibilities For Improved Treatment Outcomesmentioning

confidence: 99%

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

Demetri

2001

Br J Cancer

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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

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