The effect of chemotherapy-induced anemia on dose reduction and dose delay

Family, Leila; Xu, Lanfang; Xu, Hairong; Sattayapiwat, Olivia; Page, John H.; Bohac, Chet; Chao, Chun

doi:10.1007/s00520-016-3258-3

Cited by 17 publications

(21 citation statements)

References 28 publications

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“…34 These data suggest that the development of moderate to severe anemia directly affects subsequent chemotherapy administration and prevention and that timely management may result in fewer dose reductions and delays. 34 In the setting of chemotherapyinduced myelosuppression, many oncologists reduce doses by 20% in hopes to limit excess cytotoxic effects on the bone marrow; unfortunately, a 20% dose reduction may lead to a 50% reduction in cure rate. 10 Low hemoglobin is associated with both adverse outcomes and reduced tumor oxygenation.…”

Section: Introductionmentioning

confidence: 94%

“…31 Furthermore, inadequate bone marrow recovery following cytotoxic therapy as manifested by anemia, thrombocytopenia, and neutropenia is responsible for most chemotherapy dose delays and dose reductions. [32][33][34] In patients with both solid and liquid malignancies, the development of severe anemia during the first cycle of chemotherapy is associated with an increased risk of dose delay and/or dose reduction in the subsequent chemotherapy cycle, regardless of age, gender, race/ethnicity, cancer stage, chemotherapy cycle, absolute neutrophil count, platelet counts, liver function, renal function, and history of other comorbidities. 34 These data suggest that the development of moderate to severe anemia directly affects subsequent chemotherapy administration and prevention and that timely management may result in fewer dose reductions and delays.…”

Section: Introductionmentioning

confidence: 99%

“…[32][33][34] In patients with both solid and liquid malignancies, the development of severe anemia during the first cycle of chemotherapy is associated with an increased risk of dose delay and/or dose reduction in the subsequent chemotherapy cycle, regardless of age, gender, race/ethnicity, cancer stage, chemotherapy cycle, absolute neutrophil count, platelet counts, liver function, renal function, and history of other comorbidities. 34 These data suggest that the development of moderate to severe anemia directly affects subsequent chemotherapy administration and prevention and that timely management may result in fewer dose reductions and delays. 34 In the setting of chemotherapyinduced myelosuppression, many oncologists reduce doses by 20% in hopes to limit excess cytotoxic effects on the bone marrow; unfortunately, a 20% dose reduction may lead to a 50% reduction in cure rate.…”

Section: Introductionmentioning

confidence: 99%

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Chemotherapy-induced anemia: etiology, pathophysiology, and implications for contemporary practice

Bryer¹,

Henry²

2018

IJCTM

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Chemotherapy-induced anemia (CIA) is a multifaceted entity influenced by a variety of patient-and treatment-specific factors. Some sources of variation within CIA include chemotherapeutic agent as well as dose and administration schedule, type and stage of malignancy, baseline pretreatment hemoglobin, target hemoglobin, timing of intervention (red blood cell transfusion, iron, erythropoietin stimulating agent), nutritional status, renal function, age, and gender. The diversity of patient presentation and symptomatology within the broader spectrum of CIA contributes to the challenge of establishing universal criteria to govern optimal management therapies. This manuscript will review the development and evolution of CIA with an emphasis on assorted therapeutic interventions.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chemotherapy-induced anemia: etiology, pathophysiology, and implications for contemporary practice

Bryer¹,

Henry²

2018

IJCTM

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“…As a common complication of myelosuppressive cancer treatment, Moderate to severe anemia is associated with symptoms such as fatigue, dyspnea, tachycardia, and depression. [ 19 , 20 ] This situation will negatively affect both physical functioning and quality of life of cancer patients. [ 20 ] In TCM theory, CIA can be classified as the area of “XueKu,” “XuLao” according to it clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 , 20 ] This situation will negatively affect both physical functioning and quality of life of cancer patients. [ 20 ] In TCM theory, CIA can be classified as the area of “XueKu,” “XuLao” according to it clinical symptoms. It can improve the symptoms of anemia in patients with cancer by strengthening the body, replenishing qi and promoting blood, reconciling the spleen and stomach, invigorating the kidney and essence, soothing the liver and blood.…”

Section: Discussionmentioning

confidence: 99%

Erythropoietin combined with traditional Chinese medicine for chemotherapy-induced anemias

Wang¹,

Song

Huang

et al. 2020

Medicine

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Background: As far as we know, several systematic review and meta-analysis have assessed the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in the patients with chemotherapy-induced anemia (CIA). But no study assesses the safety and efficacy of ESAs combined with traditional Chinese medicine (TCM). The aim of our study is to assess the efficacy and safety of ESAs combination with TCM for patients with CIA and will provide a higher level of evidence for clinical applications. Methods: This protocol adheres to the preferred reporting items for systematic reviews and meta-analysis protocol statement. The source of literature will be a structured search of the following 7 electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database. Records will be independently evaluated by 2 reviewers. Disagreements will be resolved through consensus or third-party adjudication. Review Manager 5.3 software (Cochrane Collaboration, Copenhagen Denmark) will be used to perform meta-analysis. For dichotomous variables, odds ratio with 95% confidence intervals will be obtained by the Mantel–Haenszel method. For continuous data, mean difference with 95% confidence intervals will be used. P < 0.05 will be considered to be statistically significant. Results: This study will be performed to test the efficacy and safety of ESAs combined with TCM for CIA in patients with cancer. Conclusions: The result of this study will be promoted mainly in 2 ways: publish in peer-reviewed journals in the fastest way; and promotion in domestic and foreign conferences. INPLASY registration number: INPLASY202080041.

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Incidence and predictors for chemotherapy modifications and their impact on the outcome of ovarian cancer patients

Hatsy

Brambs

Kiechle

2022

Arch Gynecol Obstet

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Purpose Chemotherapy (CTX) is an important part of the treatment strategy of stage II–IV ovarian cancer. CTX modifications, such as delays, dose reductions or premature terminations might have a negative impact on overall survival (OS) and progression free survival (PFS). The goal of this study was to determine the incidence and predictors of CTX modifications and their influence on survival. Methods An observational retrospective cohort analysis of 192 ovarian cancer patients who were treated at the Department of Obstetrics and Gynaecology, Technical University Munich, Germany, according to international guidelines was performed including from 2009 to 2013. A potential association between patient and disease characteristics and CTX modifications was tested with multivariate logistic regression. OS and PFS were estimated by Kaplan–Meier analysis. Results 44.8% (86/192) received a modification of CTX. 34 (17.7%) women discontinued CTX prematurely, 17 (8.9%) underwent a dose reduction, 16 (8.3%) experienced a CTX delay and 10 (5.2%) had both a delay and a dose modification. In nine (4.7%) patients, the dose needed to be divided. Leukopenia (p < 0.001) and anaemia (p = 0.003) were significantly more common in patients with CTX modifications. Significant predictors for CTX modifications were a history of thrombosis or embolism (p < 0.001) and residual tumour postoperatively (p = 0.003). Patients with CTX modifications showed a significantly lower OS as well as PFS (p < 0.001), even after adjustment for prognostic factors such as age, body-mass-index, residual tumour, histology, FIGO stage and grading (p = 0.005 for OS and p = 0.001 for PFS). Conclusion CTX modifications have a negative impact on survival. Significant predictors for such modifications are a history of thrombosis or embolism and the presence of residual postoperative tumour. Further studies are needed to avoid CTX modifications and to improve survival of ovarian cancer patients.

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The effect of chemotherapy-induced anemia on dose reduction and dose delay

Abstract: These results provide insight into novel risk factors for chemotherapy dose modification that may inform clinicians on management strategies to optimize treatment outcomes.

Cited by 17 publications

References 28 publications

Chemotherapy-induced anemia: etiology, pathophysiology, and implications for contemporary practice

Chemotherapy-induced anemia: etiology, pathophysiology, and implications for contemporary practice

Erythropoietin combined with traditional Chinese medicine for chemotherapy-induced anemias

Incidence and predictors for chemotherapy modifications and their impact on the outcome of ovarian cancer patients

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