Anemia and neutropenia in cancer patients receiving chemotherapy

Boyle, P. and Robertson, C. and Kerr, D.J. (2004) Anemia and neutropenia in cancer patients receiving chemotherapy. Journal of Clinical Oncology, 22 (14S). 886S-886S. ISSN 0732-183X

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Background: Anemia and neutropenia are common and serious side effects in chemotreated cancer patients. It negatively impacts their quality of life and questions their chemotherapy compliance. Literature has scarcely reported incidence numbers of both complications in Europe. Using a series of cross-sectional surveys, it has been proven possible to estimate the incidence of both conditions over time. Methods: Data were available from study surveys conducted in five European countries (France, Italy, Germany, Spain and United Kingdom) in 1999, 2000, 2001 and 2003, using the same Case Report Form (CRF). Details of one cycle out of all cycles of chemotherapy were recorded retrospectively in 41,114 cancer patients. Anemia was determined as hemoglobin levels <12, <10 or < 8 g/dL and Absolute Neutrophil Count (ANC) cut-off, measuring the neutropenia, was specified at <0.5 x 109/L with fever >38.2 C° for febrile neutropenia (FN). Logistic regression was used to investigate the effects of gender, age, country, chemotherapy type, outcome of cycle number and year of treatment with 95% confidence intervals (CI). Results: Anemia (hemoglobin <12 g/dL) was found in 67% of the cancer patients receiving chemotherapy. Severe anemia (Hb<8g/dL) occurred in 10% of the patients. The incidence was 50% in AML patients compared to only 4% in breast cancer patients. The frequency of anemia was significantly lower in the United Kingdom and higher in Germany. Comparing the results of the last survey (2003) with the first (1999), a two-fold increase in the use of as well blood transfusions as erythropoietins was observed. FN affected 70% of AML patients and averaged 19% in all other cancer types. Conclusions: Overall anemia <10 Hb/gL was found in 25% of the patients receiving chemotherapy. It was more frequent in men, in younger persons and in the initial cycle of the chemotherapy. Further research is required to better identify patients at high risk of anemia, particularly in the initial cycle, since adequate measures of prevention and/or treatment are readily available. Management of neutropenia remained fairly unchanged over the last years in Europe.