Determinants of anemia in cancer patients receiving chemotherapy

Robertson, C. and Boyle, P. and Kerr, D.J. (2004) Determinants of anemia in cancer patients receiving chemotherapy. Journal of Clinical Oncology, 22 (14S). 889S-889S. ISSN 0732-183X

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Background: Anemia is common in cancer patients. It affects their quality of life and puts them at risk of severe complications when treated with blood transfusions. Little is known about the determinants of anemia. Improvements in this regard could lead to better management. Methods: Data were available from cross-sectional 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 Forms (CRF). Details of one cycle out of all chemotherapy cycles were recorded retrospectively in 41,114 patients. Anemia was defined as a hemoglobin level < 12g/dL. Risk of anemia was investigated through the effects of gender, age, chemotherapy type, country, cycle number and year of treatment with logistic regression (with 95% confidence intervals (CI)). Eight different tumor types were considered: breast, Small Cell lung (SCL), Non Small Cell lung (NSCL), ovarian, Acute Myeloid Lymphoma (AML), Non Hodgkin Lymphoma (NHL), Hodgkin Disease (HD), Multiple Myeloma (MM). Results: Across all tumor types anemia was reported in 67% of the patients and in > 95% in AML patients. Incidence increased over time for breast cancer, SCL, NSCL, NHL and MM. It was decreasing for ovarian cancer. Age had no independent effect except for NHL with less anemia in patients > 40 years. Consistent differences across countries were observed. The UK (Odds Ratio (OR) = 0.44), Spain (0.47) and Italy (0.54) have less likely anemia compared to Germany (OR = 1 (referent)) and France (0.85). Apart from MM and NHL a clear risk tendency for anemia to increase with subsequent cycles is observed. No association between cisplatin and platinum-based regimens with anemia in first cycle was seen. Conclusions: Anemia affects the majority of cancer patients receiving chemotherapy, being more frequent in men and during subsequent chemotherapy cycles. Research is required to better understand the frequency differences noted across countries in Europe and to identify patients at high risk, particularly in the initial cycle, since prevention and/or treatment measures are readily available.