impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center

ABSTRACT

Anemia in cancer patients is common, but often under-recognized and under-treated. Erythropoiesis stimulating agents [ESAs] are widely used to prevent and treat cancer and chemotherapy-related anemia, but recent studies suggest a negative impact on disease progression and survival associated with their use. This retrospective study describes the prevalence of anemia in cancer patients and recent trends in its management given the negative studies. All consecutive adult cancer patients [n=959] admitted to regular medical units over one year were reviewed. Patients with a hemoglobin [Hb] value<12 g/dL on admission were considered anemic. Information on the primary tumor, main reasons for admission and treatment given were collected. At the time of enrollment, anemia was detected in 755 [78.7%] patients. The mean Hb value for anemic patients was 9.5 g/dL. Prevalence and severity of anemia varied according to tumor type and reason for admission. The majority [68.6%] of the anemic patients were not offered treatment. The mean Hb value at which treatment was started was 8.0 g/dL. Anemia treatment was related to its severity; treatment rates were 94.4%, 32.9%, and 5.0% in patients with severe, moderate and mild anemia, respectively [P<.0001]. Blood transfusion was used the most while ESAs were rarely used. Length of hospital stay was affected by the presence of anemia [7.2 days in anemic patients vs. 4.85 days in nonanemic patients] [P<.001]. Blood transfusion was used the most for cancer-related anemia, while ESAs were rarely used. The majority of patients with moderate anemia were not treated, including patients on active chemotherapy. Better guidelines addressing anemia management in this subgroup of patients are highly needed