1593P Real-world data on anemia management in patients with solid tumors and malignant lymphoma in Germany

Abstract

Anemia is a frequent complication in patients with breast cancer (BC), gastrointestinal tumors (GC), lung cancer (LC) and malignant lymphomas (ML). Guidelines (GL) on anemia management (ESMO, DGHO) provide dedicated algorithms for diagnosis and treatment of anemia. GL adherence (GLAD) was analyzed. This was a retrospective sample analysis representative for practices and hospitals in Germany. Data on tumor treatments and anemia management was collected from records of cancer patients (pts) with grade ≥ 2 anemia diagnosed between January and June 2021. Definition of diagnosis GLAD score (GLAD-D): 2 points (pt) for full adherence, 1 pt for a lack in differential diagnosis on iron metabolism. 0 pt if differential diagnosis is missing. Treatment GLAD score (GLAD-T): 2 pt for full adherence to GL recommendation in relation to diagnosis. 1 pt for indicated red blood cells (RBC) as only anemia therapy or no therapy in pts with Hb ≥8g/dl. 0 pt for RBC without indication, p.o. iron substitution under inflammatory conditions (CRP>5mg/l) or vitamin B12 or folate deficiency without substitution. Data from 1046 pts (311 BC, 371 GC, 260 LC, 104 ML) were collected from 143 centers. Hb-values at diagnosis of anemia were 8-10 g/dl in 899 (85.9%) pts, 6-8g/dl in 135 (12.9%) and <6g/dl (1.2%) in 12 pts. 456 pts were treated with RBC (43.6%), 198 (18.9%) with iron substitution, 106 (10.1%) with ESA and 60 (5.7%) with vitamin B12. 60.6% of the pts with iron substitution were treated i.v. and 39.4% p.o. 37.5% of pts with RBC had no indication in the sense of the restrictive RBC policy recommended by the GLs. GLAD was poor in diagnosis and treatment: GLAD-D was 2 pt in 310 pts (29.6%) of pts, 1 pt at 168 (16.1%) and 0 pt in 568 (54.3%) pts. GLAD-T was 2 pt in 270 pts (25.8%), 1 pt in 310 (29.6%) and 0 pt in 466 (44.6%). Higher GLAD-D correlated significantly to a higher GLAD-T (τB 0.262, p<0.001). Full GLAD-T (2 pt) was significantly associated with a greater Hb increase (p<0.001) at 28 days (10.2 vs. 9.7 g/dl) and at 2 months (10.4 vs 9.9 g/dl). GLAD is insufficient in Germany, especially concerning liberal transfusion policy and the lack of differential diagnostics of iron metabolism. Pts with anemia management as per GL had a significantly greater Hb-increase.