Anaemia in hospitalized cancer patients: a retrospective study of two cohorts before and after the guideline update.

Abstract

Introduction The incidence of anaemia and its consequences are often underestimated during cancer management. We propose to evaluate the situation before and after the recommendations were updated in order to assess their impact on the day-to-day practice. Methods In this single-center retrospective study, eligible patients were treated for cancer and warranted overnight hospitalization over two periods (n=206 in 2011, n=143 in 2018). The diagnosis of anaemia was defined by a hemoglobin level below 12 and 13 g/dl for women and men, respectively. Results The prevalence of anaemia was 26% in 2011 and 16% in 2018 (p<.001). Biological assessment had changed between the two periods, with more tests of iron metabolism and measurements of inflammatory parameters. Patients hospitalized in 2018 had more advanced cancer and more severe anaemia (8.2 g/dl [±1.07] in 2011 vs 7.9 g/dl [±1.18] in 2018). Rate of transfusion therapy did not change, but patients with mild and moderate anaemia were transfused less in 2018 (57% in 2011 vs 44% in 2018). Intravenous iron and erythropoiesis-stimulating agent were used more frequently in 2018 (1% and 5%, and 13% and 23% in 2011 and 2018, respectively), mainly for mild anaemia and life-threatening anaemia, respectively. Overall survival was poor in both cohorts at 24 months (15.4% in 2011 and 6.5% in 2018, p=.048). Conclusion Practices have changed in the diagnosis of anaemia and prescriptions for erythropoiesis-stimulating agents and intravenous iron have increased. Efforts must continue to explore the causes of anaemia, optimize patients' quality of life of and reduce transfusions.