Anaemia prevalence and blood transfusion rates in patients receiving chemoradiation for head and neck cancer

Abstract

Purpose/Objective: Between April 2004 and April 2006,1 O0 patients completed concurrent chemoradiation (CRT) for head and neck cancer at the Edinburgh Cancer Centre. The prevalence of anaemia in these patients was assessed. Materials/Methods: The patients' medical records were retrospectively reviewed. Haemoglobin (Hb) levels were assessed prior to receiving any initial treatment and prior to commencing CRT. Blood counts were assessed at least weekly whilst receiving CRT. The lowest Hb level and neutrophil count was recorded. Anaemic patients who received blood transfusions (BT) were identified and their post-transfusion Hb noted. Anaemia was defined as Hb d 1.5 g/dL for females and d3.0 g/dL for males. Radiotherapy treatment comprised 68Gy in 2Gy fractions. Chemotherapy (cisplatin lOOmg/m 2) was administered on the 1st day of starting radiotherapy with a second cycle three weeks later. Results: Patient details are shown in Table 1. Prior to initial treatment (surgery, neoadjuvant chemotherapy, or CRT), the median Hb was 14.0 g/dL (Range 9.2-17.4). Fifteen patients were defined as anaemic. Prior to CRT the median Hb was 13.7 (Range 10.1-16.6) and 17 patients were anaemic. The median Hb nadir of patients during CRT was 10.8 g/dL (Range 7.4-13.9) representing a median fall of 2.9 g/dE Ninety patients were anaemic during CRT but only 12 received BT. The median post-transfusion Hb of these patients was 11.0 g/dL (Range 9.2 13.9). Ten of the patients (83%) remained anaemic after BT. Twelve patients developed febrile neutropenia. Conclusions: CRT has become the standard of care for patients with locally advanced disease. Anaemia is recognised as a poor prognostic factor in such patients. We demonstrate that CRT is associated with high rates of anaemia. Only a minority of patients received BT and most were given insufficient blood to return their Hb levels to within normal limits. It is likely that the paucity of evidence for improved outcomes in patients whose anaemia is corrected, prevents clinicians taking a more aggressive approach. Prospective trials to fully assess the potential benefits of maintaining an adequate Hb in patients undergoing CRT are required.