Abstract
Perioperative blood transfusion in early stage cancer patients had a negative effect on the prognosis of patients, but the prognostic impact of transfusion in advanced cancer patients remains unclear. To minimize and guide rational transfusion, an institutional patient blood management (PBM) program was launched, and we evaluated the new program that has changed the practice and impacted on the prognosis of advanced cancer patients. We investigated the medical records of colorectal cancer patients who received chemotherapy from 2015 to 2020. The amount and frequency of transfusion, iron replacement and laboratory findings, and overall survival were compared before and after implementation of PBM. The rate of transfusion in colorectal cancer patients was significantly decreased from 23.5/100 person-quarter in 2015 to 1.2/100 person-quarter in 2020, but iron supplementation therapy was frequently used, and the proportion of patients who received transfusion under hemoglobin 7 g/dL significantly increased from 15.9% in 2015 to 55.3% in 2020. Multivariate analysis revealed that transfusion was a significant risk factor affecting the overall survival of patients (HR 2.70, 95% CI: 1.93-3.78, p<0.001). Kaplan-Meier analysis revealed that overall survival was significantly longer in non-transfused patients than in transfused patients (11.0 versus 22.4 months; HR 0.69, 95% CI: 0.56-0.86, p<0.001). This study shows that minimized transfusion through an institutional PBM can positively affect the prognosis of patients who are receiving chemotherapy for advanced colorectal cancer.
Highlights
The Anemia is a common problem in patients with cancer, among those receiving cytotoxic chemotherapy
We examined the impact of the implementation of patient blood management (PBM) in cancer care on the patterns of anemia management in the real world setting and evaluated if it affects the prognosis of patients who are receiving chemotherapy for advanced cancer
Demographic and disease characteristics such as age at diagnosis, gender, primary tumour location, metastatic sites at diagnosis, number of total chemotherapy regimens, tumour histology, molecular biomarkers (KRAS, NRAS, BRAF mutation), the status of microsatellite instability (MSI), and survival status were collected from electronic health records
Summary
The Anemia is a common problem in patients with cancer, among those receiving cytotoxic chemotherapy. The prevalence of anemia in patients with cancer varies according to clinical factors, including the type of malignancy, stage, duration of disease, and chemotherapy regimen. The prevalence of anemia in cancer patients ranges from 30–90% [1], and one study reported that approximately 40% of cancer patients are already anaemic prior to treatment [2]. The aetiology of cancer-related anemia is multifactorial, including gastrointestinal bleeding, iron deficiency, malnutrition, metastatic bone marrow infiltration, and chemotherapy-induced myelosuppression [3, 4]. Patients receiving chemotherapy frequently report fatigue, nausea, loss of appetite, and dyspnoea, but these symptoms of anemia are often mistaken for cancer-related symptoms. It is important to proactively correct anemia in patients receiving chemotherapy to achieve an optimal clinical outcome
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