Abstract
Anemia is a common finding in cancer patients, most often as a result of chemotherapy. Management of anemia requires a comprehensive approach of appropriate diagnosis, exclusion of reversible causes, use of erythropoiesis-stimulating agents (ESAS), and iron supplementation. Recently, consensus guidelines on the management of chemotherapy-induced anemia were published in Europe and the United States. The present review is intended to be a practical guide for Canadian physicians, based on published guidelines, but specifically tailored to the Canadian environment. Recommendations for the use of ESAS are presented, including initiation, target hemoglobin, dosing and adjustments, monitoring, and re-initiation. Issues of safety are also addressed, including thromboembolic risk, impact on survival, and tumour progression. The importance of iron metabolism and the use of iron supplementation (both oral and parenteral) is discussed.
Highlights
Anemia is common in cancer 1 and may be the result of many factors, including chemotherapy, marrow infiltration, radiation, nutritional deficiencies, and blood loss
The data have demonstrated improvements in quality of life contributing to the indication for the use of erythropoiesis-stimulating agents (ESAs) in Canada [2,3,4,5,6]
The 2002 ASCO/ASH guidelines 7 were based on a U.S Agency for Healthcare Research and Quality topic review covering the literature on ESAs published between January 1985 and October 1999
Summary
Anemia is common in cancer 1 and may be the result of many factors, including chemotherapy, marrow infiltration, radiation, nutritional deficiencies, and blood loss. Anemia in cancer adversely affects the patient by producing fatigue, cognitive impairment, a need for blood transfusions, and possible disruption of therapy. It is incumbent on the treating physician to address anemia in cancer. Reversible causes such as nutritional deficiencies, hypothyroidism, and iron deficiency should be corrected immediately; these causes account for only a small proportion of anemias in cancer patients. The data have demonstrated improvements in quality of life contributing to the indication for the use of ESAs in Canada [2,3,4,5,6]
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