Chemotherapy-induced anemia at an urban academic medical center: Iron studies and supplementation

Abstract

Objectives: To determine the number of patients with chemotherapy-induced anemia receiving an erythropoiesis-stimulating agent (ESA) in whom iron studies were completed and iron supplementation was provided and to document the response rate of ESA therapy without parenteral iron at our medical center.Design: Retrospective chart review.Setting: Urban (Chicago) academic medical center between January 2004 and December 2005.Patients: Ambulatory patients with a nonmyeloid malignancy receiving chemotherapy during a 2-year period in whom hemoglobin (Hb) was less than 11 grams/dL or ESA therapy was documented.Intervention: Review of medical records.Main outcome measures: Number of patients reaching target Hb, time to reach target Hb, number of patients receiving a transfusion, number of patients with iron studies, and number of patients receiving iron supplementation.Results: A total of 174 medical records were reviewed, and 50 patients met study criteria. Of these, 38 patients were treated with darbepoetin alfa, 11 patients were treated with epoetin alfa, and 1 patient was not treated with either agent. 20 patients achieved the target Hb level of 12 grams/dL within a median of 7 weeks (range 1-24 weeks). Only five patients treated with an ESA received iron supplementation, one responder and four nonresponders. Iron indices were measured in 20 patients (40%); 14 patients were candidates for iron therapy based on transferrin saturation, and 3 of these 14 patients received oral iron supplementation. Six responders and six nonresponders received a transfusion (25%).Conclusion: The overall response rate and time to Hb response were consistent with previous reports. Iron indices were not commonly measured before ESA therapy was started, and only a few patients were provided oral iron supplementation at our medical center.