Abstract
Background: Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice. Methods: This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded. Results: Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 26/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a significant increase in overall mean haemoglobin were observed. Conclusions: This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.
Highlights
Anaemia is common in hospice populations and associated with significant symptom burden1
We looked at the results of tests for iron deficiency done at a UK hospice in day-to-day practice
Despite these considerations there is very little evidence related to iron deficiency (ID) in palliative care populations and neither investigating for, nor treating ID are routinely performed in palliative care settings4
Summary
Anaemia is common in hospice populations and associated with significant symptom burden. There is evidence that treating even mild to moderate anaemia may lead to symptomatic benefit and improvements in quality of life in patients with cancer. Treatment of ID is recommended in oncology settings, with intravenous iron having evidence of quality of life benefit and superior efficacy and tolerability versus oral preparations. Treatment of ID is recommended in oncology settings, with intravenous iron having evidence of quality of life benefit and superior efficacy and tolerability versus oral preparations8,9 Despite these considerations there is very little evidence related to ID in palliative care populations and neither investigating for, nor treating ID are routinely performed in palliative care settings. Conclusions: This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, version 2 (revision)
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