Abstract
Cancer related anemia (CRA) adversely affects patient Quality of Life (QoL) and overall survival. We prospectively studied the prevalence, etiology and the impact of anemia on QoL in 218 Indian cancer patients attending a tertiary referral hospital. The study used the sTfR/log Ferritin index to detect iron deficiency anemia and assessed patient QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) tool, standardized for language. Mean patient age was 51±13 years and 60% were female. The prevalence of cancer related anemia in this setting was 64% (n = 139). As expected, plasma ferritin did not differ significantly between anemic (n = 121) and non-anemic cancer patients (n = 73). In contrast, plasma sTfR levels were significantly higher in anemic cancer patients compared to non-anemic cancer patients (31 nmol/L vs. 24 nmol/L, p = 0.002). Among anemic cancer patients, using the sTfR/log Ferritin index, we found that 60% (n = 83) had iron deficiency anemia (IDA). Interestingly, plasma sTfR levels were significantly higher in cancer patients with CRA+IDA (n = 83) compared with patients having CRA (n = 38) alone (39 nmol/L vs. 20 nmol/L, p<0.001). There was a significant linear correlation between Hb and QoL (Spearman ρ = 0.21; p = 0.001) and multivariate regression analysis revealed that every gram rise in Hb was accompanied by a 3.1 unit increase in the QoL score (95% CI = 0.19–5.33; p = 0.003). The high prevalence of anemia in cancer patients, a major portion of which is due to iron deficiency anemia, the availability of sensitive and specific biomarkers of iron status to detect IDA superimposed on anemia of inflammation, suggests an urgent need to diagnose and treat such patients. Despite the potential negative consequences of increasing metabolically available plasma iron in cancer, our clinical data suggest that detecting and treating IDA in anemic cancer patients will have important consequences to their QoL and overall survival. Clinical trials of iron therapy in these patients will be able to demonstrate the potential for benefit or harm.
Highlights
The incidence of anemia is high among cancer patients with 39% anemic at the time of diagnosis of the cancer [1, 2] and a further 13% of non anemic cancer patients developing anemia during the course of their treatment/disease [3]
Using the soluble transferrin receptor (sTfR)/ferritin index as a biochemical means of detecting iron-deficiency anemia combined with cancer related anemia (CRA), we found that over 60% of cancer patients had both CRA and iron deficiency anemia (IDA)
The results of this study demonstrate 3 key observations: (1) the prevalence of anemia is high in cancer patients (64%), consistent with findings from other studies [1, 15,16,17,18,19] (2) the etiology of cancer related anemia in this setting is mostly iron deficiency anemia, and (3) there is a significant association between hemoglobin level and quality of life in cancer patients
Summary
The incidence of anemia is high among cancer patients with 39% anemic at the time of diagnosis of the cancer [1, 2] and a further 13% of non anemic cancer patients developing anemia during the course of their treatment/disease [3]. A major etiological factor for cancer-related anemia is iron deficiency, in low middle income settings [10]. Since retrospective studies in our setting demonstrating a high prevalence of CRA [12] and population survey data revealed high iron deficiency anemia prevalence, we hypothesized that anemia in cancer patients would be predominantly due to iron deficiency. To test this hypothesis, we undertook a cross-sectional study of cancer patients undergoing treatment at a tertiary medical centre in South India and assessed the prevalence and etiology of anemia and its relationship to QoL
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