Prevalence of anemia in cancer patients not receiving antineoplastic treatment (ANT): Data from the European Cancer Anaemia Survey (ECAS)

Abstract

8565 Background: Cancer-associated anemia occurs frequently in patients receiving ANT. Patients not receiving ANT may also have low hemoglobin (Hb) levels that may compromise optimal disease management and patient outcomes. Methods: Patients enrolled in ECAS (Ludwig et al, Eur J Cancer 2004;40:2293–2306) and not receiving ANT (chemotherapy, radiotherapy, or hormonal treatment) at enrollment were evaluated for prevalence of anemia (Hb <12.0 g/dL), effect of anemia on performance according to WHO score (0 to 4), and anemia treatment. Disease status at enrollment was catagorized as newly diagnosed (ND), persistent/recurrent (P/R), or in remission. Results: Of 15,367 enrolled patients, 7947 (53%) were not receiving ANT: 60% ND; 28% P/R disease; 12% in remission. Anemia was present in 32% of patients, with Hb levels 10.0–11.9 g/dL in 24%, and <10.0 g/dL in 8%. Anemia rates were P/R, 38%; ND, 30%; in remission, 25%. Poor performance scores correlated positively with lower Hb levels; for patients with Hb <8.0 g/dL, 8.0–9.9 g/dL, 10.0–11.9 g/dL, and ≥12.0 g/dL, worse WHO scores of 2–4 were recorded for 43%, 41%, 25%, and 15%, respectively. During ECAS 1168 patients with data after enrollment never received ANT, and 40% were anemic at some time (at enrollment and/or at follow-up). Hb nadirs were approximately evenly distributed: 11.0–11.9 g/dL, 37%; 10.0–10.9 g/dL, 29%, and <9.0–9.9 g/dL, 34%. Anemia was infrequently treated with only 31.4% of patients receiving anemia treatment at any time. Anemia treatments administered and mean Hb at initiation were 14% epoetin alone ± transfusion ± iron (9.8 g/dL); 9% transfusion ± iron (8.4 g/dL); 8% iron (11.7 g/dL). Conclusions: Almost one-third of cancer patients who are not actively receiving ANT are anemic, including 25% of patients considered to be in remission. Anemia has a negative effect on performance, with worse WHO scores related to lower Hb levels. Anemia appears to be undertreated, with less than one-third of anemic patients receiving anemia treatment, and then only when Hb nadirs are <10.0 g/dL. To insure optimal management of cancer patients, all should be screened for anemia and receive the most effective anemia treatment. [Table: see text]