Severity, risk factors, and physician practices in the management of anemia during concurrent chemoradiation for head and neck carcinoma

Abstract

Anemia is a well-recognized complication of concurrent chemoradiation therapy for head and neck carcinoma. It impairs quality of life and many studies also have reported an association between anemia and increased tumor recurrence and decreased long-term survival. In the current study, the authors attempted to identify the severity, risk factors, and physician practices in the management of anemia. Medical records of those patients receiving concurrent chemoradiation for head and neck carcinoma between 1999-2003 were reviewed. The average weekly nadir hemoglobin level (AWNH) was defined as the mean value of the lowest hemoglobin concentration in each week. Independent predictors for an AWNH < 11 g/dL were identified using multivariable logistic regression analyses. Seventy-two patients were included in the current study, 66.7% of whom had unresectable disease. The overall median survival was 402 days. At baseline, 76.4% (95% confidence interval [95% CI], 66.3-86.4%) of patients already had a hemoglobin level < 13.5 g/dL. The hemoglobin level dropped 2.5 +/- 1.9 g/dL during concurrent chemoradiation, resulting in 95.8% of patients having a hemoglobin level < 13.5 g/dL at the end of the observation period. Blood was transfused to 24 patients (33.3%); erythropoietin or darbepoietin was administered to 2 patients (2.7%). The mean lowest hemoglobin threshold of transfusion was 7.3 +/- 1.0 g/dL. The cumulative percentage of patients who received a transfusion reached 50% when the mean nadir hemoglobin level was 7.4 g/dL. Independent predictors of an AWNH < 11.0 g/dL were low baseline hemoglobin and receiving multiple concurrent chemotherapeutic agents, with relative risks of 13.6 and 1.8, respectively (95% CI,1.9-93.9 and 1.1-3.1, respectively). Anemia is prevalent in patients undergoing treatment for head and neck carcinoma and can be severe with concurrent chemoradiation therapy. However, the intensity of anemia management is low. A low baseline hemoglobin level and the reception of multiple concurrent chemotherapeutic agents are considered to be the main risk factors of anemia. Cancer 2006.