Anemia in Cancer patients
Hemoglobin (Hb) estimation is an important parameter in patients suffering from cancer. Cancer-induced anemia, mainly categorized as anemia of chronic disease, is often seen before or during the diagnosis of the underlying malignancy [1]. Up to 39% of cancer patients present with anemia at the time of diagnosis of which 40% have iron deficiency. Also, up to 53% of patients who do not present with anemia at diagnosis develop it during therapy like chemotherapy (CT) and/or radiotherapy (RT) treatment, so up to 67% of cancer patients will have anemia at some time during the evolution of their disease and therapy [2].
Anemia is associated with easy fatiguability, shortness of breath, weakness, lethargy, and reduced quality of life (QoL). Retrospective data analysis from patients with hematological malignancies and solid tumors indicates that a low baseline hemoglobin level is a prognostic marker that is associated with poor outcomes, though there is a dearth of prospective data [3]. Patients planned for surgery need to have an optimized level of hemoglobin to achieve adequate oxygen delivery to tissue due to increased demand, wound healing, and enhanced recovery after surgery.
The pathogenesis of anemia in cancer patients is complex and multifactorial, with iron deficiency (ID) often being a major and potentially treatable entity. ID in cancer patients can be due to multiple overlapping mechanisms, like bleeding (e.g., in gastrointestinal/hepato-pancreaticobiliary cancers or surgery), malnutrition, and medications [4].
However, not all causes are of equal importance in different cancers overt or occult bleeding and iron deficiency are often prominent in gastrointestinal, urogenital, and gynecological tumors, while bone marrow replacement by metastases is relatively frequent in breast and prostate cancer [5].
Given the significant impact of anemia on quality of life (QoL), disease progression, prognostication, and survival in cancer patients, adequate treatment strategies are of paramount importance. Several studies have shown that the treatment of cancer anemia determines a marked improvement in QoL, particularly among patients with mild-to-moderate anemia [6].
References:
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