Anemia is a common but neglected complication of adjuvant chemotherapy for early breast cancer

Abstract

In this study, we set out to determine the frequency and severity of anemia and the corrective interventions used during adjuvant chemotherapy for breast cancer.We conducted a retrospective electronic chart review of 702 patients who received adjuvant breast cancer chemotherapy at four BC Cancer Agency centres in 2002 and 2003. For these patients, we recorded the initial hemoglobin reading and the date of the first hemoglobin reading in the ranges 110-119 g/L, 100-109 g/L, 90-99 g/L, and <90 g/L. We also recorded any discussion about, or delivery of, interventions for anemia [transfusion, epoetin (epo) or both].Median age of the study population was 51 years, and it varied with chemotherapy type. Among the patients, 12% had a hemoglobin reading <120 g/L before the start of chemotherapy. Overall, the proportion of patients with at least one hemoglobin reading <120 g/L was 78%; <110 g/L, 54%; <100 g/L, 31%; and <90 g/L, 14%. Depending on chemotherapy type, a hemoglobin reading <100 g/L occurred in 5% to 54% of patients. Intervention rates increased as hemoglobin declined. For 99 patients with a hemoglobin reading <90 g/L, a discussion of anemia was documented in the treatment chart in 49% of cases, a transfusion was delivered in 23%, epo was used in 11%, and transfusion and epo were both delivered in 5%.Anemia was relatively common and varied with chemotherapy type. Documentation of a discussion of anemia occurred in fewer than 20% of the patients with a hemoglobin reading of 90-99 g/L and in only half the patients with a hemoglobin reading <90 g/L. Intervention rates were low at hemoglobin readings for which randomized trials have shown that intervention can improve quality of life.

Keywords: Anemia; breast cancer; chemotherapy; epoetin; transfusion.

FIGURE 1

Median duration between the start of chemotherapy and first hemoglobin (Hgb) reading at each level (patients with a pre-chemotherapy Hgb < 120 g/L were excluded).

FIGURE 2

The proportion of patients having a discussion of, or intervention for, anemia increased at lower hemoglobin (Hgb) levels.

FIGURE 3

Discussion of or treatment for anemia in patients receiving cef (cyclophosphamide + epirubicin + 5-fluorouracil) chemotherapy (n = 325), by hemoglobin (Hgb) level.

FIGURE 4

Rates of discussion of or intervention for anemia in patients receiving cef (cyclophosphamide + epirubicin + 5-fluorouracil) chemotherapy (n = 325), by cancer centre. Hgb = hemoglobin; A, B, C, D = the four study centres.