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. 2014 Aug;22(8):2197-206.
doi: 10.1007/s00520-014-2189-0.

A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia

Heinz Ludwig, M Aapro, C Bokemeyer, J Glaspy, M Hedenus, T J Littlewood, A Österborg, B Rzychon, D Mitchell, Y Beguin

A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia

Heinz Ludwig et al. Support Care Cancer. 2014 Aug.

Abstract

Purpose: Patients with cancer frequently experience chemotherapy-induced anaemia (CIA) and iron deficiency. Erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management.

Methods: Medical oncologists and/or haematologists from nine European countries (n=375) were surveyed on their last five cancer patients treated for CIA (n=1,730). Information was collected on tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin saturation (TSAT), as well as applied anaemia therapies.

Results: Diagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94%) and ferritin (48%) measurements. TSAT was only tested in 14%. At anaemia diagnosis, 74% of patients had Hb ≤ 10 g/dL, including 15% with severe anaemia (Hb <8 g/dL). Low-iron levels (ferritin ≤ 100 ng/mL) were detected in 42% of evaluated patients. ESA was used in 63%of patients, blood transfusions in 52 % and iron supplementation in 31% (74% oral, 26% intravenous iron). Only 30% of ESA-treated patients received a combination of ESA and iron supplementation. Blood transfusions formed part of a regular anaemia treatment regimen in 76% of transfused patients. Management practices were similar in 2009 and 2011.

Conclusion: Management of anaemia and iron status in patients treated for CIA varies substantially across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is under utilised and mainly based on oral iron supplementation. Implementation of guidelines needs to be increased to minimize the use of blood transfusions.

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Figures

Fig. 1
Fig. 1
a Diagnostic tests used to assess anaemia and iron status in cancer patients with CIA. Hb haemoglobin, TSAT transferrin saturation. b Proportion of anaemic cancer patients with low levels of haematological parameters at diagnosis of anaemia. Hb haemoglobin, TSAT transferrin saturation
Fig. 2
Fig. 2
a Treatments used for CIA. *Patients who received RBC transfusions at some stage (survey 1) or during the last 12 months (survey 2); †current (survey 1) or last (survey 2) treatment. RBC red blood cells, ESA erythropoiesis-stimulating agents. b Administration routes used for iron therapy; †current (survey 1) or last (survey 2) treatment received
See this image and copyright information in PMC

References

    1. Ludwig H, Van BS, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, Kosmidis P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40:2293–2306. doi: 10.1016/j.ejca.2004.06.019. - DOI - PubMed
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