Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 16;2(5):e126.
doi: 10.1097/og9.0000000000000126. eCollection 2025 Oct.

Evaluation of a Quality-Improvement Initiative to Address Nutritional Anemia in Gynecologic Oncology

Olivia W Foley  1 , Brenda Vega  1 , Nicole Tasker  1 , Lakshmi Jayaram  1 , Dario Roque  1 , Emily Hinchcliff  1 , Jenna Marcus  1 , Edward Tanner  1 , Emma L Barber  1
Affiliations

Evaluation of a Quality-Improvement Initiative to Address Nutritional Anemia in Gynecologic Oncology

Olivia W Foley et al. O G Open. .

Abstract

Objective: Anemia is common among patients with gynecologic cancers receiving systemic treatment and is associated with adverse outcomes. We describe a quality-improvement initiative designed to improve screening and treatment for nutritional causes of anemia in this population, and we assess the effect of this intervention on hemoglobin levels and blood transfusions.

Methods: We implemented a quality-improvement intervention that automatized regular laboratory evaluation for nutritional causes of anemia in patients with gynecologic malignancies receiving systemic treatment who had hemoglobin levels below 12 g/dL. Patients with nutritional deficiencies were treated with intravenous iron or oral vitamin B12. We evaluated the association of the intervention and change in hemoglobin levels over three cycles of treatment (delta hemoglobin), along with the rate of blood transfusion. Thirty patients with hemoglobin levels below 12 g/dL were administered a survey regarding anemia, fatigue, and the acceptability of the intervention.

Results: The overall rates of iron and vitamin B12 deficiency were 54.2% and 8.1%, respectively. The control period included 117 patients, and the intervention period included 101 patients. Our quality-improvement process increased the rate of evaluation for iron and vitamin B12 deficiency in patients with anemia from 23.1% and 20.5%, respectively, to more than 90%. When controlling for relevant demographic and cancer-related characteristics, the delta hemoglobin was 0.45 g/dL higher in patients treated after the intervention when compared with patients treated before the intervention. In patients with hemoglobin levels below 11 g/dL, the delta hemoglobin was 0.91 g/dL higher after the intervention. There was no significant difference in the rate of blood transfusion. Patients with anemia who were surveyed were concerned about fatigue and overall accepting of the intervention.

Conclusion: Using medical record treatment plans to send reflex anemia evaluation tests was effective at increasing rates of screening for nutritional deficiencies. Proactively addressing nutritional causes of anemia was associated with maintenance of higher hemoglobin levels in patients with gynecologic cancer receiving systemic treatment.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.. Ideal state process map for the quality-improvement intervention. CBC, complete blood count; TSH, thyroid-stimulating hormone; IDA, iron deficiency anemia; PO, oral.
See this image and copyright information in PMC

References

    1. Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 2001;91:2214–21. doi: 10.1002/1097-0142(20010615)91:12<2214::aid-cncr1251>3.3.co;2-g - DOI - PubMed
    1. Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016;316:2025–35. doi: 10.1001/jama.2016.9185 - DOI - PubMed
    1. Harper P, Littlewood T. Anaemia of cancer: impact on patient fatigue and long-term outcome. Oncology 2005;69(suppl 2):2–7. doi: 10.1159/000088282 - DOI - PubMed
    1. Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med 2004;116(suppl 7A):11S–26S. doi: 10.1016/j.amjmed.2003.12.008 - DOI - PubMed
    1. Hufnagel DH, Mehta ST, Ezekwe C, Brown AJ, Beeghly-Fadiel A, Prescott LS. Prevalence of anemia and compliance with NCCN guidelines for evaluation and treatment of anemia in patients with gynecologic cancer. J Natl Compr Canc Netw 2021;19:513–20. doi: 10.6004/jnccn.2020.7638 - DOI - PubMed

LinkOut - more resources