EVANSTON, IllinoisAnemia is the most treatable cause of fatigue in
cancer patients and aggressively managing anemia could significantly improve
the quality of life of cancer patients and may also impact survival,
according to David Cella, PhD. Anemia has been associated with poor
prognosis and increased mortality among cancer patients, although a causal
relationship has not yet been established, he noted.
Dr. Cella is Director of the Center on Outcomes Research and Education at
Evanston Northwestern Healthcare and professor of psychiatry and behavioral
science at Northwestern University School of Medicine in Evanston, Illinois.
Targets of Therapy
Hemoglobin is the major target of erythropoietic therapy and available
data show that such therapy is effective in raising hemoglobin levels.
Hemoglobin would be the bull’s eye in an erythropoietic therapy outcomes
target. As you go outside the center, outcome targets such as fatigue,
physical functioning, mood and general well-being are impacted to a lesser
extent (see Figure 1).
Symptoms of Anemia
At hemoglobin levels of less than 8 g/dL, anemia is severe with
"markedly reduced exercise capacity, difficulty breathing even at rest,
rapid or irregular heartbeat at rest, an increased risk of angina,
myocardial infarction, and transient ischemic events. This is the point
where most people would clearly have a transfusion trigger," Dr. Cella
said. A transfusion can achieve an immediate turnaround, while
erythropoietic therapy might be used when time is not so crucial.
"Anemia," Dr. Cella said will directly reduce your activity
level, require more rest, reduce your productivity, probably reduce your
cognitive efficiency either directly or indirectly, and lead to a general
functional decline. That in turn, if not reversed and if it becomes chronic,
can lead to reduced self-esteem, compromised social roles in relationships,
and even place patients at risk for depression and withdrawal."