LONG BEACH, CaliforniaTreating anemia can reverse the declines it
causes in physical function and quality of life for cancer patients and may
have an impact on outcomes of cancer therapy, reported Simon Tchekmedyian,
MD. Statistics suggest that anemia and its effects are under-recognized and
undertreated, he noted, but barriers to treatment may fall as new
therapeutic agents prove to be more effective and can be administered more
easily and less frequently.
Dr. Tchekmedyian serves as medical director, cancer care services, at St.
Mary Medical Center and Pacific Shores Medical Group in Long Beach,
California, and associate clinical professor of medicine, University of
California School of Medicine in Los Angeles. He was also co-chair of the
Fifth Quality of Life in Oncology Symposium.
Normal hemoglobin levels are currently defined as 12 to 16 g/dL in
females and 14 to 18 g/dL in males, although there is some controversy about
what should be considered normal. There is fairly good consensus that
hemoglobin levels below the normal range but above 10 or 11 g/dL indicate
grade 1 or mild anemia. The most severe anemia, grade 4, occurs at
hemoglobin levels below 6.5 g/dL.
The malignancy itself or chemotherapy and other therapies can cause
decreased erythropoietin production or reduced responsiveness of the bone
marrow to erythropoietin. These are probably the most common causes of
cancer-related anemia. Other causes include iron/B-12 deficiency,
nutritional deficiencies and endocrinopathies, blood loss (particularly
occult gastrointestinal blood loss), shortened red cell survival/hemolysis,
infection, renal disease, and a variety of hematologic and inflammatory
Current therapeutic approaches to cancer-related anemia include
erythropoietic agents, iron, and vitamin B-12, as well as nutritional
support. Blood transfusions are reserved for more symptomatic, severe cases
of anemia. "Rituximab (Rituxan) has evolved recently as a very
interesting and potentially very useful option for patients with
immune-mediated hemolytic anemia," Dr. Tchekmedyian said. "Therapy
of the underlying process, especially the malignancy but also occult
gastrointestinal bleeding, infection, and sepsis all play important
roles," he added.
In between the severe cases of anemia that need to be reversed quickly by
transfusions, and mild cases where a watch and wait approach may be
reasonable, are cases with clinical symptomatology and quality of life
issues that affect the ability of the patient to function. "In those
cases, erythropoietin therapy is very useful," Dr. Tchekmedyian said.
It can also be combined with transfusions to manage more severe anemias.