LONG BEACH, California—Treating 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(Drug information on 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 disorders.
Current Approaches
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.
