Since our first "Quality of Life in Current Oncology Practice and Research"
symposium was held at St. Mary Medical Center in Long Beach, California in February
1989, and published in ONCOLOGY in May 1990, there has been a marked
increase in the use of quality of life measures to determine the outcomes of
interventions in clinical oncology. Measuring the effects of anemia treatment
with quality of life tools is a fine example of the importance of these tools
to gauge the impact and clinical significance of interventions. It is, therefore,
both timely and relevant that we dedicate our fifth symposium to the management
of anemia in patients with cancer.
In these proceedings, just as we did back in 1990, we
pursue a pragmatic approach to the subject of anemia in cancer and
intend to provide practical and helpful information for practicing
physicians and other oncology professionals. The authors have presented,
where applicable, not only summaries of relevant scientific information,
but also their personal clinical experience and approach to specific
patient management problems.
We are happy to also include, as we did 12 years ago,
an appendix to the proceedings listing 17 commonly used quality of life
scales (see pages 189-256). It is rewarding to report that while in 1990
the proceedings were mostly dedicated to introducing the use of quality
of life scales in oncology, the current proceedings demonstrate the
results in the clinical arena of the application of these tools.
Incidence, Causes, and Management of Anemia in Cancer Patients
Dr. N. Simon Tchekmedyian describes national
estimates with regards to the prevalence of and approach to the anemia of cancer
and presents statistics obtained in a community-based oncology practice addressing
these variables. The U.S. population demographics and trends in therapy indicate
that anemia will continue to increase as a clinical problem in oncology.
Dr. Jerry L. Spivak addresses the very complex
subject of iron metabolism, erythropoiesis regulation, and the role of cytokines
in the anemia of chronic illness. His outstanding didactic discussion should
be of great interest to all clinicians.
Dr. John A. Glaspy addresses various issues
relating to the impact of anemia on cancer progression and prognosis as well
as its implications on the efficacy of various modalities of cancer therapy.
He suggests that survival outcomes should be a focus of future anemia treatment
Dr. Jeffrey Crawford presents clearly and elegantly
the results of the initial registration studies of erythropoietin therapy in
cancer-related anemia as well as the results of three large community-based
studies of erythropoietin therapy for cancer-related anemia. The striking correlation
of hemoglobin improvements with measurable improvements in quality of life assessments
is presented. Importantly, from a quality of life perspective, a minimum optimal
hemoglobin level of 12 to 13 is proposed, given that quality of life assessments
show distinct and profound declines below those levels.