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The anemia of chronic disease traditionally is defined as a hypoproliferative anemia of no apparent cause that occurs in association with an inflammatory, infectious, or neoplastic disorder, and resolves when the underlying disorder is corrected. Disordered iron metabolism as manifested by a low serum iron, decreased serum transferrin, decreased transferrin saturation, increased serum ferritin, increased reticuloendothelial iron stores, increased erythrocyte-free protoporphyrin, and reduced iron absorption, is a characteristic feature of the anemia of chronic disease and has been thought to be a major factor contributing to the syndrome.

In its hormonal role, erythropoietin is produced by the kidney in response to hypoxic stress and signals the bone marrow to increase the number of circulating erythrocytes. It has become clear in recent years, however, that erythropoietin and its receptor are members of a cytokine superfamily that mediates diverse functions in nonhematopoietic tissues. Nonhormonal erythropoietin actions include a critical role in the development, maintenance, protection, and repair of the central nervous system (CNS).

This article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors.

The clinical development of recombinant human erythropoietin (rHuEPO) has had a remarkable impact on the clinical practice of oncology. A decade ago, randomized, placebo-controlled trials in anemic cancer patients demonstrated that rHuEPO resulted in an improvement in hemoglobin and hematocrit, a reduction in transfusion requirements, and improvement in quality-of-life (QOL) end points. Based on these trials, recombinant erythropoietin was approved for the treatment of anemia in patients with nonmyeloid malignancies in whom the anemia was caused by the effect of chemotherapy.

Symptom burden is certainly not a new concept in the literature on disease and treatment, but recent developments in our understanding of how to measure symptoms and their impact make it possible to cast symptom burden as a reasonable summary measure of both disease- and treatment-outcome status. We discuss the use of symptom burden as an alternative to quality-of-life measures or as a supplement to these measures.

Barriers to use of erythropoietic therapy in cancer patients include nonresponse in a sizable proportion, resultant lowering of cost-effectiveness, and inconvenience. Darbepoetin alfa represents the outcome of efforts to develop agents with improved erythropoietic potency.

Fatigue is common in patients with cancer. Fatigue is very distressing to patients, who often view it as an indication that their disease is progressing or that treatment is ineffective.

One of the most fundamental challenges to multicellular life is the delivery of sufficient oxygen and metabolic substrate to all cells and the rapid elimination of acid formed during cellular respiration. Thus it is logical to wonder whether anemia, by compromising these pathways, might contribute to the progression of cancer.

Anemia in cancer patients is associated with a decline in energy levels, activity levels, and quality of life, and these variables improve when hemoglobin levels rise. Importantly, the impact of improved hemoglobin levels on response to chemotherapy, radiation therapy, and survival time is under study.

Erythropoietin is the primary physiological regulator of erythropoiesis, and it exerts its effect by binding to cell surface receptors. It has recently been shown that both erythropoietin and its receptor are found in the human cerebral cortex, and that, in vitro, the cytokine is synthesized by astrocytes and neurons, has neuroprotective activity, and is up-regulated following hypoxic stimuli. In animal models, exogenous recombinant human erythropoietin has been reported to be beneficial in treating experimental global and focal cerebral ischemia and reducing nervous system inflammation

There is a growing recognition in oncology of the importance of maintaining or improving patients’ quality of life (QOL) throughout the disease course. With this goal in mind, many clinical trials in oncology now seek to evaluate QOL end points.

Anemia is the most common hematologic abnormality seen in patients with cancer. Anemia is associated with debilitating symptoms and poorer health-related quality of life and may result in less than optimal disease/treatment outcomes.

NIAGARA-ON-THE-LAKE, Ontario, Canada-"Adequate knowledge of a cancer diagnosis and treatment is necessary in order to offer appropriate follow-up to cancer survivors," Nina Kadan-Lottick, MD, said at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer (abstract 22), hosted by Roswell Park Cancer Institute.

SEATTLE-The number of HIV-infected patients that a physician has treated independently predicts HIV-related mortality in patients starting anti-retroviral therapy for the first time, Robert S. Hogg, PhD, said at the 9th Conference on Retroviruses and Opportunistic Infections (abstract 749W).

Depending on what the Senate does in September, there is a slight chance Congress could act on the Medicare Market Acquisition Drug Price Act (H.R. 5167). Introduced by Rep. Pete Stark (D-Calif) in July, the bill would change the way Medicare reimburses oncologists for the oncology drugs they purchase to administer to patients in the office. Even the American Society of Clinical Oncology (ASCO) agrees change in the reimbursement format is necessary. Nevertheless, Paul A. Bunn, Jr, MD, president of ASCO, says, "Under this bill, reductions in Medicare reimbursement would make it very difficult for many doctors to continue providing high-quality treatment to people with cancer."

BOSTON-Elderly cancer patients who are very healthy can usually tolerate cancer treatments. Most elderly patients have comorbidities, however, and oncologists are being urged to conduct a comprehensive geriatric evaluation before deciding on a course of treatment.

OTTAWA, Canada-MDS Nordion has received 510(k) approval from the US Food and Drug Administration, as well as from Health Canada, for its Monte Carlo electron radiotherapy treatment calculation technique. Developed in collaboration with scientists at the National Research Council Canada, the software provides greater accuracy in calculating the dose required for cancer patients receiving radiation therapy, the company said in a news release.

ORLANDO-The tyrosine inhibitor imatinib mesylate (Gleevec) is active in gastrointestinal stromal tumors (GISTs) but not in other soft-tissue sarcomas not characterized by C-KIT or PDGF-R expression, the targets of imatinib, Ian R. Judson, MD, said at the American Society of Clinical Oncology annual meeting (abstract 1609).

ROCKVILLE, Maryland-Every man and woman age 50 or older with an average risk of colorectal cancer should be screened for colorectal cancer periodically, according to a new and strong recommendation from the US Preventive Services Task Force (USPSTF). The panel’s report also said screening for the disease at an earlier age in people at high risk is a reasonable practice.

BETHESDA, Maryland-A new partnership between the National Institutes of Health and five major drug companies will provide a total of $6 million to several cancer centers to find ways to increase accrual to early clinical trials. The five pharmaceutical firms involved in the pilot program are Aventis, Bristol-Myers Squibb, Eli Lilly and Co., GlaxoSmithKline, and Novartis.

Officials from the American Society for Therapeutic Radiology and Oncology (ASTRO) have announced that Ann Barrett, md, of the University of East Anglia in the United Kingdom, and John J. Curry, of the American College of Radiology, have

NIAGARA-ON-THE-LAKE, Ontario, Canada-Treatment for acute lymphoblastic leukemia (ALL) as a child may increase the risk for obesity in adulthood, and a new study suggests that cranial irradiation may be a factor. The results (abstract 13) were presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute.

SAN DIEGO, California-The prevalence of drug resistance in men newly infected with HIV is increasing, and such patients are more likely to fail initial antiretroviral therapy, according to a study of 202 subjects from 10 North American cities.

WASHINGTON- The Centers for Disease Control and Prevention (CDC) reported a modest but statistically significant decrease in the number of US cigarette smokers. The new analysis involved self-reported data generated by the 2000 National Interview Survey sample adult core questionnaire and cancer control module. The report found that about 23.3% of adults are current smokers vs 25.0% in 1993. Seventy percent of adult smokers said they wanted to quit, and 41% had tried to quite at least once.

LUGANO, Switzerland-Combination monoclonal antibody treatment of lymphoid malignancies may be as safe as single-antibody therapy, and produces a better overall response rate, new data suggest. The data come from a recent study of 48 heavily pretreated, poor-prognosis patients treated with the combination of alemtuzumab (Campath-1H) and rituximab (Rituxan), presented at the 8th International Conference on Malignant Lymphoma (ICML).

ORLANDO-A neoadjuvant treatment approach that involves the administration of liposomal doxorubicin (Myocet, investigational in the United States) and paclitaxel (Taxol), then heat delivery to the tumor, appears to enhance the efficacy of the chemotherapy, according to a study reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 200). Lead investigator Kimberly Blackwell, MD, a medical oncologist at Duke University Comprehensive Cancer Center, called the results "impressive."

WASHINGTON-Dying children and their families often fail to get consistent care and effective help to meet spiritual, physical, and emotional needs, according to a new report from the Institute of Medicine. In funding research on dying children and their families, the report concluded, the National Institutes of Health should begin priority studies to improve the treatment of pain and aspects of care affecting families.

WASHINGTON-The National Institute of Allergy and Infectious Diseases (NIAID) has awarded a 5-year, $14.8 million grant to bolster China’s HIV/AID research effort. Health and Human Services Secretary Tommy G. Thompson and Chinese Health Minister Zhang Wenkang signed a Memorandum of Understanding and announced the grant in a ceremony here.

NUTLEY, New Jersey-Roche’s selective 5-HT3 receptor antagonist Kytril Injection (granisetron) has received FDA approval for both the prevention and treatment of postoperative nausea and vomiting. The FDA first approved Kytril Injection in December 1993 for chemotherapy-induced nausea and vomiting. Kytril oral tablets were approved in July 1999 for use in radiotherapy-induced nausea and vomiting.

ROCKVILLE, Maryland-Every man and woman age 50 or older with an average risk of colorectal cancer should be screened for colorectal cancer periodically, according to a new and strong recommendation from the US Preventive Services Task Force (USPSTF). The panel’s report also said screening for the disease at an earlier age in people at high risk is a reasonable practice.