A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia

Abstract

PurposePatients with cancer frequently experience chemotherapy-induced anaemia (CIA) and iron deficiency. Erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management.MethodsMedical oncologists and/or haematologists from nine European countries (n = 375) were surveyed on their last five cancer patients treated for CIA (n = 1,730). Information was collected on tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin saturation (TSAT), as well as applied anaemia therapies.ResultsDiagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94 %) and ferritin (48 %) measurements. TSAT was only tested in 14 %. At anaemia diagnosis, 74 % of patients had Hb ≤10 g/dL, including 15 % with severe anaemia (Hb <8 g/dL). Low-iron levels (ferritin ≤100 ng/mL) were detected in 42 % of evaluated patients. ESA was used in 63 % of patients, blood transfusions in 52 % and iron supplementation in 31 % (74 % oral, 26 % intravenous iron). Only 30 % of ESA-treated patients received a combination of ESA and iron supplementation. Blood transfusions formed part of a regular anaemia treatment regimen in 76 % of transfused patients. Management practices were similar in 2009 and 2011.ConclusionManagement of anaemia and iron status in patients treated for CIA varies substantially across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is underutilised and mainly based on oral iron supplementation. Implementation of guidelines needs to be increased to minimize the use of blood transfusions.

Management of anemia and iron deficiency in a cancer center in France

“…Ludwig et al estimated that at least one third of European patients had not undergone any iron status assessment at diagnosis of anemia [22]. Our own observations of the extent of iron status assessment come approximately midway between the findings of these earlier publications.…”

“…Firstly, assessments of anemia and iron status vary substantially from one country to another [22]. Secondly, medical practice has wavered over the past decade due to several changes in guidelines [15,16,[31][32][33].…”

“…Nevertheless, the most recent large-scale studies still maintain that anemia and iron deficiency are underdiagnosed [21,22] and often inadequately treated [14,[23][24][25].…”

Clinical use of ferric carboxymaltose in patients with solid tumours or haematological malignancies in France

“…In routine practice, iron status is assessed only at low frequency [16] although assessment of haematopoiesis and iron metabolism in patients eligible for ESA therapy identified 21 % of patients to be absolute iron-deficient, defined by elevated ferritin index, and 29 % of patients to have absolute and/or functional iron deficiency, defined by elevated ferritin and/or diminished Hb content of reticulocytes, before the start of anaemia treatment [17]. Iron therapy, if given at all, is mainly based on oral iron despite that clinical studies have shown that oral iron had limited effect in ESA-treated cancer patients [18,19].…”

Management of anaemia in oncohaematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study

“…In the ACT study, an Hb increase of >1 g/dl was obtained in 65% of patients [Ludwig et al 2009] [Ludwig et al 2014]. Despite the demonstration of iron deficiency in 42% of evaluated patients, iron supplementation was only used in 31% of the cases, with oral administration in the majority of cases.…”