Anemia in Stage II and III Breast Cancer Patients Treated With Adjuvant Doxorubicin and Cyclophosphamide Chemotherapy

Abstract

Purpose. The incidence and severity of prechemotherapy anemia and chemotherapy-induced anemia experienced by women treated with adjuvant doxorubicin and cyclophosphamide (AC) therapy for stage II and III breast cancer are described.Patients and Methods. Medical charts of 310 breast cancer patients who received chemotherapy at eight oncology practices during 1997 through 2001 were reviewed in this historical case series study. Prechemotherapy anemia was defined as a baseline hemoglobin value <12 g/dl. An anemic event during chemotherapy (used to define chemotherapy-induced anemia) was defined as either a drop in hemoglobin level below the threshold (≤10 g/dl), the receipt of a blood transfusion(s), or treatment with epoetin alfa. 315-472-7504; Fax: 315-479-9639; e-mail: Jkirshner@Hoacny.com Received January 9, 2003; accepted for publication September 30, 2003. ©AlphaMed Press 1083-7159/2004 The Oncologist ® Results LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Identify the prevalence and incidence of anemia in early-stage breast cancer patients and the proportion of patients untreated for anemia.2. Discuss the relationship between certain patient characteristics (i.e., age and prechemotherapy hemoglobin level) and the risk of developing moderate to severe anemia during chemotherapy.3. Explain how anemia may progress from cycle to cycle of chemotherapy and quantify the drop in hemoglobin levels for different groups of patients.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S. Copyright law. Unauthorized reproduction is prohibited. For reprints contact: Reprints@AlphaMedPress.com anemic prechemotherapy and that the incidence of anemia increases substantially from prechemotherapy through the postchemotherapy period. This evidence appears to warrant earlier evaluation of anemia and an intervention in the prechemotherapy stage. The Oncologist 2004;9:25-32 26

Anemia during adjuvant non-taxane chemotherapy for early breast cancer: Incidence and risk factors from two trials of the International Breast Cancer Study Group

“…Among our patients, prevalence of anemia (Hgb<12 g/dl) after surgery and before chemotherapy was about 25%: similar to other reported series [9,18,26], and was slightly more frequent in premenopausal patients. Possible reasons include iron deficiency and blood loss from surgery or from prolonged or abundant menses [9], while anemia of chronic disease related to cancer should not be a factor in these patients with stage I, II, and III breast cancer.…”

“…2 Cumulative incidence of anemia by quartile of baseline hemoglobin (g/dl). Cumulative incidence was computed using the product-limit method (log-rank P<0.0001) metabolism evaluated, thus missing the opportunity to detect and treat iron deficiency anemia, an easily treatable condition [18]. During chemotherapy, anemia incidence in our studies was lower than that reported by others [9,18].…”

“…Cumulative incidence was computed using the product-limit method (log-rank P<0.0001) metabolism evaluated, thus missing the opportunity to detect and treat iron deficiency anemia, an easily treatable condition [18]. During chemotherapy, anemia incidence in our studies was lower than that reported by others [9,18]. In patients without baseline anemia, treated with similar adjuvant regimens, some degree of anemia was recorded in 42% [9] or even 88% [18] of cases after chemotherapy, although only 27% of patients developed moderate to severe anemia [18].…”

“…Anemia represents a significant cause of morbidity [3] with a broad spectrum of clinical manifestations such as fatigue, weakness, respiratory distress, and variable effects on physical and cognitive capacities; it is a frequent complication in patients with metastatic breast cancer, particularly when treated with taxane-based regimens [12,26]. However, data about anemia in patients with early breast cancer treated with adjuvant chemotherapy are more limited, possibly due to underestimation and under-treatment of anemia [9,18,26]. In a large study designed to evaluate serious adverse effects (SAE) experienced by women younger than 63 years and receiving chemotherapy for recently diagnosed breast cancer (metastatic or not), 2.2% of patients had a SAE because of anemia or transfusions.…”

Frequency of Chemotherapy Induced Anemia in Breast Cancer Patients

“…The patients 35-45 years old were the second prevalent anemic group. Kirshner et al observed that the majority (52.4%) of patients who did not develop anemia during the course of chemotherapy were aged 50 -64, which means that postmenopausal women tend to maintain a higher concentration of hemoglobin possibly since they lose less blood (15).…”