Cancer-Related Anemia: Pathogenesis, Prevalence and Treatment

Abstract

Cancer-related anemia is a cytokine-mediated disorder resulting from complex interactions between tumor cells and the immune system. Overexpression of certain inflammatory cytokines results in shortened survival of red blood cells, suppression of erythroid progenitor cells, impaired iron utilization, and inadequate erythropoietin production. Numerous other factors may also contribute to the development of anemia in cancer patients. The European Cancer Anaemia Survey (ECAS) has provided the most current, comprehensive, prospectively collected data on the incidence and prevalence of anemia among cancer patients, as well as important perspectives on anemia treatment and relationship of hemoglobin and performance status. ECAS enrolled over 15,000 treated and untreated patients with various malignancies from cancer centers in 24 European countries and followed them for up to 6 months. The initial analysis of the ECAS data revealed that 39% of the total cancer patient population was anemic (hemoglobin <12.0 g/dl) at enrollment, although the rate varied according to tumor type, disease status, and cancer treatment status. Of the patients who were not anemic at enrollment and started cancer treatment during the survey, those undergoing chemotherapy – either alone or in combination with radiotherapy – had the highest incidence of anemia (63 and 42%, respectively). Low hemoglobin levels correlated with poor performance status and only 40% of patients who were anemic at some time during the survey received treatment for their anemia. These findings are noteworthy, since a growing body of clinical evidence indicates that the treatment of anemia can significantly improve patients’ quality of life and may also improve the clinical outcome.

Anemia Is Associated with Decreased Survival Time in Dogs with Lymphoma

“…[20][21][22][23] Previous reports suggest that anemia of inflammation in dogs is of minimal clinical significance and rarely requires treatment. 4,7 The results of this study suggest to the contrary that there is a correlation between pretreatment anemia in lymphoma patients and decreased survival time.…”

“…[1][2][3]20 Although quality of life in dogs is difficult to assess, a survey of clients revealed that anorexia, weight loss, exercise intolerance, and weakness were the most important quality of life factors in the decision to euthanize dogs with congestive heart failure. 24 These clinical manifestations are also associated with anemic patients.…”

Predictive Effect of Preoperative Anemia on Long-Term Survival Outcomes with Non-Muscle Invasive Bladder Cancer

“…Besides, anemia is also associated with the elevated level of cytokines due to the interaction between the tumor cells and the immune system. This situation was explained with decreased lifetime of erythrocytes due to aggressively increased levels of inflammatory cytokines, suppression of erythroid progenitor cells, restricted iron use, decreased level of erythropoietin and/or decreased response level of bone narrow to erythropoietin (Birgegard et al, 2005). Although a previous study has emphasized the prognostic importance of anemia in patients with T2 to T4 stage BC, our first aim was to analyze preoperative anemia status of patients who were first treated with TURBT for NMBIC (Panneerselvam et al, 2012).…”

The Role Of Erythropoietin In The Treatment Of Anemia In Patients With Malignant Lymphoma

“…Th is may be due to the reduction of erythropoesis, manifested by reduction of erythrocyte half-life, poor iron reutilization by the bone marrow and inadequate response to erythropoetin with reduced endogenous erythropoetin levels [4,5,6]. Anemia may have a signifi cantly negative eff ect on the quality of life of patients suff ering from malignant lymphoma, producing symptoms such as dizziness, fatigue, weakness, nausea, headache and depression [7].…”