Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Abstract

PurposeAnaemia is a common complication of cancer causing symptoms including fatigue. It is also associated with shorter survival. Cancer causes systemic inflammation which interrupts iron metabolism leading to a functional iron deficiency (FID). There are few data on prevalence or aetiology of anaemia in those with advanced cancer. We aimed to establish the prevalence of anaemia and estimate extent of FID anaemia in patients with advanced cancer. MethodsAll patients with advanced cancer referred to two UK specialist palliative care services over one year were identified. Demographic and clinical data were linked with routinely collected haematological and biochemical profiles. We assessed the numbers of patients with abnormal values for haemoglobin, %hypochromic red cells (>5% indicates iron restricted erythropoiesis) and CRP (>10 indicates systemic inflammation). We judged that FID anaemia was likely when patients had all three abnormalities and ferritin 30-800ng/ml. Results 1797/2416 patients had a cancer diagnosis and laboratory data available. Mean haemoglobin was 116g/L. 63% of patients were anaemic; mild 25%, moderate 35% and severe 3%. Women had significantly higher mean haemoglobin than men and there was wide variation in anaemia prevalence across tumour sites. Thirty nine percent of patients' who had all four parameters checked met our criteria for FID anaemia. There were significant relationships between haemoglobin, %hypochromic red cells and CRP (p=0.0001). ConclusionsAnaemia was common in this population and we estimate this was caused by FID in 66% of anaemic patients. Further research is needed to validate our diagnostic criteria before this approach can be used in clinical practice.

Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians

“…Anaemia is a common complication of cancer and is more common in advanced disease. In a cohort of 1797 patients with advanced cancer referred to palliative care services, we found that 38% had moderate to severe anaemia and that functional iron deficiency was present in 39%–43% 1. Anaemia can cause symptoms including fatigue and breathlessness, with fatigue being the most frequently reported symptom in cancer 2…”

A Importância Do Profissional Biomédico Na Prática De Cuidados Paliativos No Tratamento Oncológico / the Importance of the Biomedical Professional in the Practice of Palliative Care in Cancer Treatment

“…Anemia é uma complicação comum em pacientes com câncer e causa diversos sintomas como fadiga e falta de ar. Neoh et al (2017)…”

Iron deficiency in children at the time of initial neuroblastoma diagnosis

“…[6][7][8] Patients with advanced cancer are likely to have FID as the predominant etiology of anemia. 9 ID anemia is also associated with shorter survival times in some types of cancers, including colon cancer, lung cancer, and breast cancer. [10][11][12] Notably however, little is known about ID in NB patients.…”