Intravenous iron and iron deficiency anemia in gastrointestinal cancer patients: a systematic review

Abstract

Background Iron deficiency anemia (IDA) is a prevalent hematological complication associated with gastrointestinal (GI) cancers due to an increased loss of iron and decreased iron absorption. We estimated the efficacy of parenteral iron on hemoglobin levels, blood transfusion needs and overall quality of life in patients with GI malignancies. Methods In this systematic review, we used PubMed, Cochrane, EMBASE, CINHAL and Scopus to conduct an electronic search from January 1, 2010 to March 24, 2022 with no language or study design restrictions. Studies were included if they discussed IDA, GI neoplasms, use of iron supplementation (with or without erythropoietin-stimulating agents [ESAs]), defined anemia and had a patient population of adults. Studies were excluded if were published before 2010. We assessed the efficacy of parenteral iron in comparison to other iron supplementation methods when treating IDA in GI cancer patients. The Cochrane Risk of Bias Tool 2 (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tools were used to assess the quality of the included studies. Moreover, the Cochrane Effective Practice and Organization data collection form was used to collect pertinent study information. Results Our search yielded 3,156 studies across all databases. With the exclusion of duplicates, ineligible study designs, as well as studies that did not pass abstract and full-text screening, 17 studies were included in our final analysis (4 randomized control trials; 13 non-randomized studies). Of the 13 studies evaluating hemoglobin (Hgb) response, seven studies found an increase in Hgb levels when patients were treated with IV iron. The 8 studies evaluating red blood cell (RBC) transfusion rates found no significant differences in RBC transfusion needs when treated with IV iron. Studies analyzing health related outcomes typically found an increase quality of life and decreased post-operative complications. Discussion This review reveals the improved outcomes of IDA in GI cancer patients treated with IV iron instead of other iron supplementation methods. Timely diagnosis and appropriate IDA management can greatly improve quality of life in this patient population, especially if myelosuppressive chemotherapy is required. Our systematic review presents some limitations due to heterogenous interventions in the randomized control trials, the varying time points of data collection in each study, and the use of small sample sizes.