Iron Deficiency Anemia Coexists with Cancer Related Anemia and Adversely Impacts Quality of Life

Abstract

Cancer related anemia (CRA) adversely affects patient Quality of Life (QoL) and overall survival. We prospectively studied the prevalence, etiology and the impact of anemia on QoL in 218 Indian cancer patients attending a tertiary referral hospital. The study used the sTfR/log Ferritin index to detect iron deficiency anemia and assessed patient QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) tool, standardized for language. Mean patient age was 51±13 years and 60% were female. The prevalence of cancer related anemia in this setting was 64% (n = 139). As expected, plasma ferritin did not differ significantly between anemic (n = 121) and non-anemic cancer patients (n = 73). In contrast, plasma sTfR levels were significantly higher in anemic cancer patients compared to non-anemic cancer patients (31 nmol/L vs. 24 nmol/L, p = 0.002). Among anemic cancer patients, using the sTfR/log Ferritin index, we found that 60% (n = 83) had iron deficiency anemia (IDA). Interestingly, plasma sTfR levels were significantly higher in cancer patients with CRA+IDA (n = 83) compared with patients having CRA (n = 38) alone (39 nmol/L vs. 20 nmol/L, p<0.001). There was a significant linear correlation between Hb and QoL (Spearman ρ = 0.21; p = 0.001) and multivariate regression analysis revealed that every gram rise in Hb was accompanied by a 3.1 unit increase in the QoL score (95% CI = 0.19–5.33; p = 0.003). The high prevalence of anemia in cancer patients, a major portion of which is due to iron deficiency anemia, the availability of sensitive and specific biomarkers of iron status to detect IDA superimposed on anemia of inflammation, suggests an urgent need to diagnose and treat such patients. Despite the potential negative consequences of increasing metabolically available plasma iron in cancer, our clinical data suggest that detecting and treating IDA in anemic cancer patients will have important consequences to their QoL and overall survival. Clinical trials of iron therapy in these patients will be able to demonstrate the potential for benefit or harm.

Prevalence of Anemia in Patients With Solid Tumors: A Single Center Cross-Sectional Study at a Tertiary Care Center in West India

“…Similar findings have also been reported by Kanuri G et al they reported that when patients were categorized according to the type of cancer, the mean hemoglobin value was lowest in patients with a diagnosis of lymphoma followed by lung cancer, GI tumors and cancer of head and neck. There were no demonstrable differences in mean hemoglobin values based on patients cancer stage in their study, this can be attributed to the fact that most of the patients in their study were in stage IV at the time of diagnosis [11]. Wu Y et al [12] also observed patients with hematologic malignancies were more likely to have anemia at the time of diagnosis, the next highest prevalence for anemia was 53.3% among patients with breast cancer, and 50.9% among patients with non-small cell lung cancer (NSCLC).…”

An observational hospital based study to compare hemoglobin level among cancer patients

“…7 As far as distribution of Hb level is concerned among all cancer patients, 87.56% patients were having Hb level more than 9gm% and around 12.43% patients were having Hb level less than 9 gm%. Majority of patients whose Hb level was less than 9gm% were belonging to age group more than 45 years.…”

Diet quality and its relationship with overweight and laboratory parameters in breast cancer patients undergoing treatment

“…Iron status of cancer patients should be closely monitored as the incidence of anemia could compromise greatly their quality of life 44 . Current finding showed that higher quality diet was associated with reduced risk of low serum hemoglobin only after adjusting for physical activity and BMI (Model 2), suggests that diet quality might indirectly improve anemia by reducing excess body weight.…”