Cancer anemia survey in Division of Medical Oncology at Siriraj Hospital (CAS).

BACKGROUND

Causes of anemia in cancer patients are multifaceted and include such factors as nutritional deficiency anemia, anemia of malignancy and treatment-related anemia. Chemotherapy, especially a platinum-based regimen, is well recognized to cause anemia. Anemia results in decrease of functional capacity, lower performance status, poor compliance and adverse prognosis. Optimal management of anemia in cancer patients is an essential component of cancer treatment. Previously, there was no information about this condition available in Thailand.

OBJECTIVE

1) To evaluate frequency, characteristics of anemia and treatments of anemia in our cancer patients who received chemotherapy treatment. 2) To identify the factors that influence hemoglobin (Hb) level in cancer patients especially chemotherapy regimens.

MATERIAL AND METHOD: Patients with diagnosis of solid malignancy who were scheduled to receive chemotherapy for least 4 cycles between June 2006 and December 2007 were included. All enrolled patients' data which included demographics, types and stages of cancer, chemotherapy regimen, Hb at baseline, Hb level before each cycle of chemotherapy and treatment of anemia, were recorded.

STATISTICAL ANALYSIS: Patients' data were presented in terms of percent, mean or median. Logistic-regression analysis was performed to identify risk factors of anemia in cancer patients.

RESULTS

Three-hundred and four patients were enrolled, 233 patients were female and 71 were male. The age of patients varied from 15 to 86 years old. Median age was 52 years old. Hb level at enrollment ranged from 7.7 to 16.1 g/dl, mean baseline Hb was 12.5 g/dl. Incidence of anemia at baseline was 34.5 percent whereas the incidence increased to 61.1 percent after receiving chemotherapy. The incidence of anemia in all patients was not significantly different from that of a subgroup of patients with normal baseline Hb. The patients who received platinum and anthracycline-based chemotherapy developed more anemia than those who received other chemotherapy regimens, with odd ratios of 9.4 (95% CI; 3.1-28.9, p < 0.001) and 3.5 (95% CI; 1.4-8.5, p = 0.005), respectively. Most anemic patients were asymptomatic; twenty-one out of 214 anemic patients (9.8%) received specific treatment for anemia.

CONCLUSION

Chemotherapy-induced anemia is a common problem found in cancer patients, especially in those receiving platinum-based chemotherapy Most of the anemic patients had asymptomatic grade I and II anemia. Blood transfusion was the treatment of choice for severe, symptomatic anemia in our hospital.