Journal Mobile Options
Table of Contents
Vol. 68, Suppl. 1, 2005
Issue release date: April 2005
Oncology 2005;68(suppl 1):12–21
(DOI:10.1159/000083129)

Cancer-Related Anemia: Biological Findings, Clinical Implications and Impact on Quality of Life

Blohmer J.-U. · Dunst J. · Harrison L. · Johnston P. · Khayat D. · Ludwig H. · O’Brien M. · van Belle S. · Vaupel P.
aSankt Gertrauden, Berlin, Germany; bMartin-Luther-University, Halle, Germany; cBeth Israel Medical Center, New York, N.Y., USA; dQueen’s University Belfast, Belfast, Northern Ireland; eGroupe Hospital Pitié-Salpêtrière, Paris, France; fWilhelminenspital, Vienna, Austria; gRoyal Marsden Hospital, Surrey, UK; hUniversity Hospital, Ghent, Belgium; iJohannes Gutenberg University of Mainz, Mainz, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Anemia is a common symptom in cancer patients. The relationship among anemia, cancer progression and clinical outcomes of cancer treatment is complex and much remains to be elucidated. One hypothesis for an etiological link is that anemia contributes to the development of tumor hypoxia, which in turn has been shown to induce proteomic and genomic changes within the tumor cells that ultimately favor malignant progression and treatment resistance. A substantial body of clinical data indicates that anemia can be a significant independent prognostic factor for treatment response and survival in cancer patients treated with chemotherapy or radiotherapy. In addition, studies have shown a correlation between anemia and decline in quality of life (QOL) in cancer patients. Of the many factors that impact cancer patients’ QOL, fatigue has emerged as the most prevalent, troubling, under-recognized and under-treated of all symptoms experienced by anemic cancer patients. Systematic correction of anemia with appropriate supportive therapies prior to or during chemotherapy or radiotherapy may enhance patients’ QOL.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Fallowfield L, Gagnon D, Zagari M, et al: Multivariate regression analyses of data from a randomised, double-blind, placebo-controlled study confirm quality of life benefit of epoetin alfa in patients receiving non-platinum chemotherapy. Br J Cancer 2002;87:1341–1353.
  2. Carelle N, Piotto E, Bellanger A, et al: Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 2002;95:155–163.
  3. Cella D: Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 1998;25:43–46.
  4. Groopman JE, Itri LM: Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 1999;91:1616–1634.
  5. Caro JJ, Salas M, Ward A, et al: Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 2001;91:2214–2221.
  6. Moullet I, Salles G, Ketterer N, et al: Frequency and significance of anemia in non-Hodgkin’s lymphoma patients. Ann Oncol 1998;9:1109–1115.
  7. Kern W, Schoch C, Haferlach T, et al: Multivariate analysis of prognostic factors in patients with refractory and relapsed acute myeloid leukemia undergoing sequential high-dose cytosine arabinoside and mitoxantrone (S-HAM) salvage therapy: relevance of cytogenetic abnormalities. Leukemia 2000;14:226–231.
  8. Keating MJ, Smith TL, Lerner S, et al: Prediction of prognosis following fludarabine used as secondary therapy for chronic lymphocytic leukemia. Leuk Lymphoma 2000;37:71–85.
  9. Obermair A, Petru E, Windbichler G, et al: Significance of pretreatment serum hemoglobin and survival in epithelial ovarian cancer. Oncol Rep 2000;7:639–644.
  10. Sengelov L, Kamby C, Geertsen P, et al: Predictive factors of response to cisplatin-based chemotherapy and the relation of response to survival in patients with metastatic urothelial cancer. Cancer Chemother Pharmacol 2000;46:357–364.
  11. Albain KS, Crowley JJ, LeBlanc M, et al: Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 1991;9:1618–1626.
  12. Ohlhauser C, Bulzebruck H, Ebert W, et al: Prognostic factors for survival in inoperable non-small-cell lung cancer: a multivariate regression analysis of 456 patients with radiation therapy. Onkologie 1997;20:126–131.

    External Resources

  13. Waters JS, O’Brien ME, Ashley S: Management of anemia in patients receiving chemotherapy. J Clin Oncol 2002;20:601–603.
  14. Münstedt K, Kovacic M, Zygmunt M, et al: Impact of hemoglobin levels before and during chemotherapy on survival of patients with ovarian cancer. Int J Oncol 2003;23:837–843.
  15. Sevelda P, Gnant M, Lainz K: Influence of anemia on local relapse-free survival of premenopausal primary breast cancer patients under adjuvant CMF chemotherapy: and analysis of the Austrian Breast Cancer Study Group (abstract 257). Proc Am Soc Clin Oncol 2002;21:65a.
  16. Lee WR, Berkey B, Marcial V, et al: Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85–27. Int J Radiat Oncol Biol Phys 1998;42:1069–1075.
  17. Werner-Wasik M, Scott C, Cox JD, et al: Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival. Int J Radiat Oncol Biol Phys 2000;48:1475–1482.
  18. Kelleher DK, Matthiensen U, Thews O, et al: Tumor oxygenation in anemic rats: effects of erythropoietin treatment versus red blood cell transfusion. Acta Oncol 1995;34:379–384.
  19. Kelleher DK, Mattheinsen U, Thews O, et al: Blood flow, oxygenation, and bioenergetic status of tumors after erythropoietin treatment in normal and anemic rats. Cancer Res 1996;56:4728–4734.
  20. Thews O, Koenig R, Kelleher DK, et al: Enhanced radiosensitivity in experimental tumours following erythropoietin treatment of chemotherapy-induced anaemia. Br J Cancer 1998;78:752–756.
  21. Thews O, Kelleher DK, Vaupel P: Erythropoietin restores the anemia-induced reduction in cyclophosphamide cytotoxicity in rat tumors. Cancer Res 2001;61:1358–1361.
  22. Becker A, Stadler P, Lavey RS, et al: Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinomas. Int J Radiat Oncol Biol Phys 2000;46:459–466.
  23. Vaupel P, Thews O, Mayer A, et al: Oxygenation status of gynecologic tumors: what is the optimal hemoglobin level? Strahlenther Onkol 2002;178:727–731.
  24. Stüben G, Thews O, Pöttgen C, et al: Recombinant human erythropoietin increases the radiosensitivity of xenografted human tumours in anaemic nude mice. J Cancer Res Clin Oncol 2001;127:346–350.
  25. Mueller-Klieser W, Vaupel P, Manz R, et al: Intracapillary oxyhemoglobin saturation of malignant tumors in humans. Int J Radiat Oncol Biol Phys 1981;7:1397–1404.
  26. Vaupel P, Kallinowski F, Okunieff P: Blood flow, oxygen and nutrient supply, and metabolic microenvironment of human tumors: a review. Cancer Res 1989;49:6449–6465.
  27. Vaupel P, Kelleher DK, Höckel M: Oxygen status of malignant tumors: pathogenesis of hypoxia and significance for tumor therapy. Semin Oncol 2001;28:29–35.
  28. Vaupel P, Thews O, Hoeckel M: Treatment resistance of solid tumors: role of hypoxia and anemia. Med Oncol 2001;18:243–259.
  29. Höckel M, Vaupel P: Biological consequences of tumor hypoxia. Semin Oncol 2001;28:36–41.
  30. Höckel M, Vaupel P: Tumor hypoxia: definitions and current clinical, biologic, and molecular aspects. J Natl Cancer Inst 2001;93:266–276.
  31. Harris AL: Hypoxia – a key regulatory factor in tumour growth. Nat Rev Cancer 2002;2:38–47.
  32. Semenza GL: HIF-1 and tumor progression: pathophysiology and therapeutics. Trends Mol Med 2002;8:S62–S67.
  33. Henke M, Laszig R, Rübe C, et al: Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet 2003;362:1255–1260.
  34. Leyland-Jones B: Reflection and reaction: breast cancer trial with erythropoietin terminated unexpectedly. Lancet Oncol 2003;4:459–460.
  35. Van Belle SJ, Cocquyt V: Impact of haemoglobin levels on the outcome of cancers treated with chemotherapy. Crit Rev Oncol Hematol 2003;47:1–11.
  36. Hasenclever D, Diehl V: A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998;339:1506–1514.
  37. Graf W, Bergstrom R, Pahlman L, et al: Appraisal of a model for prediction of prognosis in advanced colorectal cancer. Eur J Cancer 1994;30A:453–457.
  38. Grogan M, Thomas GM, Melamed I, et al: The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999;86:1528–1536.
  39. Glaser CM, Millesi W, Kornek GV, et al: Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys 2001;50:705–715.
  40. Rai KR, Sawitsky A, Cronkite EP, et al: Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219–234.
  41. Binet JL, Auquier A, Dighiero G, et al: A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981;48:198–206.
  42. Durie BG, Salmon SE: A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975;36:842–854.
  43. Soni MK, Cella D: Quality of life and symptom measures in oncology: an overview. Am J Manag Care 2002;8:S560–S573.
  44. World Health Organization: Constitution of the World Health Organization, Geneva, Switzerland, WHO Basic Documents, 1948.
  45. Cella D: The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 1997;34:13–19.
  46. Ludwig H, Strasser K: Symptomatology of anemia. Semin Oncol 2001;28:7–14.
  47. Glaspy J, Bukowski R, Steinberg D, et al: Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol 1997;15:1218–1234.
  48. Demetri GD, Kris M, Wade J, et al: Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. Procrit Study Group. J Clin Oncol 1998;16:3412–3425.
  49. Littlewood TJ, Bajetta E, Nortier JW, et al: Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2001;19:2865–2874.
  50. Gabrilove JL, Cleeland CS, Livingston RB, et al: Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 2001;19:2875–2882.
  51. Vogelzang NJ, Breitbart W, Cella D, et al: Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 1997;34:4–12.
  52. Stone P, Richardson A, Ream E, et al: Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol 2000;11:971–975.
  53. Dillon E, Kelly J: The status of cancer fatigue on the island of Ireland: AIFC Professional and Interim Patient Surveys. Oncologist 2003;8(suppl 1):22–26.
  54. Curt GA, Breitbart W, Cella D, et al: Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 2000;5:353–360.
  55. Curt GA: Impact of fatigue on quality of life in oncology patients. Semin Hematol 2000;37:14–17.
  56. Mock V, Atkinson A, Barsevick A, et al: NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Huntingt) 2000;14:151–161.
  57. Cella D, Lai JS, Chang CH, et al: Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 2002;94:528–538.
  58. Mercadante S, Gebbia V, Marrazzo A, et al: Anaemia in cancer: pathophysiology and treatment. Cancer Treat Rev 2000;26:303–311.
  59. Nowrousian MR: Pathophysiology of cancer-related anemia; in Nowrousian MR (ed): Recombinant Human Erythropoietin in Clinical Oncology: Scientific and Clinical Aspects of Anemia in Cancer, pp 13–34. New York, Springer Medicine, 2002.
  60. Kurzrock R: The role of cytokines in cancer-related fatigue. Cancer 2001;92:1684–1688.
  61. Stone P, Ream E, Richardson A, et al: Cancer-related fatigue – a difference of opinion? Results of a multicentre survey of healthcare professionals, patients and caregivers. Eur J Cancer Care (Engl) 2003;12:20–27.
  62. Wang XS, Giralt SA, Mendoza TR, et al: Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin’s lymphoma. J Clin Oncol 2002;20:1319–1328.
  63. Ludwig H, Birgegard G, Olmi P, et al: European Cancer Anaemia Survey (ECAS): prospective evaluation of anemia in over 15,000 cancer (CA) patients (pts) (abstract 623PD). Ann Oncol 2002;13(suppl 5):169.
  64. Palumbo A, Falco P, Baldini L, et al: Correlation between fatigue and hemoglobin (Hb) level in multiple myeloma (MM) patients: results of a cross-sectional study (abstract 5096). Blood 2002;100:383b.
  65. Shasha D, George MJ, Harrison LB: Once-weekly dosing of epoetin-alpha increases hemoglobin and improves quality of life in anemic cancer patients receiving radiation therapy either concomitantly or sequentially with chemotherapy. Cancer 2003;98:1072–1079.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50