Effects of recombinant erythropoietin in palliative treatment of unselected cancer patients.
OBJECTIVE
The purpose is to evaluate relationships between objectively assessed exercise capacity and subjectively assessed scoring of physical functioning and well-being after erythropoietin treatment in cancer patients on palliative care.


METHODS
Unselected cancer patients (n = 108) who experienced progressive cachexia were randomized to receive either anti-inflammatory treatment alone (indomethacin) or recombinant erythropoietin plus indomethacin to prevent the appearance of disease-induced anemia and thereby protect patients' exercise capacity. Follow-up investigations of nutritional status, exercise capacity, and health-related quality of life assessed by SF-36 and the European Organization for Research and Treatment of Cancer QLQ-C30 were compared.


RESULTS
Effective treatment by erythropoietin on top of basal whole body anti-inflammatory treatment was confirmed and indicated by time course changes of biochemical, physiologic, and nutritional objectives, whereas individual self-reported scoring of physical functioning and general health did not indicate a clear-cut effectiveness, particularly at moderately subnormal hemoglobin levels.


CONCLUSIONS
Discrepancies between objective and subjective self-reported measures may be either fundamental or indicate scoring limitations for evaluation of therapeutic results. Present results demonstrate a clinical benefit of erythropoietin treatment in cancer patients with subnormal to normal hemoglobin levels, whereas the patients' own subjective scoring was insufficient to sense such improvements. The discrepancy may be either fundamental or methodological but emphasizes the importance to document therapeutic outcome in both subjective and objective perspectives in palliative care of cancer patients.
Lindholm
Elisabet
E
Department of Surgery, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
Daneryd
Peter
P
Körner
Ulla
U
Hyltander
Anders
A
Fouladiun
Marita
M
Lundholm
Kent
K
D000284:Administration, Oral; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use; D002100:Cachexia; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000494:pharmacology* / Q000627:therapeutic use*; D017079:Exercise Tolerance; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007213:Indomethacin / Q000494:pharmacology / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D009752:Nutritional Status; D010166:Palliative Care; D011788:Quality of Life; D011994:Recombinant Proteins; D015203:Reproducibility of Results
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011994:Recombinant Proteins; D004921:Erythropoietin; D007213:Indomethacin