Iron Deficiency Anemia Coexists with Cancer Related Anemia and Adversely Impacts Quality of Life.
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.
Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India.
Giridhar
G
Kanuri
Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India.
Ritica
R
Sawhney
College of Nursing, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India.
Jeeva
J
Varghese
College of Nursing, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India.
Madonna
M
Britto
Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India.|Department of Medical Oncology, St. Johns Medical College Hospital, Bangalore, Karnataka, India.
Arun
A
Shet
Int J Hematol. 2007 Jul;86(1):37-41
17675265
Clin Transl Oncol. 2013 Jun;15(6):477-83
23263906
Cancer. 2001 Jun 15;91(12):2214-21
11413508
Support Care Cancer. 2012 Jan;20(1):23-8
21107613
Oncology. 2005;68 Suppl 1:3-11
15855811
Tokai J Exp Clin Med. 2013 Apr 20;38(1):7-11
23564569
Sci Transl Med. 2010 Aug 4;2(43):43ra56
20686179
N Engl J Med. 2005 Mar 10;352(10):1011-23
15758012
Lab Hematol. 2005;11(1):14-23
15790548
BMJ. 2003 May 24;326(7399):1124
12763985
Am J Hematol. 2011 Nov;86(11):923-7
21812017
Med Oncol. 2008;25(1):12-21
18188710
Clin Chem Lab Med. 2005;43(3):326-31
15843240
Blood. 2010 Dec 2;116(23):4754-61
20826717
Br J Cancer. 2002 Apr 22;86(8):1243-9
11953880
Semin Oncol. 1998 Jun;25(3 Suppl 7):43-6
9671330
J Clin Oncol. 1998 Oct;16(10):3412-25
9779721
Eur J Cancer. 2004 Oct;40(15):2293-306
15454256
Cancer Manag Res. 2013 Aug 02;5:205-14
23946669
Oncology (Williston Park). 2002 Sep;16(9 Suppl 10):17-24
12380951
Ter Arkh. 2016;88(4):61-7
27070165
Cancer Treat Rev. 2000 Aug;26(4):303-11
10913385
Semin Oncol. 2001 Apr;28(2 Suppl 8):7-14
11395846
Ann Oncol. 2012 Aug;23(8):1954-62
22575608
Cancer. 2002 Aug 15;95(4):888-95
12209734
N Engl J Med. 2009 Dec 17;361(25):2436-48
19920054
J Clin Oncol. 2004 Apr 1;22(7):1301-7
15051778
Semin Hematol. 1997 Jul;34(3 Suppl 2):20-6
9253780
Med J Aust. 2005 May 2;182(9):453-7
15865588
Blood. 1997 Feb 1;89(3):1052-7
9028338