Anemia in patients with cancer: Incidence, causes, impact, management, and use of treatment guidelines and protocols

The incidence, etiology, impact, and considerations in developing guidelines for treating anemia in patients with cancer are described. Anemia is common in patients with cancer. The incidence and severity of anemia depend on the type and extent of the malignancy; the type, schedule, and intensity of cancer therapy; and patient age, gender, and comorbid conditions. Anemia may be the result of the malignancy itself, cancer treatment, blood losses, nutritional deficiencies, hemolysis, endocrine disorders, or inflammatory cytokines associated with chronic disease. Anemia can have a profound impact on physical and psychosocial function and quality of life. Guidelines and protocols for treating anemia should be evidence-based and take into consideration patient age, the type and extent of malignancy, comorbid conditions, and the etiology and impact of anemia. Patient-specific issues that guidelines should address include strategies for identifying patients with anemia, treating anemia, evaluating the response to treatment, and modifying treatment based on response. Erythropoietic agents are preferred over blood transfusions for patients whose anemia is chronic, although transfusions are indicated for acute, severe blood losses. Iron supplementation often is required in patients receiving erythropoietic therapy or with iron deficiency due to hemorrhage. The use of evidence-based guidelines and protocols that take into consideration the heterogeneity of patients with cancer can optimize anemia treatment.