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Luporsi E, Turpin A, Massard V, Morin S, Chauffert B, Carnot A, Cacoub P. Iron deficiency in patients with cancer: a prospective cross-sectional study. BMJ Support Palliat Care 2024; 14:215-221. [PMID: 34330792 DOI: 10.1136/bmjspcare-2021-002913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the deleterious consequences of iron deficiency (ID) in patients with cancer, underdiagnosis is frequent. The CARENFER study aimed to assess the prevalence of ID using both serum ferritin concentration and transferrin coefficient saturation (iron-saturation of transferrin, TSAT) index, as well as ID anaemia in patients with cancer. METHODS This prospective cross-sectional study was conducted in 15 oncology units in France in 2019. All patients present in the medical unit during the 2-week study period, regardless of the type of tumour (solid or haematological) and treatment, were eligible. Serum ferritin concentration, TSAT index and haemoglobin level were determined. ID and ID-associated anaemia were defined according to European Society of Medical Oncology 2018 Guidelines: ID was defined either as ferritin <100 µg/L (absolute ID) or as ferritin ≥100 µg/L and TSAT <20% (functional ID). RESULTS A total of 1221 patients with different types of solid malignant tumours were analysed: median age 64 years; 89.4% under treatment for their cancer, mainly by chemotherapy (75.4%). Overall, ID was found in 57.9% (55.1-60.6) of patients. Among them, functional ID accounted for 64% of cases. ID anaemia was reported in 21.8% (19.6-24.2) of all patients with cancer. ID was highly prevalent in untreated (75/130, 57.4%) and non-anaemic (419/775, 54.1%) patients. CONCLUSION This study highlights the high prevalence of ID in patients with cancer, whether or not associated with anaemia or treatment. These results emphasise the need to a better detection and management of ID in cancer, thereby optimising overall patient care. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03924271.
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Affiliation(s)
| | - Anthony Turpin
- Medical Oncology Department, CHU Lille, Lille, France
- UMR9020 - UMR-S 1277 Canther, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Vincent Massard
- Oncology Unit, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
| | - Sophie Morin
- Oncology Unit, Institut Bergonié, Bordeaux, France
| | | | - Aurélien Carnot
- Medical Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hopital Universitaire AP HP Pitie Salpetriere, Paris, France
- UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), Sorbonne Université, Paris, France
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Saint A, Viotti J, Borchiellini D, Hoch B, Raimondi V, Hebert C, Largillier R, Evesque L, Follana P, Ferrero JM, Delaby C, Schiappa R, Chamorey E, Barriere J. Iron deficiency during first-line chemotherapy in metastatic cancers: a prospective epidemiological study. Support Care Cancer 2019; 28:1639-1647. [DOI: 10.1007/s00520-019-04938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
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Luporsi E, Toledano A, Spaeth D, Scotté F, Espié M, Perot S, Duvillié L, Pithois Merli I, Bugat R. Use of iron sucrose and red blood cell transfusions in anaemic cancer patients in France (OncoFer study). Support Care Cancer 2016; 25:973-982. [PMID: 27915456 DOI: 10.1007/s00520-016-3489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This report describes the results of an observational, retrospective cohort study, evaluating the use of iron sucrose (IS) and red blood cell (RBC) transfusions in patients with cancer in routine clinical practice in France. A parallel investigated cohort treated with ferric carboxymaltose (FCM) has been reported earlier. METHODS Data of patients with a solid tumour or haematological malignancy who have received IS or an RBC transfusion during 2010 from 3 months prior (M-3) to 3 months post first treatment (M+3) were analysed. RESULTS Data from 46 patients who had received IS (400 mg median total iron dose) and 357 patients who had received RBC transfusions as first treatment (baseline) were included. Median haemoglobin levels improved from 9.9 g/dL (interquartile range 9.2; 11.0 g/dL) at baseline to 12.4 g/dL (11.4; 13.1 g/dL) at M+3 in IS-treated patients and from 8.2 g/dL (7.8; 8.8 g/dL) at baseline to 10.1 g/dL (8.8; 11.1 g/dL) in transfused patients. An erythropoiesis-stimulating agent was given to 54.3 and 28.9% of patients in the IS and the RBC transfusion groups, respectively, resulting in slightly better mean haemoglobin increase in both groups (2.4 vs 1.5 g/dL and 2.0 vs 1.6 g/dL, respectively). No severe nor serious adverse reaction and no hypersensitivity reactions were reported. CONCLUSION Both IS and RBC transfusions effectively increased Hb levels in patients with cancer. IS was safe and well tolerated in this population. Considering prior reported results with FCM, using FCM may reduce ESA dose requirements and the required number of infusions.
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Affiliation(s)
- Elisabeth Luporsi
- Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
- Oncologue médical, Biostatisticien, Généticien, PMSI Oncomed, Coordination réseau lorrain GENECAL, Institut de Cancérologie de Lorraine Alexis Vautrin, Avenue de Bourgogne, F 54511, Vandoeuvre-Les-Nancy, France.
| | | | | | | | | | | | | | | | - Roland Bugat
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
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Launay-Vacher V, Janus N, Deray G, Scotté F. Results from the LIDO anemia survey: adherence to EORTC guidelines in cancer patients in France. Support Care Cancer 2016; 24:3347-51. [DOI: 10.1007/s00520-016-3162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Laï-Tiong F, Brami C, Dubroeucq O, Scotté F, Curé H, Jovenin N. Management of anemia and iron deficiency in a cancer center in France. Support Care Cancer 2015; 24:1091-6. [PMID: 26253586 DOI: 10.1007/s00520-015-2877-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/29/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE Anemia affects most patients treated for cancer by chemotherapy. It is a known major contributor to fatigue and loss of quality of life and is likely to have a negative effect on prognosis and mortality from cancer. The main purpose of this study was to characterize the management of anemia and iron deficiency in a French oncology day-care center. METHODS A retrospective study was conducted between May and November 2012 in the oncology day unit of the Jean Godinot Cancer Center (France). The 133 patients included were all over the age of 18 and being treated by chemotherapy and had mild, moderate, or severe anemia. RESULTS Over half (58%) the patients were shown to be receiving no specific treatment for anemia. Iron balance was assessed in 71 patients and iron deficiency diagnosed in 37. Stepwise logistic regression showed that patients with severe to moderate anemia were nearly four times more likely to have an iron balance assessment than those with mild anemia (OR, 3.78; 95% CI, 1.84-7.76; P = 0.0003). Classical logistic regression shows that older patients (≥70) are three times less likely to have an iron balance assessment than patients <70 years (OR, 0.32; 95% CI, 0.12-0.86; P = 0.06). CONCLUSION An ideal medical setting for the management of anemia and iron deficiency, and the associated quality-of-life concerns, has yet to be defined for patients with cancer. Screening and treatment of mild to moderate anemia are inadequate, despite the advent of erythropoiesis-stimulating agents. Large scale, multicenter studies are required to define a clear medical framework for the management of anemia and iron deficiency.
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Affiliation(s)
- Florence Laï-Tiong
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France.
| | - Cloé Brami
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | - Olivier Dubroeucq
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | | | - Hervé Curé
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | - Nicolas Jovenin
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
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Ludwig H, Aapro M, Bokemeyer C, Glaspy J, Hedenus M, Littlewood T, Österborg A, Rzychon B, Mitchell D, Beguin Y. A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia. Support Care Cancer 2014; 22:2197-206. [PMID: 24659244 PMCID: PMC4082648 DOI: 10.1007/s00520-014-2189-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/02/2014] [Indexed: 01/28/2023]
Abstract
Purpose Patients with cancer frequently experience chemotherapy-induced anaemia (CIA) and iron deficiency. Erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management. Methods Medical oncologists and/or haematologists from nine European countries (n = 375) were surveyed on their last five cancer patients treated for CIA (n = 1,730). Information was collected on tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin saturation (TSAT), as well as applied anaemia therapies. Results Diagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94 %) and ferritin (48 %) measurements. TSAT was only tested in 14 %. At anaemia diagnosis, 74 % of patients had Hb ≤10 g/dL, including 15 % with severe anaemia (Hb <8 g/dL). Low-iron levels (ferritin ≤100 ng/mL) were detected in 42 % of evaluated patients. ESA was used in 63 % of patients, blood transfusions in 52 % and iron supplementation in 31 % (74 % oral, 26 % intravenous iron). Only 30 % of ESA-treated patients received a combination of ESA and iron supplementation. Blood transfusions formed part of a regular anaemia treatment regimen in 76 % of transfused patients. Management practices were similar in 2009 and 2011. Conclusion Management of anaemia and iron status in patients treated for CIA varies substantially across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is underutilised and mainly based on oral iron supplementation. Implementation of guidelines needs to be increased to minimize the use of blood transfusions.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - M. Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
| | | | - J. Glaspy
- UCLA School of Medicine, Los Angeles, USA
| | | | | | - A. Österborg
- Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | | | - Y. Beguin
- CHU of Liège and University of Liège, Liège, Belgium
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Finnamore H, Le Couteur J, Hickson M, Busbridge M, Whelan K, Shovlin CL. Hemorrhage-adjusted iron requirements, hematinics and hepcidin define hereditary hemorrhagic telangiectasia as a model of hemorrhagic iron deficiency. PLoS One 2013; 8:e76516. [PMID: 24146883 PMCID: PMC3797784 DOI: 10.1371/journal.pone.0076516] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 08/27/2013] [Indexed: 12/27/2022] Open
Abstract
Background Iron deficiency anemia remains a major global health problem. Higher iron demands provide the potential for a targeted preventative approach before anemia develops. The primary study objective was to develop and validate a metric that stratifies recommended dietary iron intake to compensate for patient-specific non-menstrual hemorrhagic losses. The secondary objective was to examine whether iron deficiency can be attributed to under-replacement of epistaxis (nosebleed) hemorrhagic iron losses in hereditary hemorrhagic telangiectasia (HHT). Methodology/Principal Findings The hemorrhage adjusted iron requirement (HAIR) sums the recommended dietary allowance, and iron required to replace additional quantified hemorrhagic losses, based on the pre-menopausal increment to compensate for menstrual losses (formula provided). In a study population of 50 HHT patients completing concurrent dietary and nosebleed questionnaires, 43/50 (86%) met their recommended dietary allowance, but only 10/50 (20%) met their HAIR. Higher HAIR was a powerful predictor of lower hemoglobin (p = 0.009), lower mean corpuscular hemoglobin content (p<0.001), lower log-transformed serum iron (p = 0.009), and higher log-transformed red cell distribution width (p<0.001). There was no evidence of generalised abnormalities in iron handling Ferritin and ferritin2 explained 60% of the hepcidin variance (p<0.001), and the mean hepcidinferritin ratio was similar to reported controls. Iron supplement use increased the proportion of individuals meeting their HAIR, and blunted associations between HAIR and hematinic indices. Once adjusted for supplement use however, reciprocal relationships between HAIR and hemoglobin/serum iron persisted. Of 568 individuals using iron tablets, most reported problems completing the course. For patients with hereditary hemorrhagic telangiectasia, persistent anemia was reported three-times more frequently if iron tablets caused diarrhea or needed to be stopped. Conclusions/significance HAIR values, providing an indication of individuals’ iron requirements, may be a useful tool in prevention, assessment and management of iron deficiency. Iron deficiency in HHT can be explained by under-replacement of nosebleed hemorrhagic iron losses.
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Affiliation(s)
- Helen Finnamore
- National Heart and Lung Institute, Cardiovascular Sciences, Imperial College London, London, United Kingdom
- Diabetes and Nutritional Sciences Division, King’s College London, School of Medicine, London, United Kingdom
- University of Liverpool Medical School, Liverpool, United Kingdom
| | - James Le Couteur
- Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mary Hickson
- Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mark Busbridge
- Clinical Chemistry, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King’s College London, School of Medicine, London, United Kingdom
| | - Claire L. Shovlin
- National Heart and Lung Institute, Cardiovascular Sciences, Imperial College London, London, United Kingdom
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
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Administration of intravenous iron complexes on implantable central venous access port in cancer patients in France: the FERPAC survey. Support Care Cancer 2013; 21:2743-8. [DOI: 10.1007/s00520-013-1845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
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Ludwig H, Müldür E, Endler G, Hübl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol 2013; 24:1886-1892. [PMID: 23567147 PMCID: PMC3690908 DOI: 10.1093/annonc/mdt118] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Only limited data on the prevalence of iron deficiency (ID) and its correlation with clinical parameters are available in cancer. ID frequently contributes to the pathogenesis of anemia in patients with cancer and may lead to several symptoms such as impaired physical function, weakness and fatigue. PATIENTS AND METHODS Parameters of iron status and clinical parameters were evaluated in 1528 patients with cancer who presented consecutively within a four-month period at our center. One thousand fifty-three patients had solid tumors and 475 hematological malignancies. RESULTS ID [transferrin saturation (TSAT) < 20%] was noted in 645 (42.6%) of the 1513 patients with TSAT tests available and 500 (33.0%) were anemic. ID rates were highest in pancreatic (63.2%), colorectal (51.9%) and lung cancers (50.7%). Of the 409 iron-deficient patients in whom serum ferritin levels were available additionally to TSAT, 335 (81.9%) presented with functional ID (FID) (TSAT < 20%, serum ferritin ≥30 ng/ml) and 74 (18.1%) with absolute ID. In patients with solid tumors, prevalence of ID correlated with cancer stage at diagnosis (P = 0.001), disease status (P = 0.001) and ECOG performance status (P = 0.005). CONCLUSIONS ID was frequently noted in cancer and was associated with advanced disease, close proximity to cancer therapy, and poor performance status in patients with solid tumors.
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Affiliation(s)
- H Ludwig
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna.
| | - E Müldür
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna
| | - G Endler
- Central Laboratory, Wilhelminenspital, Vienna, Austria
| | - W Hübl
- Central Laboratory, Wilhelminenspital, Vienna, Austria
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