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Zhan B, Zhu Y, Yu J, Zhu Q, Zhang H, Ye X. Red cell size factor is a sensitive index in the early diagnosis of nondigestive tract cancer-related anemia: An observational study. Medicine (Baltimore) 2024; 103:e39736. [PMID: 39331897 DOI: 10.1097/md.0000000000039736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
Cancer-related anemia (CRA) is a common comorbidity in cancer patients, and it can lead to a worse prognosis. The aim of this cross-sectional study is to investigate the clinical value of the red cell size factor (Rsf) in the early diagnosis of nondigestive tract CRA. A total of 231 patients with nondigestive tract solid cancer were included, and they were divided into anemic and nonanemic subjects according to the hemoglobin (Hb) levels. A BC-7500 blood analyzer was used to detect the indices of red blood cell and reticulocyte, and the mean corpuscular volume (MCV), mean reticulocyte volume (MRV), reticulocyte hemoglobin (RHE) content, and reticulocyte production index were observed. Subsequently, the Rsf was calculated. Receiver operating characteristic curve analysis was used to evaluate the identifying power of Rsf for anemia diagnosed by the combination of RHE and reticulocyte production index. The adjusted-multivariate analysis and quartiles were used to assess the relation of reduced Rsf level with the risk and incidence of anemia diagnosed by combining the MCV, MCH, and mean corpuscular hemoglobin concentration (MCHC), respectively. Rsf levels showed no statistical differences between anemia and nonanemia subjects grouped by Hb (P > .05). Rsf has a high correlation with the RHE level (R > 0.900, P < .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, P < .001). Receiver operating characteristic curves showed that Rsf had the highest overall area under curve of 0.886 (95% confidence interval: 0.845-0.927) in identifying anemia of cancer patients (P < .001). When the optimal cutoff values of Rsf were set at 97.05 fl in males and 94.95 fl in females, the sensitivity and specificity were 0.94 and 0.76, and 0.98 and 0.75, respectively. Being treated as a categorical variable, Rsf had a highest odds ratio value of 30.626 (12.552-74.726; P < .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trend < 0.001). The study suggests that decreased Rsf level is a potentially powerful predictor of overt anemia in nondigestive tract cancer, and it can be used as a convenient, practical, cost-free, and sensitive index in early diagnosis of nondigestive tract CRA.
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Affiliation(s)
- Bicui Zhan
- Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yongjia Zhu
- Department of Laboratory Medicine, The Second Haining People's Hospital, Haining, Zhejiang, China
| | - Jiahong Yu
- Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiaojuan Zhu
- Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huaying Zhang
- Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaoqiang Ye
- Department of Laboratory Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Wondm SA, Dagnew SB, Gubae K, Tesfaye TC, Tamene FB. Determinants of anemia among patients receiving cancer chemotherapy in Northwest Ethiopia. Front Med (Lausanne) 2024; 11:1415877. [PMID: 39055698 PMCID: PMC11269183 DOI: 10.3389/fmed.2024.1415877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background Chemotherapy-induced anemia (CIA) is a hematologic complication that frequently affects patients with cancer undergoing chemotherapy. It is associated with worse treatment outcomes, higher rates of morbidity and mortality, worse quality of life, and higher healthcare costs. The incidence and predictors of CIA in Ethiopia, particularly in Northwest Ethiopian oncology centers, are poorly understood. This study was conducted at Northwest Ethiopian oncology centers to evaluate the incidence and determinants of chemotherapy-induced anemia in adult patients with cancer undergoing chemotherapy. Methods This 3-year hospital-based retrospective follow-up study included adult patients with cancer receiving chemotherapy between 2019 and 2021 at two oncology centers in Northwest Ethiopia. Data were collected from October to December 2021. A binary logistic regression model was used to select variables and determine the Crude Odds Ratio (COR). Variables with P-value < 0.2 were entered into the multivariable logistic regression and Adjusted odds ratio (AOR) with 95% Confidence intervals (CI) for variables with P-value < 0.05 were estimated to show determinants of chemotherapy-induced anemia among cancer patients who received chemotherapy. Results A total of 402 patients were included in the final analysis. The overall incidence of CIA was 75.4% (95% CI 70.7, 79.8). Older age [AOR = 1.8, 95% CI (1.4-3.5); P = 0.043], hematologic cancer [AOR = 3.7, 95% CI (3.2-5.7), P = 0.021], obesity [AOR = 3.4, 95% CI (2.3-6.9); P = 0.028], ≥6 chemotherapy cycles [AOR = 3.8, 95% CI (3.2-5.1), P = 0.019], cancer metastasis to bone [AOR = 2.9, 95% CI (1.2-4.7), P = 0.025] were statistically significant predictors of chemotherapy-induced anemia. Conclusion Chemotherapy-induced anemia persisted in a significant percentage of cancer patients. Chemotherapy-induced anemia developed in three-quarters of patients undergoing chemotherapy. Chemotherapy-induced anemia was significantly associated with older age, hematologic malignancy, obesity, a greater number of chemotherapy cycles, and cancer metastasis to bone. To lower the risk of morbidity related to anemia, patients with chemotherapy-induced anemia should be regularly evaluated and treated with appropriate treatment.
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Affiliation(s)
- Samuel Agegnew Wondm
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Samuel Berihun Dagnew
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kale Gubae
- Pharmacology Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tegenu Chanie Tesfaye
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Bayafers Tamene
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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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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Stević I, Janković SM, Georgiev AM, Marinković V, Lakić D. Factors associated with hematological adverse reactions of drugs authorized via the centralized procedure. Sci Rep 2024; 14:9074. [PMID: 38643204 PMCID: PMC11032331 DOI: 10.1038/s41598-024-59710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
Serious hematological adverse drug reactions (HADRs) may lead to or prolong hospitalization and even cause death. The aim of this study was to determine the regulatory factors associated with HADRs caused by drugs that were authorized up to July 2023 by the European Medicines Agency (EMA) and to evaluate the frequency of HADRs. Using a cross-sectional approach, the type and frequency of HADRs were collected from the Summaries of Product Characteristics of Drugs Authorized by the EMA and analyzed within proprietary, nonproprietary, and biosimilar/biological frameworks. Multivariate statistical analysis was used to investigate the associations of generic status, biosimilar status, conditional approval, exceptional circumstances, accelerated assessment, orphan drug status, years on the market, administration route, and inclusion on the Essential Medicines List (EML) with HADRs. In total, 54.78% of proprietary drugs were associated with HADRs at any frequency, while anemia, leucopenia, and thrombocytopenia were observed in approximately 36% of the patients. The predictors of any HADR, anemia, and thrombocytopenia of any frequency are generic status, biosimilar status, and inclusion on the EML, while the only protective factor is the administration route. Biosimilars and their originator biologicals have similar frequencies of HADRs; the only exception is somatropin. Knowledge of the regulatory factors associated with HADRs could help clinicians address monitoring issues when new drugs are introduced for the treatment of patients.
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Affiliation(s)
- Ivana Stević
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
| | | | | | | | - Dragana Lakić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Lim M, Kim J, Rhu J, Choi GS, Joh JW. Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis. JOURNAL OF LIVER CANCER 2024; 24:102-112. [PMID: 38351676 PMCID: PMC10990670 DOI: 10.17998/jlc.2024.01.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM Hepatocellular carcinoma (HCC) tumor thrombi located in the first branch of the portal vein (Vp3) or in the main portal trunk (Vp4) are associated with poor prognosis. This study aimed to investigate the clinicopathological characteristics and risk factors for HCC recurrence and mortality following liver resection (LR) in patients with Vp3 or Vp4 HCC. METHODS The study included 64 patients who underwent LR for HCC with Vp3 or Vp4 portal vein tumor thrombosis (PVTT). RESULTS Fifty-eight patients (90.6%) had Vp3 PVTT, whereas the remaining six patients exhibited Vp4 PVTT. The median tumor size measured 8 cm, with approximately 36% of patients presented with multiple tumors. Fifty-four patients (84.4%) underwent open LR, whereas 10 patients underwent laparoscopic LR. In the Vp4 cases, combined LR and tumor thrombectomy were performed. The 3-year cumulative disease-free survival rate was 42.8% for the Vp3 group and 22.2% for the Vp4 group. The overall survival (OS) rate at 3 years was 47.9% for the Vp3 group and 60.0% for the Vp4 group. Intrahepatic metastasis has been identified as an important contributor to HCC recurrence. High hemoglobin levels are associated with high mortality. CONCLUSION LR is a safe and effective treatment modality for selected patients with Vp3 or Vp4 HCC PVTT. This suggests that LR is a viable option for these patients, with favorable outcomes in terms of OS.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Myoungji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lin H, Zhan B, Shi X, Feng D, Tao S, Wo M, Fei X, Wang W, Yu Y. The mean reticulocyte volume is a valuable index in early diagnosis of cancer-related anemia. PeerJ 2024; 12:e17063. [PMID: 38435983 PMCID: PMC10909343 DOI: 10.7717/peerj.17063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Background Cancer-related anemia (CRA) is a functional iron deficient anemia, and the early diagnosis will improve the prognosis of the patients. This prospective study aimed to investigate the utility of mean reticulocyte volume (MRV) in the early diagnosis of CRA. Methods A total of 284 first-diagnosed cancer patients were enrolled, and the subjects were assigned anemia and non-anemia groups by hemoglobin (Hb) concentrations. The mature RBC and reticulocyte indices were detected with BC-7500 blood analyzer, and the MRV, reticulocyte hemoglobin (RHE) content, and reticulocyte production index (RPI) were obtained. ROC curves were constructed in identifying anemia diagnosed by the combination of RHE and RPI. An adjusted multivariate analyse and quartiles were used to assess the associations of MRV with early CRA diagnosed by combining RBC indices (MCV, MCH and MCHC), respectively. Results No statistical differences were observed in MCV, RHE and MRV levels between anemia and non-anemia subjects (p > 0.05). MRV exhibited a complete or high correlation with the RHE levels (r = 1.000, p < 0.001), or MCV, MCH, and MCHC in anemia patients (R: 0.575-0.820, p < 0.001). ROC curves analyse indicated a highest area under curve of 0.829 (95% CI [0.762-0.895]) and 0.884 (95% CI [0.831-0.936]) for MRV in identifying anemia in male and female patients, respectively (p < 0.001). When the optimal cutoff values of MRV were set at 100.95 fl in males and 98.35 fl in females, the sensitivity and specificity were 1.00 and 0.68, and 1.00 and 0.73, respectively. The regression analyse showed that, when being as a categorical variable, MRV showed an odds ratio of 19.111 (95% CI [6.985-52.288]; p < 0.001) for the incidence of CRA. The incidence of overall anemia demonstrated a more significant decrease trend along with the increase of MRV quartiles (p-trend < 0.001). Conclusion This study revealed that the MRV can be used as a convenient and sensitive index in early diagnosis of cancer-related anemia, and decreased MRV level may be the powerful predictor of overt anemia in cancer patients.
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Affiliation(s)
- Huijun Lin
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Bicui Zhan
- Department of Clinical Laboratory, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Shi
- Department of Clinical Laboratory, South Jinjiang Branch of Jinjiang Hospital, Jinjiang, Fujian, China
| | - Dujin Feng
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuting Tao
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Mingyi Wo
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xianming Fei
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Weizhong Wang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yan Yu
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Jin J, Ran Z, Noseda E, Roubert B, Marty M, Mezzacasa A, Göring UM. A randomized, controlled, open label non-inferiority trial of intravenous ferric carboxymaltose versus iron sucrose in patients with iron deficiency anemia in China. Front Med 2024; 18:98-108. [PMID: 37897561 DOI: 10.1007/s11684-023-1001-2] [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: 08/16/2022] [Accepted: 04/01/2023] [Indexed: 10/30/2023]
Abstract
Iron deficiency (ID) and ID anemia (IDA) pose significant public health concerns in China. Although iron sucrose (IS) treatment is well-established in the country, ferric carboxymaltose (FCM) offers the advantage of higher doses and fewer infusions. This open label, randomized, controlled, non-inferiority trial was conducted at multiple sites in China to compare the outcomes of FCM (maximum of 2 doses, 500 or 1000 mg iron) and IS (up to 11 infusions, 200 mg iron) treatments in subjects with IDA. The primary endpoint was the achievement of hemoglobin (Hb) response (an increase of ⩾2 g/dL from baseline) within 8 weeks, whereas secondary endpoints included changes in Hb, transferrin saturation, and serum ferritin levels. Among the 371 randomized subjects, a similar percentage of subjects treated with FCM and IS achieved Hb-response (FCM 99.4%, IS 98.3%), thereby confirming the non-inferiority of FCM compared with IS (difference 1.12 (-2.15, 4.71; 95% confidence interval (CI))). Furthermore, a significantly higher proportion of FCM-treated subjects achieved early Hb-response at Week 2 (FCM 85.2%, IS 73.2%; difference 12.1 (3.31, 20.65; 95% CI)). Additionally, the increase in TSAT and serum ferritin levels from baseline was significantly greater at all time points for FCM-treated subjects. The safety profiles of FCM and IS were comparable, with the exception of transient hypophosphatemia and pyrexia, which are consistent with FCM's known safety profile. In conclusion, FCM proves to be an efficacious treatment for IDA, providing faster Hb-response and correction of ID with fewer administrations than IS.
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Affiliation(s)
- Jie Jin
- The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, 310058, China
| | - Zhihua Ran
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Nunthanawanich P, Wichansawakun S, Luangjinda C, Hudthagosol C. Effectiveness of Web Applications on Improving Nutritional Status of Patients with Colorectal Cancer. Nutrients 2024; 16:408. [PMID: 38337693 PMCID: PMC10857273 DOI: 10.3390/nu16030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The most common cancer in Thailand is colorectal cancer (CRC). A lack of knowledge and misleading information from social media have contributed to cancer deaths from malnutrition. A web application is a tool that provides easy access to scientific nutritional information via an online platform. In this study, our goal was to compare the nutritional status of CRC patients using different nutrition-based educational tools with nutrition counseling, namely the Nutrition Educational Prototype based on Smartphone Web Applications (NEPSA) and standard hospital leaflets. Anthropometric and biochemical analyses and a dietary assessment, especially calories and protein, were measured during three visits. This study finally included 28 CRC patients who were undergoing chemotherapy and malnutrition with a body mass index (BMI) of <20 kg/m2. Thirteen participants received NEPSA while the remaining fifteen participants received a standard hospital leaflet. The results showed that NEPSAs improved nutritional outcomes by encouraging weight gain, increasing BMI, hemoglobin, hematocrit, and albumin levels, and consuming more calories and protein. NEPSA should be implemented to enhance the nutrition outcomes from anthropometric, biochemical, and dietary perspectives from nutrition advice among CRC patients. There could be positive impacts at the national level regarding equal accessibility to Thailand's nutrition information.
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Affiliation(s)
- Pornpimon Nunthanawanich
- Doctor of Public Health (International Program), Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
| | - Sanit Wichansawakun
- Division of Clinical Nutrition, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Cholrit Luangjinda
- Research and Development Office, Thailand Institute of Occupational Safety and Health, Ministry of Labor, Bangkok 10170, Thailand
| | - Chatrapa Hudthagosol
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
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Link H, Kerkmann M, Holtmann L, Detzner M. Anemia diagnosis and therapy in malignant diseases: implementation of guidelines-a representative study. Support Care Cancer 2024; 32:113. [PMID: 38240843 PMCID: PMC10799088 DOI: 10.1007/s00520-023-08267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Anemia in cancer should be diagnosed and treated according to guideline recommendations. The implementation of ESMO and German guidelines and their effect on anemia correction was analyzed. METHODS This retrospective epidemiological study, representative for Germany, analyzed data on anemia management of cancer patients with anemia ≥ grade 2. The Guideline Adherence Score (GLAD) for diagnosis (GLAD-D) and therapy (GLAD-T) was defined as follows: 2 points for complete, 1 point for partial, 0 point for no adherence. RESULTS Data were analyzed for 1046 patients. Hb levels at diagnosis of anemia were 8-10 g/dL in 899 (85.9%) patients, 7-8 g/dL in 92 (8.7%), and < 7 g/dL (5.0%) in 52. Transferrin saturation was determined in 19% of patients. Four hundred fifty-six patients received RBC (43.6%), 198 (18.9%) iron replacement, 106 (10.1%) ESA, and 60 (5.7%) vitamin B12 replacement. 60.6% of patients receiving iron replacement were treated intravenously and 39.4% were treated orally. Two hundred eighty-eight (36.6%) of 785 patients receiving transfusions had no guideline-directed indication. GLAD-D was 2 in 310 patients (29.6%), 1 in 168 (16.1%), and 0 in 568 (54.3%). GLAD-T was 2 in 270 patients (25.8%), 1 in 320 patients (30.6%), and 0 in 456 patients (43.6%). Higher GLAD-D significantly correlated with higher GLAD-T (τB = 0.176, p < 0.001). GLAD-T 2 was significantly associated with greater Hb increase than GLAD-T 0/1 (p < 0.001) at 28 days (10.2 vs. 9.7 g/dL) and at 2 months (10.4 vs. 9.9 g/dL). CONCLUSIONS Anemia assessment is inadequate, transfusion rates too high, and iron and ESA therapy too infrequent. TRIAL REGISTRATION ClinicalTrials.gov, NCT05190263, date: 2022-01-13.
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Affiliation(s)
- Hartmut Link
- Internal Medicine, Hematology and Medical Oncology, D-67661, Kaiserslautern, Germany.
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany.
| | - Markus Kerkmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Laura Holtmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Markus Detzner
- AIO-Studien-gGmbH, Kuno-Fischer-Straße 8, D-14057, Berlin, Germany
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Long Y, Zhou XL, Zhang CL, Wang YN, Pan WS. Nomogram based on clinical characteristics for predicting overall survival in gastric cancer patients with preoperative anemia. World J Gastrointest Surg 2023; 15:1375-1387. [PMID: 37555125 PMCID: PMC10405121 DOI: 10.4240/wjgs.v15.i7.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Preoperative anemia is associated with increased postoperative morbidity and mortality and increased perioperative transfusion risk. For surgical patients, this affects physical and cognitive ability and quality of life, but it is an important and modifiable risk factor. AIM To determine the effect of preoperative anemia on the prognosis of gastric cancer (GC) patients and generate a prognostic nomogram to predict the postoperative overall survival (OS) of GC patients with preoperative anemia. METHODS Clinicopathological and follow-up data of GC patients treated at Zhejiang Provincial People's Hospital (China) from 2010 to 2015 were collected. Independent prognostic factors were screened by univariate and multivariate Cox regression analyses. Then, these factors were used to construct a nomogram to predict 1-, 3-, and 5-year postoperative OS in preoperative anemic GC patients. The nomogram was assessed by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). RESULTS Nine hundred and sixty GC patients were divided into two groups (preoperatively anemic and nonanemic), and postoperative survival analysis was performed on both groups, yielding a shorter postoperative survival for preoperatively anemic patients than for nonanemic patients. A total of 347 GC patients with preoperative anemia were included. Age, preoperative alpha-fetoprotein level, monocyte count, lymphocyte count, clinicopathological stage, liver metastasis, and GC type were identified as independent prognostic factors for OS. The area under the ROC curve (AUC) of the nomogram for predicting 1-, 3-, and 5-year OS was 0.831, 0.845, and 0.840, respectively, for the training cohort, and the corresponding AUC values in the validation cohort were 0.827, 0.829, and 0.812, respectively. Calibration curves and DCA indicated good performance of the nomogram. CONCLUSION In all, we have successfully produced and verified a useful nomogram for predicting OS in GC patients with preoperative anemia. This nomogram based on a variety of clinicopathological indices can provide an effective prognostic assessment and help clinicians choose an appropriate treatment strategy for GC patients with preoperative anemia.
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Affiliation(s)
- Yan Long
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xiao-Lu Zhou
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Cheng-Long Zhang
- Department of Traumatology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Ya-Nan Wang
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, Zhejiang Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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11
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Shamsi A, Cannata A, Piper S, Bromage DI, McDonagh TA. Treatment of Iron Deficiency in Heart Failure. Curr Cardiol Rep 2023; 25:649-661. [PMID: 37329419 PMCID: PMC10307722 DOI: 10.1007/s11886-023-01889-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is commonly associated with iron deficiency (ID), defined as insufficient levels of iron to meet physiological demands. ID's association with anaemia is well understood but it is increasingly recognised as an important comorbidity in HF, even in the absence of anaemia. This review summarises contemporary evidence for the measurement and treatment of ID, in both HFrEF and HFpEF, and specific HF aetiologies, and highlights important gaps in the evidence-base. RECENT FINDINGS ID is common among patients with HF and associated with increased morbidity and mortality. Correcting ID in patients with HF can impact upon functional status, exercise tolerance, symptoms, and overall quality of life, irrespective of anaemia status. ID is a modifiable comorbidity in HF. Therefore, recognising and treating ID has emerging therapeutic potential and is important for all clinicians who care for patients with HF to understand the rationale and approach to treatment.
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Affiliation(s)
- Aamir Shamsi
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Susan Piper
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK.
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12
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Kennedy NA, Achebe MM, Biggar P, Pöhlmann J, Pollock RF. A systematic literature review and meta-analysis of the incidence of serious or severe hypersensitivity reactions after administration of ferric derisomaltose or ferric carboxymaltose. Int J Clin Pharm 2023:10.1007/s11096-023-01548-2. [PMID: 37010731 DOI: 10.1007/s11096-023-01548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/25/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Intravenous iron is the preferred treatment for patients with iron deficiency anemia in a variety of clinical situations. Although uncommon, administration of modern IV iron formulations can result in hypersensitivity reactions (HSRs) and, rarely, anaphylactic or anaphylactoid reactions. AIM The objective of the present study was to systematically review the literature to identify and analyze data on the incidence of HSRs after administration of ferric derisomaltose (FDI) or ferric carboxymaltose (FCM). METHOD A prospectively-registered systematic literature review was conducted to identify prospective randomized controlled trials comparing FDI and FCM with other intravenous iron formulations or oral iron. Searches were conducted in PubMed (including MEDLINE), EMBASE, and the Cochrane Library in November 2020. The relative incidence of serious or severe HSRs occurring on the day or day after dosing of intravenous iron, recorded under the standardized Medical Dictionary for Regulatory Activities query for anaphylactic reaction. RESULTS Data were obtained from seven randomized controlled trials of FCM (N = 2683) and ten of FDI (N = 3474) enrolling 10,467 patients in total. The number of patients experiencing any serious or severe HSR event was 29/2683 (1.08%) with FCM versus 5/3474 with FDI (0.14%). Bayesian inference of proportions showed the event rates to be significantly lower with FDI relative to FCM. CONCLUSION HSR events were uncommon with both intravenous iron formulations; however, the present study showed a significantly lower incidence of HSRs with FDI relative to FCM. Further large-scale, head-to-head trials of the iron formulations would be required to confirm this finding.
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Affiliation(s)
- Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Maureen M Achebe
- Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Patrick Biggar
- Department of Nephrology, Klinikum Coburg GmbH, Coburg, Germany
| | - Johannes Pöhlmann
- Covalence Research Ltd, Rivers Lodge, West Common, Harpenden, AL5 2JD, UK
| | - Richard F Pollock
- Covalence Research Ltd, Rivers Lodge, West Common, Harpenden, AL5 2JD, UK.
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13
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Parikh PM, Aggarwal S, Biswas G, Gulia S, Agarwala V, Basade M, Mohapatra P, Vamshi KM, Warrier A, Prasad K, Roy P, Chandrakant M, Malhotra H, Hingmire S, Paul D, Maniar V, Gupta A, Panda SS, Samar A, Rohatgi N, Dattatreya S, Krishnamurthy M, Thirumalairaj R. Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries. South Asian J Cancer 2023; 12:93-99. [PMID: 37969669 PMCID: PMC10635760 DOI: 10.1055/s-0043-1771445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Purvish M. ParikhCancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.
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Affiliation(s)
- Purvish Mahendra Parikh
- Department of Clinical Hematology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Shyam Aggarwal
- Department of Medical Oncology, Sir Gangaram Hospital, New Delhi, India
| | - Ghanashyam Biswas
- Department of Medical Oncology, Sparsh Hospitals and Critical Care Private Ltd., Bhubaneswar, Odisha, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
| | - Vivek Agarwala
- Department of Medical Oncology, Narayana Superspeciality Hospital and Cancer Institute, Kolkata, West Bengal, India
| | - Maheboob Basade
- Department of Medical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | - P.N. Mohapatra
- Department of Medical Oncology, Apollo Cancer Center, Kolkata, West Bengal, India
| | | | - Arun Warrier
- Department of Medical Oncology, Aster Medicity, Cochin, Kerala, India
| | - Krishna Prasad
- Department of Medical Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Partha Roy
- Department of Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India
| | - M.V. Chandrakant
- Department of Medical Oncology, Narayana Hospital, Howrah, West Bengal, India
| | - Hemant Malhotra
- Department of Medical Oncology, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | - Sachin Hingmire
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Davinder Paul
- Department of Medical Oncology, Fortis Hospital, Ludhiana, Punjab, India
| | - Vashista Maniar
- Department of Medical Oncology, Mumbai Oncocare Center, Mumbai, Maharashtra, India
| | - Alok Gupta
- Department of Medical Oncology, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Soumya S. Panda
- Department of Medical Oncology, The Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India
| | - Aseem Samar
- Department of Medical Oncology, Bhagwan Mahavir Cancer Hospital & Research Center, Jaipur, Rajasthan, India
| | - Nitesh Rohatgi
- Department of Medical Oncology, Fortis Cancer Institute, Delhi, India
| | - Satya Dattatreya
- Department of Medical Oncology, Renova Soumya Hospital, Secundarabad, Telangana, India
| | | | - Raja Thirumalairaj
- Department of Medical Oncology, Apollo Cancer Center, Chennai, Tamil Nadu, India
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O’Mahony D, Mabunda SA, Mntonintshi M, Iruedo J, Kaswa R, Blanco-Blanco E, Ogunsanwo B, Namugenyi KAF, Vasaikar S, Yogeswaran P. Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3584. [PMID: 36834279 PMCID: PMC9966846 DOI: 10.3390/ijerph20043584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. METHODS A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. RESULTS Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. CONCLUSIONS HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.
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Affiliation(s)
- Don O’Mahony
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Sikhumbuzo A. Mabunda
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Mbulelo Mntonintshi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Joshua Iruedo
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ernesto Blanco-Blanco
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa
| | - Basil Ogunsanwo
- Department of Surgery, Walter Sisulu University, Mthatha 5117, South Africa
| | | | - Sandeep Vasaikar
- Department of Microbiology, Walter Sisulu University, Mthatha 5117, South Africa
| | - Parimalaranie Yogeswaran
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
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15
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Ola IO, Okunowo AA, Habeebu MY, Miao Jonasson J. Clinical and non-clinical determinants of cervical cancer mortality: A retrospective cohort study in Lagos, Nigeria. Front Oncol 2023; 13:1105649. [PMID: 36874121 PMCID: PMC9978796 DOI: 10.3389/fonc.2023.1105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Cervical cancer (CCa) is the fourth most frequent and a common cause of cancer mortality in women, the majority of whom live in low- and middle-income countries. Data on CCa mortality and its determinants have been poorly studied in Nigeria, resulting in a paucity of information that can assist patient management and cancer control policy. Aim The purpose of this study was to assess the mortality rate among CCa patients in Nigeria as well as the major factors influencing CCa mortality. Study design Data from the medical records of 343 CCa patients seen at the Lagos University Teaching Hospital and NSIA-LUTH Cancer Center from 2015 to 2021 were used in a retrospective cohort analysis. The hazard ratios (HR) and confidence intervals (CI) associated with the exposure variables and CCa mortality were calculated using Cox proportional hazard regression. Results The CCa mortality rate was 30.5 per 100 women-years after 2.2 years of median follow-up. Clinical factors such as HIV/AIDS (adjusted HR [aHR]: 11.9; 95% CI: 4.6, 30.4), advanced clinical stage (aHR: 2.7; 95% CI: 1.5, 4.7), and anemia at presentation (aHR: 1.8; 95% CI: 1.1, 3.0) were associated with a higher mortality risk, as were non-clinical factors such as age at diagnosis >50 years (aHR: 1.4; 95% CI: 1.0, 1.9) and family history of CCa (aHR: 3.5; 95%CI: 1.1, 11.1). Conclusion CCa has a high mortality rate in Nigeria. Incorporating these clinical and non-clinical factors into CCa management and control policies may improve women's outcomes.
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Affiliation(s)
- Idris Olasunmbo Ola
- Global Health Program, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Departments of Clinical and Community Service, The Blue-Pink Center for Women's Health, Lagos, Nigeria
| | - Adeyemi Adebola Okunowo
- Department of Obstetrics & Gynaecology, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Muhammad Yaqub Habeebu
- Department of Radiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria
- Lead Oncologist, NSIA-LUTH Cancer Centre (NLCC), Lagos, Nigeria
| | - Junmei Miao Jonasson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Research and Development, Region Halland, Halmstad, Sweden
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16
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Rohr M, Brandenburg V, Brunner-La Rocca HP. How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome. Eur J Med Res 2023; 28:15. [PMID: 36617559 PMCID: PMC9827648 DOI: 10.1186/s40001-022-00922-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/30/2022] [Indexed: 01/10/2023] Open
Abstract
Iron deficiency (ID) is the most common nutritional disorder worldwide. It is often observed in patients with chronic diseases, such as heart failure (HF), chronic kidney disease (CKD), inflammatory bowel disease (IBD) and cancer. ID is associated with poor clinical outcome, including poor performance, reduced quality of life, as well as increased hospitalization and mortality. The aim of this review is to provide an overview about the role of ID in chronic diseases (HF, CKD, IBD, cancer) regarding their current definitions and clinical relevance; diagnostic accuracy of iron parameters in chronic inflammatory conditions and its potential as prognostic markers. Due to different definitions and guideline recommendations of ID, various laboratory parameters for ID diagnostic exist and there is no general consensus about the definition of ID and its treatment. Still, a general trend can be observed across all investigated indications of this review (HF, CKD, IBD, cancer) that serum ferritin and transferrin saturation (TSAT) are the two parameters mentioned most often and emphasized in all guidelines to define ID and guide treatment. The most commonly used threshold values for the diagnosis of ID are TSAT of < 20% and serum ferritin of < 100-300 µg/L. Noteworthy, both TSAT and particularly ferritin are frequently applied, but both may vary due to inflammatory conditions. Studies showed that TSAT is less affected by inflammatory processes and may therefore be more accurate and reliable than serum ferritin, particularly in conditions with elevated inflammatory state. A low iron status and particularly a low TSAT value was associated with a poor outcome in all investigated indications, with the strongest evidence in HF patients. Routine surveillance of iron status in these groups of patients with chronic conditions is advisable to detect ID early. Depending on the inflammatory state, TSAT < 20% may be the more accurate diagnostic marker of ID than ferritin. Moreover, TSAT may also be the more reliable estimate for the prognosis, particularly in HF.
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Affiliation(s)
- Martina Rohr
- grid.476593.a0000 0004 0422 3420Vifor Pharma Deutschland GmbH, Baierbrunner Straße 29, 81379 Munich, Germany
| | - Vincent Brandenburg
- Dept of Cardiology and Nephrology, Rhein-Maas Klinikum Würselen, Mauerfeldchen 25, 52146 Würselen, Germany
| | - Hans-Peter Brunner-La Rocca
- grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Cardiology, MUMC+, Maastricht University Medical Centre, P. Debyelaan 25, Main Building, 3rd Floor, room 3.B2.022, 6229 HX Maastricht, The Netherlands ,PO Box 5800, 6202 AZ Maastricht, The Netherlands
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17
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Kim NH, Park JH, Koo DH, Jung YS, Yang JY, Lee HY. A Pilot Study of Peritumor Administration of 5-FU for Preventing Bleeding in Advanced Gastric Cancer. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:273-280. [PMID: 36567441 DOI: 10.4166/kjg.2022.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022]
Abstract
Five-FU is a potent chemotherapeutic agent for suppressing endothelial cell growth. The purpose of this study was to investigate the usefulness of local peritumor injection of 5-FU for patients with advanced gastric cancer (AGC) for the prevention of anemia. Between January 2020 and January 2022, patients aged 18 years or older with AGC and moderate anemia were included. A total of 200 mg of 5-FU was injected per session at ten points of the lesion (20 mg at each point) every 7 days for 4 to 12 weeks. Patients received a blood test for toxicity at every cycle. From one of these patients, endoscopic biopsy specimens were taken from gastric cancer before and after injecting 5-FU for immunostaining. A total of five AGC patients participated in this study. For most patients, hemoglobin levels were maintained without transfusions during 5-FU injection, and expression levels of thrombospondin-1 was increased after injection compared to those before injection. Blood test results during 5-FU injection showed no significant change in serum glutamic oxalacetic transaminase/glutamic pyruvic transaminase, total bilirubin, or creatinine level. The results of this study showed the possibility of local peritumor 5-FU injection as a treatment for relieving anemia of patients with gastric cancer.
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Affiliation(s)
- Nam-Hee Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Yang
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Hee-Young Lee
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
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18
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Decruyenaere A, Kortbeek K, Delanghe S, Rottey S, Denys H, Lapeire L. Incidence, evolution and risk factors of hypophosphatemia in patients with solid tumors receiving ferric carboxymaltose: a retrospective cohort study. Acta Clin Belg 2022:1-10. [DOI: 10.1080/17843286.2022.2153465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alexander Decruyenaere
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Koen Kortbeek
- Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
| | - Sigurd Delanghe
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Sylvie Rottey
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore Denys
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lore Lapeire
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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19
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Choi WJ, Ivanics T, Claasen MPAW, Gallinger S, Hansen B, Sapisochin G. Is it safe to administer neoadjuvant chemotherapy to patients undergoing hepatectomy for intrahepatic cholangiocarcinoma? ACS-NSQIP propensity-matched analysis. HPB (Oxford) 2022; 24:1535-1542. [PMID: 35474005 DOI: 10.1016/j.hpb.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of neoadjuvant chemotherapy (NAC) in patients with intrahepatic cholangiocarcinoma (iCCA) is increasing. The objective of this study was to compare the 30-day post-operative complications and length-of-stay (LOS) between patients undergoing hepatectomy for iCCA with and without NAC. METHODS A retrospective study was conducted using the ACS-NSQIP database queried from 2014 to 2018. Patients with NAC receipt were propensity-score matched into 1:3 ratio with controls using the greedy-matching algorithm and a caliper of 0.2. Logistic and Poisson regression models were used to estimate the effect sizes. RESULTS A total of 1508 patients who underwent hepatectomy for iCCA were included. 706 patients remained after matching and balance were achieved. The NAC group had 110 (60.1%) complications vs. 289 (55.3%) complications in the non-NAC group (p = 0.29). NAC was not associated with worse 30-day postoperative complications [OR 1.24, 95% CI: 0.87-1.76; p = 0.24]. Post-operative LOS in the NAC group was 8.56 days (mean, SD 7.4) vs. non-NAC group 9.27 days (mean, SD 8.41, p = 0.32). NAC was not associated with longer post-operative LOS [RR 0.93, 95% CI:0.80, 1.08; p = 0.32]. CONCLUSION NAC may be safely administered without increasing the risk of 30-day complications or post-operative hospital LOS.
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Affiliation(s)
- Woo Jin Choi
- University of Toronto, Department of General Surgery, Toronto, Canada; University Health Network, HPB Surgical Oncology, Toronto, Canada
| | - Tommy Ivanics
- University Health Network, HPB Surgical Oncology, Toronto, Canada; Department of Surgery, Henry Ford Hospital, Detroit, MI, USA; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Marco P A W Claasen
- University Health Network, HPB Surgical Oncology, Toronto, Canada; Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Steven Gallinger
- University of Toronto, Department of General Surgery, Toronto, Canada; University Health Network, HPB Surgical Oncology, Toronto, Canada
| | - Bettina Hansen
- University Health Network, Center for Liver Disease, Toronto, Canada
| | - Gonzalo Sapisochin
- University of Toronto, Department of General Surgery, Toronto, Canada; University Health Network, HPB Surgical Oncology, Toronto, Canada.
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20
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Intravenous Iron Supplementation for the Treatment of Chemotherapy-Induced Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2022; 11:jcm11144156. [PMID: 35887920 PMCID: PMC9317757 DOI: 10.3390/jcm11144156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: The pathophysiology of cancer-related anemia is multifactorial, including that of chemotherapy-induced anemia (CIA). The guidelines are not consistent in their approach to the use of intravenous (IV) iron in patients with cancer as part of the clinical practice. Materials and methods: All randomized controlled trials that compared IV iron with either no iron or iron taken orally for the treatment of CIA were included. We excluded trials if erythropoiesis-stimulating agents (ESAs) were used. The primary outcome was the percentage of patients requiring a red blood cell (RBC) transfusion during the study period. The secondary outcomes included the hematopoietic response (an increase in the Hb level by more than 1 g/dL or an increase above 11 g/dL), the iron parameters and adverse events. For the dichotomous data, risk ratios (RRs) with 95% confidence intervals (Cis) were estimated and pooled. For the continuous data, the mean differences were calculated. A fixed effect model was used, except in the event of significant heterogeneity between the trials (p < 0.10; I2 > 40%), in which we used a random effects model. Results: A total of 8 trials published between January 1990 and July 2021 that randomized 1015 patients fulfilled the inclusion criteria. Of these, 553 patients were randomized to IV iron and were compared with 271 patients randomized to oral iron and 191 to no iron. IV iron decreased the percentage of patients requiring a blood transfusion compared with oral iron (RR 0.72; 95% CI 0.55−0.95) with a number needed to treat of 20 (95% CI 11−100). IV iron increased the hematopoietic response (RR 1.23; 95% CI 1.01−1.5). There was no difference with respect to the risk of adverse events (RR 0.97; 95% CI 0.88−1.07; 8 trials) or severe adverse events (RR 1.09; 95% CI 0.76−1.57; 8 trials). Conclusions: IV iron resulted in a decrease in the need for RBC transfusions, with no difference in adverse events in patients with CIA. IV iron for the treatment of CIA should be considered in clinical practice.
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Prevalence and Associated Factors of Anemia among Breast Cancer Patients Undergoing Chemotherapy: A Prospective Study. Adv Pharmacol Pharm Sci 2022; 2022:7611733. [PMID: 35464620 PMCID: PMC9023199 DOI: 10.1155/2022/7611733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to ascertain the prevalence and factors associated with anemia (hemoglobin [Hb] 12 g/dL) in breast cancer patients undergoing chemotherapy. Materials and Methods We conducted a prospective longitudinal study to collect demographic and clinical data on adult breast cancer patients with or without anemia who were admitted to HKL, UMMC, and NCI. The incidence of anemia was determined by detecting whether or not anemia developed during the course of chemotherapy. Mild, moderate, or severe anemia was defined. A chi-squared and logistic regression model were used to assess the effect of demographic and clinical factors on the incidence of anemia and multiple logistic regression analysis was used to evaluate the associations of potential risk factors with the presence of CRA. Results The study enrolled a total of 292 breast cancer patients. Anemia occurred at a rate of 41.1% (n = 120). Our findings indicated that clinical factors such as the number of chemotherapy regimens, dose reduction, and type of chemotherapy, for example, docetaxel, as well as demographic covariates such as age and BMI, all contribute to the incidence of anemia in cancer patients. Conclusions According to this study, the prevalence of anemia in breast cancer patients is high. Patients' age, BMI, number of chemotherapy regimens, and docetaxel were risk factors; thus, protocols are needed to identify subgroups of breast cancer likely to benefit from novel management strategies.
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Hofmann A, Aapro M, Fedorova TA, Zhiburt YB, Snegovoy AV, Kaganov OI, Ognerubov NA, Lyadov VK, Moiseenko VM, Trofimova OP, Ashrafyan LA, Khasanov RS, Poddubnaya IV. Patient blood management in oncology in the Russian Federation: Resolution to improve oncology care. J Cancer Policy 2022; 31:100315. [DOI: 10.1016/j.jcpo.2021.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
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Rashidi A, Garimella PS, Al-Asaad A, Kharadjian T, Torres MN, Thakkar J. Anemia Management in the Cancer Patient With CKD and End-Stage Kidney Disease. Adv Chronic Kidney Dis 2022; 29:180-187.e1. [PMID: 35817525 DOI: 10.1053/j.ackd.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022]
Abstract
Anemia is a common medical problem among patients with cancer and chronic kidney disease (CKD). Although anemia in patients with CKD is often treated with iron and erythropoietin-stimulating agents, there are controversies with regard to the use of erythropoietin-stimulating agents in cancer patients. In this article, we review the treatment of anemia in patients with cancer and CKD, in addition to summarizing the current guidelines in treatment of anemia in these patients.
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Affiliation(s)
- Arash Rashidi
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA
| | - Abdullah Al-Asaad
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Talar Kharadjian
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, CA
| | - Mariela Navarro Torres
- Department of Medicine/Division of Nephrology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jyotsana Thakkar
- Department of Medicine/Division of Nephrology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Gluszak C, de Vries-Brilland M, Seegers V, Baroin C, Kieffer H, Delva R, Cornuault-Foubert D. OUP accepted manuscript. Oncologist 2022; 27:328-333. [PMID: 35380718 PMCID: PMC8982399 DOI: 10.1093/oncolo/oyac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Clinical trial registration number
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Affiliation(s)
- Cassandre Gluszak
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - Manon de Vries-Brilland
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest (ICO), Angers, France
- Corresponding author: Manon de Vries-Brilland, MD, MSc, Oncology Unit, Institut de Cancérologie de l’Ouest, 15 rue André Bocquel 49100 Angers, France. Tel: + 33 2 44 85 37 54;
| | - Valérie Seegers
- Department of Biometrics, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - Céline Baroin
- Department of Physiotherapy, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - Helene Kieffer
- Department of Pharmacy, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - Remy Delva
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest (ICO), Angers, France
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Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol 2022; 9:e000759. [PMID: 34996762 PMCID: PMC8744124 DOI: 10.1136/bmjgast-2021-000759] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 02/07/2023] Open
Abstract
The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition. Although the most common causes of IDA are gastrointestinal bleeding and menstruation in women, decreased dietary iron and decreased iron absorption are also culpable causes. Patients with IDA should be treated with the aim of replenishing iron stores and returning the haemoglobin to a normal level. This has shown to improve quality of life, morbidity, prognosis in chronic disease and outcomes in pregnancy. Iron deficiency occurs in many chronic inflammatory conditions, including congestive cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.
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Affiliation(s)
- Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Esha Sharma
- Inflammatory Bowel Disease Unit, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Marley
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Mark A Samaan
- Inflammatory Bowel Disease Unit, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew James Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institue, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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Sirenko O, Kuryata O, Tykhomyrov A, Yatsenko T. Plasminogen activator inhibitor-1 and circulating ceruloplasmin levels in men with iron-deficiency anemia and heart failure with concomitant prostate cancer and their dynamics after treatment. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_427_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.
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Affiliation(s)
- Kelly O'Connor
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts, USA. kelly.o'
| | - Lynne J Goldberg
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts, USA
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Pirotte M, Fillet M, Seidel L, Jaspers A, Baron F, Beguin Y. Erythroferrone and hepcidin as mediators between erythropoiesis and iron metabolism during allogeneic hematopoietic stem cell transplant. Am J Hematol 2021; 96:1275-1286. [PMID: 34310730 PMCID: PMC9291814 DOI: 10.1002/ajh.26300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/13/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
Hematopoietic cell transplantation (HCT) brings important alterations in erythropoiesis and iron metabolism. Hepcidin, which regulates iron metabolism, increases in iron overload or inflammation and decreases with iron deficiency or activated erythropoiesis. Erythroferrone (ERFE) is the erythroid regulator of hepcidin. We investigated erythropoiesis and iron metabolism after allogeneic HCT in 70 patients randomized between erythropoietin (EPO) treatment or no EPO, by serially measuring hepcidin, ERFE, CRP (inflammation), soluble transferrin receptor (sTfR, erythropoiesis), serum iron and transferrin saturation (Tsat; iron for erythropoiesis) and ferritin (iron stores). We identified biological and clinical factors associated with serum hepcidin and ERFE levels. Serum ERFE correlated overall with sTfR and reticulocytes and inversely with hepcidin. Erythroferrone paralleled sTfR levels, dropping during conditioning and recovering with engraftment. Inversely, hepcidin peaked after conditioning and decreased during engraftment. Erythroferrone and hepcidin were not significantly different with or without EPO. Multivariate analyses showed that the major determinant of ERFE was erythropoiesis (sTfR, reticulocytes or serum Epo). Pretransplant hepcidin was associated with previous RBC transfusions and ferritin. After transplantation, the major determinants of hepcidin were iron status (ferritin at all time points and Tsat at day 56) and erythropoiesis (sTfR or reticulocytes or ERFE), while the impact of inflammation was less clear and clinical parameters had no detectable influence. Hepcidin remained significantly higher in patients with high compared to low pretransplant ferritin. After allogeneic HCT with or without EPO therapy, significant alterations of hepcidin occur between pretransplant and day 180, in correlation with iron status and inversely with erythroid ERFE.
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Affiliation(s)
- Michelle Pirotte
- Department of Hematology University Hospital of Liège and ULiege Liège Belgium
| | - Marianne Fillet
- Laboratory for the Analysis of Medicines CIRM, ULiege Liège Belgium
| | - Laurence Seidel
- Department of Biostatistics and Medico‐Economics University Hospital of Liège and ULiege Liège Belgium
| | - Aurélie Jaspers
- Department of Hematology University Hospital of Liège and ULiege Liège Belgium
| | - Fréderic Baron
- Department of Hematology University Hospital of Liège and ULiege Liège Belgium
| | - Yves Beguin
- Department of Hematology University Hospital of Liège and ULiege Liège Belgium
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Sun H, Weaver CM. Decreased Iron Intake Parallels Rising Iron Deficiency Anemia and Related Mortality Rates in the US Population. J Nutr 2021; 151:1947-1955. [PMID: 33834234 DOI: 10.1093/jn/nxab064] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prevalence of iron deficiency anemia and its related mortality rate are on the rise in the United States and causes are unclear. OBJECTIVES The aim was to examine trends and causes of Fe deficiency anemia prevalence and Fe deficiency-related mortality rates in the total US population. METHODS Changes in daily dietary Fe intake, serum iron concentration, hemoglobin, red cell distribution width (RDW), and mean corpuscular volume (MCV) obtained from the laboratory files of NHANES, Fe deficiency anemia-related mortality rates from the CDC, and iron concentrations of US food products from the USDA between 1999 and 2018 were analyzed. RESULTS Of food items with revised concentrations in USDA Nutrient Database for Standard Reference [SR28 (2015)], 62.4% had lower Fe concentrations than in SR11 (1999). There was a 15.3% reduction in beef (relatively higher in heme iron) and a 21.5% increase in chicken meat consumption in the American diet between 1999 and 2018. Dietary iron intake decreased by ∼6.6% and ∼9.5% for male and female adults, respectively. Increases of prevalence of estimated anemia in the United States ranged from 10.5% to 106% depending on age and sex. Age-adjusted mortality rates with iron deficiency anemia as the underlying cause of death increased from ∼0.04 to ∼0.08 deaths per 100,000 people, whereas all other anemias as the underlying causes of death decreased by ≥25%. Mean RDW and serum folate concentrations increased, whereas hemoglobin, serum iron concentrations, and MCV, parameters traditionally associated with Fe deficiency anemia, decreased during this period. CONCLUSIONS Increased iron deficiency anemia and related mortality rates in the US population between 1999 and 2018 were likely related to the decline in dietary iron intake resulting from an Fe concentration decline in US food products and a shift in dietary patterns.
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Affiliation(s)
- Hongbing Sun
- Health Studies Institute, Rider University, Lawrenceville, NJ, USA.,Department of Geological, Environmental, and Marine Sciences, Rider University, Lawrenceville, NJ, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.,Weaver & Associates Consulting LLC, West Lafayette, IN, USA
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Madeddu C, Neri M, Sanna E, Oppi S, Macciò A. Experimental Drugs for Chemotherapy- and Cancer-Related Anemia. J Exp Pharmacol 2021; 13:593-611. [PMID: 34194245 PMCID: PMC8238072 DOI: 10.2147/jep.s262349] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/21/2021] [Indexed: 01/03/2023] Open
Abstract
Anemia in cancer patients is a relevant condition complicating the course of the neoplastic disease. Overall, we distinguish the anemia which arises under chemotherapy as pure adverse event of the toxic effects of the drugs used, and the anemia induced by the tumour-associated inflammation, oxidative stress, and systemic metabolic changes, which can be worsened by the concomitant anticancer treatments. This more properly cancer-related anemia depends on several overlapping mechanism, including impaired erythropoiesis and functional iron deficiency, which make its treatment more difficult. Standard therapies approved and recommended for cancer anemia, as erythropoiesis-stimulating agents and intravenous iron administration, are limited to the treatment of chemotherapy-induced anemia, preferably in patients with advanced disease, in view of the still unclear effect of erythropoiesis-stimulating agents on tumour progression and survival. Outside the use of chemotherapy, there are no recommendations for the treatment of cancer-related anemia. For a more complete approach, it is fundamentally a careful evaluation of the type of anemia and iron homeostasis, markers of inflammation and changes in energy metabolism. In this way, anemia management in cancer patient would permit a tailored approach that could give major benefits. Experimental drugs targeting hepcidin and activin II receptor pathways are raising great expectations, and future clinical trials will confirm their role as remedies for cancer-related anemia. Recent evidence on the effect of integrated managements, including nutritional support, antioxidants and anti-inflammatory substances, for the treatment of cancer anemia are emerging. In this review article, we show standard, innovative, and experimental treatment used as remedy for anemia in cancer patients.
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Affiliation(s)
- Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manuela Neri
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Sara Oppi
- Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
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Steele T, Bonwick H, Nwosu AC, Chapman L. Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data. AMRC OPEN RESEARCH 2021; 3:6. [PMID: 38708071 PMCID: PMC11064982 DOI: 10.12688/amrcopenres.12963.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 05/07/2024]
Abstract
Background Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice. Methods This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded. Results Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 46/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a statistically significant increase in overall mean haemoglobin were observed. Conclusions This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.
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Affiliation(s)
- Thomas Steele
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
| | - Helen Bonwick
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
| | - Amara Callistus Nwosu
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
- International Observatory on End of Life Care, Lancaster University, Lancaster, Lancashire, LA1 4YG, UK
- Liverpool University Hospitals NHS Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Laura Chapman
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
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Zhou D, Liu X, Wang X, Yan F, Wang P, Yan H, Jiang Y, Yang Z. A prognostic nomogram based on LASSO Cox regression in patients with alpha-fetoprotein-negative hepatocellular carcinoma following non-surgical therapy. BMC Cancer 2021; 21:246. [PMID: 33685417 PMCID: PMC7938545 DOI: 10.1186/s12885-021-07916-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) (< 8.78 ng/mL) have special clinicopathologic characteristics and prognosis. The aim of this study was to apply a new method to establish and validate a new model for predicting the prognosis of patients with AFP-NHCC. Methods A total of 410 AFP-negative patients with clinical diagnosed with HCC following non-surgical therapy as a primary cohort; 148 patients with AFP-NHCC following non-surgical therapy as an independent validation cohort. In primary cohort, independent factors for overall survival (OS) by LASSO Cox regression were all contained into the nomogram1; by Forward Stepwise Cox regression were all contained into the nomogram2. Nomograms performance and discriminative power were assessed with concordance index (C-index) values, area under curve (AUC), Calibration curve and decision curve analyses (DCA). The results were validated in the validation cohort. Results The C-index of nomogram1was 0.708 (95%CI: 0.673–0.743), which was superior to nomogram2 (0.706) and traditional modes (0.606–0.629). The AUC of nomogram1 was 0.736 (95%CI: 0.690–0.778). In the validation cohort, the nomogram1 still gave good discrimination (C-index: 0.752, 95%CI: 0.691–0.813; AUC: 0.784, 95%CI: 0.709–0.847). The calibration curve for probability of OS showed good homogeneity between prediction by nomogram1 and actual observation. DCA demonstrated that nomogram1 was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram1: low-risk group, middle-risk group and high-risk group, respectively. Conclusions Novel nomogram based on LASSO Cox regression presents more accurate and useful prognostic prediction for patients with AFP-NHCC following non-surgical therapy. This model could help patients with AFP-NHCC following non-surgical therapy facilitate a personalized prognostic evaluation.
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Affiliation(s)
- Dongdong Zhou
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Xiaoli Liu
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Xinhui Wang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Fengna Yan
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Peng Wang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Huiwen Yan
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China.,First Clinical Medical College, Beijing University of Chinese Medicine, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yuyong Jiang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China
| | - Zhiyun Yang
- Center for Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, People's Republic of China.
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Ranjit R, Takalloabdal S, Galchenko A. Importance of micronutrients in the oral cavity. ACTA STOMATOLOGICA NAISSI 2021. [DOI: 10.5937/asn2183186r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Micronutrients play a potent role in the functioning of the different systems of the organism. It is necessary to sustain an adequate status of the micronutrients for maintaining the optimal condition of the oral cavity. The aim: Toemphasize the importance of different micronutrients for the normal functioning of the oral cavity, as well as their influence on the occurrence of various diseases of the soft and hard tissues of the oral cavity. Conclusion: Micronutrients such as vitamin C, B9 and E, calcium, zinc, copper and iron have a role in development so as anti-inflammatory and antioxidants properties Deficiency of certain micronutrients plays an important role in the development of periodontitis and caries. People with chronic inflammatory bowel disease, as well as children, pregnant and breastfeeding women, are usually deficient in these vitamins and therefore often susceptible to the development of inflammatory changes in soft tissues of oral cavity , periodontitis and caries.
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Čiburienė E, Čelutkienė J, Aidietienė S, Ščerbickaitė G, Lyon AR. The prevalence of iron deficiency and anemia and their impact on survival in patients at a cardio-oncology clinic. CARDIO-ONCOLOGY 2020; 6:29. [PMID: 33292849 PMCID: PMC7709383 DOI: 10.1186/s40959-020-00086-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
Background Iron deficiency (ID) and anemia are common in both heart failure (HF) and cancer patients and are associated with poor quality of life and survival. The aims of this study were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients. Methods We assessed iron, ferritin, hemoglobin concentrations, transferrin saturation (TSAT), cancer type, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), kidney function, cardiovascular risk factors and survival in 599 patients who were referred to cardio-oncology clinic from 2011 to 2017. ID was defined by a TSAT < 20%, absolute iron deficiency (AID) with a serum ferritin level < 100 μg/L while serum ferritin level of ≥ 100 μg/L was considered as functional iron deficiency (FID) and TSAT ≥ 20% was considered as no ID. Results The prevalence of ID, AID, and FID was 46, 31, and 15% of study patients, respectively. Anemia was present in approximately half (54%) of the patients with any ID. Multivariate Cox analyses showed that male gender (HR 1.704 [1.207–2.404] p = 0.002); previous cancer history (HR 1.879 [1.079–3.272] p = 0.026); elevated BNP (HR 2.126 [1.258–3.590] p = 0.005); TSAT< 20% (HR 1.721 [1.214–2.439] p = 0.002); ferritin ≥ 100 μg/L (HR 2.008 [1.088–3.706] p = 0.026); serum iron concentration < 12 μmol/L (HR 2.292 [1.614–3.255] p < 0.001); FID (HR 2.538 [1.1618–3.981] p < 0.001) and anemia (HR 2.462 [1.734–3.495] p < 0.001) were significantly associated with increased risk of all-cause death. Conclusions About half of cardio-oncology patients had anemia and iron deficiency, with the absolute type being twice as prevalent as the functional one. Patients with breast, gastrointestinal, and genitourinary cancer were affected more often. Both anemia and iron deficiency independently predicted all-cause mortality. Future studies are required to confirm ID as a risk factor and evaluate the clinical benefits of iron replacement therapy.
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Affiliation(s)
- E Čiburienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania.
| | - J Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - S Aidietienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - G Ščerbickaitė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - A R Lyon
- Cardio-Oncology Clinic at Royal Brompton Hospital, London, UK.,Imperial College London, London, UK
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Sinclair RC, Duffield KE, de Pennington JH. Improving preoperative haemoglobin using a quality improvement approach to treat iron deficiency anaemia. BMJ Open Qual 2020; 9:bmjoq-2019-000776. [PMID: 31986115 PMCID: PMC7011899 DOI: 10.1136/bmjoq-2019-000776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022] Open
Abstract
Optimising preoperative haemoglobin (Hb) before elective surgery is recommended by the National Institute of Clinical Excellence. We have used a quality improvement (QI) approach to treat iron deficiency anaemia in patients presenting to the preoperative assessment clinic (PAC) before major elective oesophagogastric surgery. Through a series of three QI cycles, we have treated iron deficiency, improved preoperative haemoglobin (Hb) and reduced the rate of postoperative blood transfusion. Our methods have included the early diagnosis of iron deficiency at the PAC attendance, the development and implementation of a new clinical guideline on the treatment of preoperative anaemia and the introduction of a one-stop clinic facilitating same-day treatment with intravenous iron, where appropriate, in conjunction with comprehensive preoperative assessment. The incidence of severe preoperative anaemia (Hb<100 g/L) has fallen from 10% in 2014 to 1.6% in 2018. The overall incidence of preoperative anaemia (defined as Hb<130 g/L by international consensus statement) has reduced from 57.9% in 2014 to 43.9% in 2018. Blood transfusion rate has declined from 16% to 6.5% of patients between 2014 and 2018. In 2018, none of the patients who required a postoperative blood transfusion presented to theatre with preoperative anaemia, a significant change from prior to the interventions. There has been a reduction of 63% in the number of units transfused. The project has successfully optimised these patients, leading to improved preoperative Hb and reduced use of blood transfusion.
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Affiliation(s)
- Rhona Cf Sinclair
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Kate E Duffield
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Abdel-Razeq H, Saadeh SS, Malhis R, Yasser S, Abdulelah H, Eljaber R, Kleib A, Ismael R. Treatment of anemia in cancer patients undergoing chemotherapy with intravenous ferric carboxymaltose without erythropoiesis-stimulating agents. Ther Adv Med Oncol 2020; 12:1758835920953292. [PMID: 32952616 PMCID: PMC7485004 DOI: 10.1177/1758835920953292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Anemia is commonly encountered in cancer patients receiving active
chemotherapy. Due to adverse events and presumed negative effects on
disease-progression and survival, erythropoiesis-stimulating agents are not
frequently used. In this study, we assess the efficacy and safety of
intravenous ferric carboxymaltose (FCM) to treat cancer-induced anemia
(CIA). Patients and Methods: We recruited adult cancer patients on active chemotherapy with a hemoglobin
(Hb) level ⩽11.0 g/dL. Based on serum ferritin (sFr) and transferrin
saturation (TSAT), patients were divided into 3 groups: group I (absolute
iron deficiency, n = 26) with sFr < 30 ng/mL and
TSAT < 20%; group II (functional iron deficiency,
n = 24) with sFr 30–800 ng/mL and TSAT < 20%; and
patients with TSAT ⩾ 20% were placed in group III as “others”
(n = 34). All patients were treated with intravenous
FCM. Serum hepcidin and C-reactive protein were used as biomarkers to
predict response. Results: A total of 84 patients with a median age (SD) of 53.8 (10.6) were recruited.
Baseline median Hb level was 10.2 (range: 8.3–11.0) gm/dL. At week 12, there
was a significant increment in Hb level for patients in groups I and II
(median increment: 2.35 and 1.5 gm/dL, respectively), with limited response
observed in group III, and most of the increment noted as early as week 3
(⩾1.0 g/dL). Responders tended to have lower levels of hepcidin. No
clinically significant adverse events were reported; however, asymptomatic
hypophosphatemia was observed in 39 (46.4%) patients. Conclusions: Intravenous FCM is a safe and effective treatment option for the management
of a subgroup of patients with CIA. The study was registered at ClinicalTrials.gov [Identifier: NCT04246021]
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Affiliation(s)
| | - Salwa S. Saadeh
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Razan Malhis
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Sameer Yasser
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Rana Eljaber
- Department of Pharmacy, King Hussein Cancer
Center, Amman, Jordan
| | - Amer Kleib
- Department of Nursing, King Hussein Cancer
Center, Amman, Jordan
| | - Rouba Ismael
- Office of Scientific Affairs and Research, King
Hussein Cancer Center, Amman, Jordan
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Sbrana A, Antonuzzo A, Brunello A, Petrelli F, Pronzato P, Tralongo A, Turrini M, Zoratto F, Danova M. Management of anemia in patients with cancer: 2019 Italian Association of Medical Oncology (AIOM) guidelines. TUMORI JOURNAL 2020; 106:337-345. [PMID: 32482149 DOI: 10.1177/0300891620921942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes the latest Italian Medical Oncology Association (AIOM) guidelines on the management of cancer-related and chemotherapy-related anemia with a particular attention to the use of erythropoiesis-stimulating agents and iron supplementation.
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Affiliation(s)
- Andrea Sbrana
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Paolo Pronzato
- Medical Oncology Unit, AOU San Martino IRCCS IST, Genova, Italy
| | - Antonino Tralongo
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Marianna Turrini
- Medical Oncology Unit, Ospedale del Valdarno, Santa Maria La Gruccia, Azienda USL Toscana Sud-Est, Montevarchi, Toscana, Italy
| | - Federica Zoratto
- Medical Oncology Unit, Ospedale S. Maria Goretti, Latina, Lazio, Italy
| | - Marco Danova
- Internal Medicine and Medical Oncology, ASST Pavia, Pavia, Lombardia, Italy
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Jang JH, Kim Y, Park S, Kim K, Kim SJ, Kim WS, Jung CW, Lee J, Lee SH. Efficacy of intravenous iron treatment for chemotherapy-induced anemia: A prospective Phase II pilot clinical trial in South Korea. PLoS Med 2020; 17:e1003091. [PMID: 32511251 PMCID: PMC7279571 DOI: 10.1371/journal.pmed.1003091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anemia is the most common and serious cancer-related complication. This study aimed to evaluate the efficacy of administration of ferric carboxymaltose without erythropoiesis-stimulating agents for treating anemia in cancer patients. Moreover, we identified the biomarkers of hemoglobin response to predict the need for iron therapy. METHODS AND FINDINGS We enrolled patients with solid cancers who were treated at a single institute (Samsung Medical Center, South Korea), from April 2015 to July 2017, in this prospective single-arm Phase II clinical trial. Patients received intravenous ferric carboxymaltose (1,000 mg) infusion on the first day (visit 1) of treatment. The primary end point was the number of hemoglobin responders, defined as patients with an increase in hemoglobin level ≥ 1.0 g/dL from the baseline, a hemoglobin level ≥ 11.0 g/dL, or both, within an 8-week observation period (week 3, 6, or 8). Secondary end points included changes in transferrin saturation and levels of soluble transferrin receptors, hepcidin, erythropoietin, interleukin-6, and C-reactive protein (CRP) at each visit. Of the 103 recruited patients, 92 were eligible for analysis. The mean patient age was 57.3 ± 12.5 years, and 54.3% of the patients were women. The most common diagnoses were breast cancer (n = 23, 25.1%), lung cancer (n = 21, 22.9%), gastrointestinal cancer (n = 20, 20.9%), and lymphoma (n = 16, 17.7%). A hemoglobin response was observed in 36 (39.1%), 53 (57.6%), and 61 (66.3%) patients in the third, fifth, and eighth weeks, respectively. The mean increase in hemoglobin levels from the baseline to the end of treatment was 1.77 ± 1.30 g/dL. Baseline values of hepcidin (p = 0.008), total iron binding capacity (p = 0.014), ferritin (p = 0.048), and CRP (p = 0.044) were significantly different between the responder and nonresponder groups. Multiple logistic regression analysis for baseline anemia-related biochemical variable significantly associated with the hemoglobin response showed that only baseline hepcidin level was a significant factor for hemoglobin response (odds ratio = 0.95, 95% confidence interval 0.90-1.0, p = 0.045). Hemoglobin responders had significantly lower hepcidin levels than nonresponders (mean [±standard deviation], 13.45 [±14.71] versus 35.22 [±40.470 ng/ml]; p = 0.007). However, our analysis had some limitations such as the different patient characteristics in the studies that were included, institutional differences in the measurement of hepcidin level, and missing data on long-term safety. Therefore, our findings need further validation. CONCLUSIONS Intravenous ferric carboxymaltose (1,000 mg) monotherapy increases hemoglobin levels without serious adverse events in patients with cancer. Hepcidin is a useful biomarker for predicting iron requirement in cancer patients. TRIAL REGISTRATION Clinicaltrials.gov NCT02599012.
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Affiliation(s)
- Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Youjin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Silvia Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Chul Won Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
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Clinical aspects of mCRPC management in patients treated with radium-223. Sci Rep 2020; 10:6681. [PMID: 32317750 PMCID: PMC7174360 DOI: 10.1038/s41598-020-63302-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Bone is the most common site of metastasis in metastatic castration-resistant prostate cancer (mCRPC), which is associated with pain and skeletal events. Radium-223 dichloride (Xofigo) is an alpha-emitting radioactive isotope that can specifically target bone lesions. Herein, we report the results of a retrospective analysis that documents our experience in the use of radium-223. Data from 63 patients (pts) with mCRPC who underwent radium-223 treatment from December 2015 to September 2017 were collected. Radium-223 (55 kBq/kg) was administered every 4 weeks for up to 6 cycles. The primary endpoint was OS. Radium-223 was administered as first line therapy in 11 pts, as second line in 19 pts, as third line in 16 pts and in successive lines in 17 pts; 42 pts out of 63 (67%) completed all six cycles. Within one month after the end of 6 cycles of radium-223, 15 pts out of 42 (35.7%) had achieved PR, 11 pts out of 42 (26.2%) had SD and 14 pts out of 42 (33.3%) had PD. Levels of pain decreased with progressive cycles of radium-223. After a minimum follow-up of 2 months and a maximum of 43 months, median OS was 15 months and median PFS was 8 months. The most frequent radium-223 related toxicity was low grade haematologic toxicity, predominantly G1-G2, that occurred halfway through treatment in about 75% of pts. The favourable results reported herein confirm that radium-223 can be considered well tolerated and effective in mCRPC, and is associated with significant decreases in pain.
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Reticulocyte Hemoglobin Content (Ret He): A Simple Tool for Evaluation of Iron Status in Childhood Cancer. J Pediatr Hematol Oncol 2020; 42:e147-e151. [PMID: 31851071 DOI: 10.1097/mph.0000000000001700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-related anemia is a common complication of cancer and its treatment that may be mediated by nutritional deficiency or inflammatory cytokines inhibiting erythropoiesis. AIM We evaluated the value of reticulocyte hemoglobin content (Ret He) as a marker of iron availability for erythropoiesis in childhood cancer and the impact of oral iron supplementation on hematologic parameters in patients with low Ret He. MATERIALS AND METHODS This prospective study included 100 pediatric patients with cancer on chemotherapy who were screened for the presence of anemia. Patients with anemia underwent testing for complete blood count including Ret He on Sysmex XE 2100 and assessment of reticulocyte count, serum iron, serum ferritin, transferrin saturation, total iron-binding capacity, and C-reactive protein. Patients were classified according to their level of Ret He into normal or low Ret He using a cutoff level of 28 pg. Patients with low Ret He were subjected to 6 weeks' treatment with oral ion and were followed up with complete blood count and iron profile. RESULTS Thirty-one (77.5%) patients had normal Ret He, and 9 (22.5%) had low Ret He. Ret He was positively correlated with red cell indices, but not with iron parameters. After oral iron supplementation, a significant increase in hemoglobin, reticulocyte count, and iron was found. CONCLUSIONS We suggest that Ret He could be used as an easy and affordable tool for the assessment of iron deficiency anemia in childhood cancer during chemotherapy treatment. A trial of oral iron in patients with low Ret He may be useful to correct the associated anemia.
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Macklin PS, Yamamoto A, Browning L, Hofer M, Adam J, Pugh CW. Recent advances in the biology of tumour hypoxia with relevance to diagnostic practice and tissue-based research. J Pathol 2020; 250:593-611. [PMID: 32086807 DOI: 10.1002/path.5402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
In this review article, we examine the importance of low levels of oxygen (hypoxia) in cancer biology. We provide a brief description of how mammalian cells sense oxygen. The hypoxia-inducible factor (HIF) pathway is currently the best characterised oxygen-sensing system, but recent work has revealed that mammals also use an oxygen-sensing system found in plants to regulate the abundance of some proteins and peptides with an amino-terminal cysteine residue. We discuss how the HIF pathway is affected during the growth of solid tumours, which develop in microenvironments with gradients of oxygen availability. We then introduce the concept of 'pseudohypoxia', a state of constitutive, oxygen-independent HIF system activation that occurs due to oncogenic stimulation in a number of specific tumour types that are of immediate relevance to diagnostic histopathologists. We provide an overview of the different methods of quantifying tumour hypoxia, emphasising the importance of pre-analytic factors in interpreting the results of tissue-based studies. Finally, we review recent approaches to targeting hypoxia/HIF system activation for therapeutic benefit, the application of which may require knowledge of which hypoxia signalling components are being utilised by a given tumour. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Philip S Macklin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Atsushi Yamamoto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monika Hofer
- Department of Neuropathology and Ocular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Julie Adam
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Fan H, Su Y, Duan C, Zhao Q, Wang X, Zhu S, Zhao W, Jin M, Ma X. Iron deficiency in children at the time of initial neuroblastoma diagnosis. Pediatr Investig 2020; 4:17-22. [PMID: 32851337 PMCID: PMC7331340 DOI: 10.1002/ped4.12156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE There is a high incidence of iron deficiency in children worldwide. Notably, however, while iron deficiency is the most common cause of anemia, little is known about the prevalence and different types of iron deficiency in neuroblastoma patients. OBJECTIVE The aim of the present study was to investigate the prevalence of iron deficiency in patients newly diagnosed with neuroblastoma. METHODS A total of 195 newly diagnosed neuroblastoma patients from November 2015 to January 2018 were analyzed retrospectively. The survival analysis was estimated by the Kaplan-Meier method. RESULTS Of the 195 neuroblastoma patients included in the study, 121 (62.1%) had iron deficiency, 55 (28.2%) had absolute iron deficiency, and 66 (33.9%) had functional iron deficiency. Being aged ≥ 18 months, tumor originating in the abdomen, International Neuroblastoma Risk Group Staging System M, high-risk neuroblastoma, lactate dehydrogenase ≥ 1500 U/L, neuron-specific enolase ≥ 100 U/L, unfavorable histologic category, MYCN amplification, chromosome 1p loss, and bone marrow metastasis were associated with significantly higher rates of functional iron deficiency (P < 0.05). INTERPRETATION Functional iron deficiency at the time of initial neuroblastoma diagnosis predicted lower event-free survival. Long-term effects of iron supplementation in neuroblastoma patients with different types of iron deficiency need to be further studied.
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Affiliation(s)
- Hongjun Fan
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yan Su
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Chao Duan
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Qian Zhao
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xisi Wang
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Shuai Zhu
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Wen Zhao
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Mei Jin
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaoli Ma
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Link H. Hematopoietic Growth Factors in the Management of Anemia and Febrile Neutropenia. Breast Care (Basel) 2019; 14:93-98. [PMID: 31798380 DOI: 10.1159/000497408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Chemotherapy-induced anemia (CIA) in cancer patients correlates with poor performance status and decreased quality of life. Currently recommended causal therapies are erythropoiesis-stimulating agents (epoetins), iron substitution, or a combination of both. Guidelines recommend considering red blood cell (RBC) transfusions for symptomatic anemia at a hemoglobin (Hb) level of <8 g/dl. Granulocyte colony-stimulating factor (G-CSF) is recommended if the risk of febrile neutropenia (FN) following from the chosen chemotherapy protocol is ≥20%. If a chemotherapy is planned that induces a moderate FN risk (10-20%), the individual overall FN risk should be assessed prior to each chemotherapy cycle, taking into account patient- or tumor-related risk factors. G-CSF is required when risk factors such as age ≥ 65 years, advanced disease or relevant comorbidity, or previous neutropenia complications are present. Neutropenia that required a shift in chemotherapy is also an indication for G-CSF prophylaxis in subsequent cycles, in order to maintain the planned dose intensity. The use of G-CSF improves patient survival and reduces the rate of neutropenia complications.
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Iron homeostasis and perioperative management of iron deficiency. BJA Educ 2019; 19:390-397. [DOI: 10.1016/j.bjae.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
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Kifle E, Hussein M, Alemu J, Tigeneh W. Prevalence of Anemia and Associated Factors among Newly Diagnosed Patients with Solid Malignancy at Tikur Anbessa Specialized Hospital, Radiotherapy Center, Addis Ababa, Ethiopia. Adv Hematol 2019; 2019:8279789. [PMID: 31781226 PMCID: PMC6855075 DOI: 10.1155/2019/8279789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/13/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anemia is a common finding in cancer, which is caused by many factors. It is a major cause of morbidity in cancer patients, worsens disease status and impairs treatment outcome; however, little is known about the prevalence of anemia and associated factors among cancer patients during diagnosis in developing countries like Ethiopia. In response to this, we have conducted research with the aim of assessing the prevalence of anemia and associated factors among newly diagnosed patients with solid malignancy at Tikur Anbessa Specialized Hospital (TASH), Radiotherapy center, Addis Ababa, Ethiopia. METHODS Descriptive cross-sectional study was conducted from April to May 2014. A total of 422 newly diagnosed patients with solid malignancy attending Radiotherapy center, TASH were enrolled to assess anemia prevalence and associated factors. Data were coded, entered and analyzed using SPSS version16. Using logistic regression, chi squares, Odds ratio and 95% confidence intervals were computed to measure strength of association between variables. p-value < 0.05 was taken as statistically significant. RESULT Out of 422 respondents, 285 (68%) were females and 153 (36%) of respondents fell into 35-49 age group with age range between 18 and 80 years and the median age of 45. Magnitude of solid cancers was gynecologic (28.9%), breast (22.7%), nasopharyngeal carcinoma (NPC) (7.6%), colorectal (7.1%), sarcoma (6.9%), head and neck (4.5%), thyroid (3.3%), hepatoma (1.9%), and others (17.1%). The overall prevalence of anemia across different tumor was 23% and higher anemia prevalence was noted in gynecologic (37.7%) and colorectal carcinomas (26.7%). The majority of the anemic patients (68%) remained untreated for anemia. The mean trigger hemoglobin for transfusion was 7.7 g/dl. About 83.5% of anemia was mild to moderate type. Performance status (AOR = 3.344; 95% CI 1.410-7.927) and bleeding history (AOR = 3.628; 95% CI 1.800-7.314) showed statistically significant association with occurrence of anemia with p-value < 0.05. CONCLUSION Among solid cancers, gynecologic cancer remained the dominant one. Anemia prevalence was 23% in general, in which gynecologic and colorectal cancers were more prevalent. ECOG performance status and bleeding history showed a statistically significant association with the occurrence of anemia.
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Affiliation(s)
- Edosa Kifle
- Wollega University, Institute of Health Science, Department of Medical Laboratory Science, P.O. Box: 395, Nekemte, Ethiopia
| | - Mintewab Hussein
- Addis Ababa University, School of allied Health Science, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | - Jemal Alemu
- Addis Ababa University, School of allied Health Science, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | - Wondemagegnhu Tigeneh
- Addis Ababa University, Tikur Anbessa Specialized Hospital, Radiotherapy Center, Addis Ababa, Ethiopia
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Anemia of Inflammation with An Emphasis on Chronic Kidney Disease. Nutrients 2019; 11:nu11102424. [PMID: 31614529 PMCID: PMC6835368 DOI: 10.3390/nu11102424] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/28/2023] Open
Abstract
Iron is vital for a vast variety of cellular processes and its homeostasis is strictly controlled and regulated. Nevertheless, disorders of iron metabolism are diverse and can be caused by insufficiency, overload or iron mal-distribution in tissues. Iron deficiency (ID) progresses to iron-deficiency anemia (IDA) after iron stores are depleted. Inflammation is of diverse etiology in anemia of chronic disease (ACD). It results in serum hypoferremia and tissue hyperferritinemia, which are caused by elevated serum hepcidin levels, and this underlies the onset of functional iron-deficiency anemia. Inflammation is also inhibitory to erythropoietin function and may directly increase hepcidin level, which influences iron metabolism. Consequently, immune responses orchestrate iron metabolism, aggravate iron sequestration and, ultimately, impair the processes of erythropoiesis. Hence, functional iron-deficiency anemia is a risk factor for several ailments, disorders and diseases. Therefore, therapeutic strategies depend on the symptoms, severity, comorbidities and the associated risk factors of anemia. Oral iron supplements can be employed to treat ID and mild anemia particularly, when gastrointestinal intolerance is minimal. Intravenous (IV) iron is the option in moderate and severe anemic conditions, for patients with compromised intestinal integrity, or when oral iron is refractory. Erythropoietin (EPO) is used to treat functional iron deficiency, and blood transfusion is restricted to refractory patients or in life-threatening emergency situations. Despite these interventions, many patients remain anemic and do not respond to conventional treatment approaches. However, various novel therapies are being developed to treat persistent anemia in patients.
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Abiri B, Vafa M. Iron Deficiency and Anemia in Cancer Patients: The Role of Iron Treatment in Anemic Cancer Patients. Nutr Cancer 2019; 72:864-872. [PMID: 31474155 DOI: 10.1080/01635581.2019.1658794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anemia is a prevalent complication in patients with cancer, both at diagnosis and during treatment, with notable negative effects on quality of life and overall prognosis. Iron deficiency is the most common cause of anemia in the patients and can affect almost half of patients with solid and hematologic malignancies. The pathogenesis is complex and multifactorial, including bleeding, malnutrition, medications, and inflammation resulted from cancer and cancer treatment. In fact, either absolute or functional iron deficiency can occur. Most iron deficient cancer patients present with functional iron deficiency, a condition with adequate iron storage but insufficient iron supply for erythroblasts and other iron dependent tissues. Functional iron deficiency is the result of the cancer related cytokine release, but in absolute iron deficiency iron reserves are depleted leading to similar but often more severe symptoms of inadequate iron store. Current therapeutic options in cancer anemia consist of iron administration, erythropoietic stimulating agents, and blood transfusion. The latter should be administered to a minimum, because of problems regarding risks. Here, we present a review on the epidemiology, pathophysiology, clinical outcomes, and therapeutic options of iron deficiency as well as the effect of iron therapy on tumor progression in anemic cancer patients.
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Affiliation(s)
- Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu R, Zheng CH, Huang CM, Li P. Preoperative Hematocrit (HCT) is a Novel and Simple Predictive Marker for Gastric Cancer Patients Who Underwent Radical Gastrectomy. Ann Surg Oncol 2019; 26:4027-4036. [PMID: 31463693 DOI: 10.1245/s10434-019-07582-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have suggested that preoperative anemia negatively influences survival in patients with gastric cancer (GC). We sought to investigate which anemic markers can better predict the prognosis of patients with resectable GC. METHODS The study involved 2277 GC patients who underwent curative resection between December 2008 and December 2014. Cox regression models were used to identify the best anemic markers associated with prognosis. Time-dependent receiver operating characteristics analysis (t-ROC) and the estimated area under the curve (AUC) were used to compare the prognostic values. RESULTS Of all patients, 1709 (75.1%) were male, and the median age was 61 years. Univariate analyses showed that preoperative hematocrit (HCT), hemoglobin, and mean corpuscular volume were associated with OS (all P < 0.05). However, in a separate analysis of individual stages, only HCT was shown to be significantly prognostic across all tumor stages (all P < 0.05). In the multivariate analysis, preoperative HCT remained an independent prognostic factor for GC. Low HCT was significantly associated with older age, female sex, lower body mass index, higher American Society of Anesthesiologists score, higher preoperative transfusion rate, 90-day mortality, adjuvant chemotherapy, larger tumor size, lymph node metastasis, later stage, and vascular involvement. The t-ROC curve and AUC for HCT were similar to those for the controlling nutritional status and prognostic nutritional index throughout the observation period. CONCLUSIONS The preoperative HCT is a novel, simple, and powerful prognostic indicator of poor outcome in patients with GC and can be used as a part of the preoperative risk stratification process.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jun-Peng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Ruhong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
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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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50
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Di Iulio F, Cravello L, Shofany J, Paolucci S, Caltagirone C, Morone G. Neuropsychological disorders in non-central nervous system cancer: a review of objective cognitive impairment, depression, and related rehabilitation options. Neurol Sci 2019; 40:1759-1774. [PMID: 31049790 DOI: 10.1007/s10072-019-03898-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
Abstract
AIM The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments. RESULTS A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed. CONCLUSION Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.
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Affiliation(s)
| | - Luca Cravello
- Centro Regionale Alzheimer ASST Rhodense, Passirana di Rho Hospital, Milan, Italy
| | | | | | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Università degli Studi di Roma Tor Vergata, Rome, Italy
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