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Li Q, Yang W, Liu H, Yao J, Wang Q, Lin D, Shi J. Analysis of related factors of CRA in lung cancer patients with different serum iron levels: A retrospective cohort study. Cancer Med 2024; 13:e7147. [PMID: 38562035 PMCID: PMC10985406 DOI: 10.1002/cam4.7147] [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: 10/10/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Serum iron, an essential component of hemoglobin (Hb) synthesis in vivo, is a crucial parameter for evaluating the body's iron storage and metabolism capacity. Iron deficiency leads to reduced Hb synthesis in red blood cells and smaller red blood cell volume, ultimately resulting in iron-deficiency anemia. Although serum iron cannot independently evaluate iron storage or metabolism ability, it can reflect iron concentration in vivo and serve as a good predictor of iron-deficiency anemia. Therefore, exploring the influence of different serum iron levels on anemia and diagnosing and treating iron deficiency in the early stages is of great significance for patients with lung cancer. AIM This study aims to explore the related factors of cancer-related anemia (CRA) in lung cancer and construct a nomogram prediction model to evaluate the risk of CRA in patients with different serum iron levels. METHODS A single-center retrospective cohort study was conducted, including 1610 patients with lung cancer, of whom 1040 had CRA. The relationship between CRA and its influencing factors was analyzed using multiple linear regression models. Lung cancer patients were divided into two groups according to their serum iron levels: decreased serum iron and normal serum iron. Each group was randomly divided into a training cohort and a validation cohort at a ratio of 7:3. The influencing factors were screened by univariate and multivariate logistic regression analyses, and nomogram models were constructed. The area under the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the models. RESULTS CRA in lung cancer is mainly related to surgery, chemotherapy, Karnofsky Performance Status (KPS) score, serum iron, C-reactive protein (CRP), albumin, and total cholesterol (p < 0.05). CRA in lung cancer patients with decreased serum iron is primarily associated with albumin, age, and cancer staging, while CRA in lung cancer patients with normal serum iron is mainly related to CRP, albumin, total cholesterol, and cancer staging. The area under the ROC curve of the training cohort and validation cohort for the prediction model of lung cancer patients with decreased serum iron was 0.758 and 0.760, respectively. Similarly, the area under the ROC curve of the training cohort and validation cohort for the prediction model of lung cancer patients with normal serum iron was 0.715 and 0.730, respectively. The calibration curves of both prediction models were around the ideal 45° line, suggesting good discrimination and calibration. DCA showed that the nomograms had good clinical utility. CONCLUSION Both models have good reliability and validity and have significant clinical value. They can help doctors better assess the risk of developing CRA in lung cancer patients. CRP is a risk factor for CRA in lung cancer patients with normal serum iron but not in patients with decreased serum iron. Therefore, whether CRP and the inflammatory state represented by CRP will further aggravate the decrease in serum iron levels, thus contributing to anemia, warrants further study.
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Affiliation(s)
- Quan‐yao Li
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wen‐xiao Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Hui Liu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jia‐lin Yao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Qin Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Dan Lin
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jun Shi
- Department of Traditional Chinese MedicineShanghai Fourth People's Hospital Affiliated to Tongji University of MedicineShanghaiChina
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2
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Shenoy G, Slagle-Webb B, Khunsriraksakul C, Pandya Shesh B, Luo J, Khristov V, Smith N, Mansouri A, Zacharia BE, Holder S, Lathia JD, Barnholtz-Sloan JS, Connor JR. Analysis of anemia and iron supplementation among glioblastoma patients reveals sex-biased association between anemia and survival. Sci Rep 2024; 14:2389. [PMID: 38287054 PMCID: PMC10825121 DOI: 10.1038/s41598-024-52492-8] [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: 03/25/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
The association between anemia and outcomes in glioblastoma patients is unclear. We analyzed data from 1346 histologically confirmed adult glioblastoma patients in the TriNetX Research Network. Median hemoglobin and hematocrit levels were quantified for 6 months following diagnosis and used to classify patients as anemic or non-anemic. Associations of anemia and iron supplementation of anemic patients with median overall survival (median-OS) were then studied. Among 1346 glioblastoma patients, 35.9% of male and 40.5% of female patients were classified as anemic using hemoglobin-based WHO guidelines. Among males, anemia was associated with reduced median-OS compared to matched non-anemic males using hemoglobin (HR 1.24; 95% CI 1.00-1.53) or hematocrit-based cutoffs (HR 1.28; 95% CI 1.03-1.59). Among females, anemia was not associated with median-OS using hemoglobin (HR 1.00; 95% CI 0.78-1.27) or hematocrit-based cutoffs (HR: 1.10; 95% CI 0.85-1.41). Iron supplementation of anemic females trended toward increased median-OS (HR 0.61; 95% CI 0.32-1.19) although failing to reach statistical significance whereas no significant association was found in anemic males (HR 0.85; 95% CI 0.41-1.75). Functional transferrin-binding assays confirmed sexually dimorphic binding in resected patient samples indicating underlying differences in iron biology. Anemia among glioblastoma patients exhibits a sex-specific association with survival.
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Affiliation(s)
- Ganesh Shenoy
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Becky Slagle-Webb
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St. Louis, MO, USA
| | - Vladimir Khristov
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Nataliya Smith
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Sheldon Holder
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - Justin D Lathia
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jill S Barnholtz-Sloan
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, USA
| | - James R Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA.
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Xu J, Wu K, Li X, Teo CS, Li G, Pan Y, Hou L. Effectiveness and safety of seven oral Chinese patent medicines as adjuvant therapy for cancer-related anemia: A systematic review and network meta-analysis of randomized controlled trials. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2023. [DOI: 10.1016/j.jtcms.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Tisserand J, Randrian V, Paccalin M, Saulnier PJ, Arviset M, Fourmy A, Arriudarré V, Jamet A, Moreno Y, Valéro S, Liuu E. Association between Iron Deficiency and Survival in Older Patients with Cancer. Cancers (Basel) 2023; 15:cancers15051533. [PMID: 36900329 PMCID: PMC10000607 DOI: 10.3390/cancers15051533] [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: 01/15/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND iron deficiency (ID) is frequent in older patients. PURPOSE to evaluate the association between ID and survival in patients ≥ 75 years old with confirmed solid tumors. METHODS a retrospective monocentric study including patients between 2009 and 2018. ID, absolute ID (AID) and functional ID (FID) were defined according to the European Society for Medical Oncology (ESMO) criteria. Severe ID was defined by a ferritin level < 30 µg/L. RESULTS in total, 556 patients were included, the mean age was 82 (±4.6) years, 56% were male, the most frequent cancer was colon cancer (19%, n = 104), and metastatic cancers were found in 38% (n = 211). Median follow-up time: 484 [190-1377] days. In anemic patients, ID and FID were independently associated with an increased risk of mortality (respectively, HR 1.51; p = 0.0065 and HR 1.73; p = 0.0007). In non-anemic patients, FID was independently associated with better survival (HR 0.65; p = 0.0495). CONCLUSION in our study, ID was significantly associated with survival, and with better survival for patients without anemia. These results suggest that attention should be paid to the iron status in older patients with tumors and raise questions about the prognostic value of iron supplementation for iron-deficient patients without anemia.
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Affiliation(s)
- Julie Tisserand
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Violaine Randrian
- ProDiCeT, CHU Poitiers, Université de Poitiers, 86000 Poitiers, France
- Gastroenterology and Hepatology Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Marc Paccalin
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Pierre-Jean Saulnier
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Marine Arviset
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Arthur Fourmy
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Victor Arriudarré
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Amélie Jamet
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Yvan Moreno
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Simon Valéro
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
| | - Evelyne Liuu
- Geriatrics Department, Poitiers University Hospital, 86000 Poitiers, France
- University Hospital Poitiers, University of Poitiers, INSERM CIC 1402, 2 rue de la Milétrie, CEDEX, 86021 Poitiers, France
- Correspondence:
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Prescott LS, Vergote I, Sun CC, Bodurka DC, Coleman RL. Transfusion use and effect on progression-free, overall survival, and quality of life in upfront treatment of advanced epithelial ovarian cancer: evaluation of the European Organization for Research and Treatment EORTC-55971 Cohort. Int J Gynecol Cancer 2023; 33:1-9. [PMID: 36356982 PMCID: PMC10046328 DOI: 10.1136/ijgc-2022-003947] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The impact of blood transfusion on ovarian cancer survival is uncertain. OBJECTIVE To investigate whether peri-operative blood transfusion negatively impacted progression-free survival, overall survival, and quality of life in patients with advanced ovarian cancer. METHODS We performed an ancillary analysis of the European Organization for Research and Treatment (EORTC) 55971 phase III trial, in which patients were randomized to primary debulking surgery versus neoadjuvant chemotherapy. Patients included in the per-protocol analysis were categorized by receipt of a transfusion. RESULTS 612 of 632 (97%) of patients had adequate data for analysis. Of those, 323 (53%) received a transfusion. The transfusion cohort was more likely to have had better Word Health Organization (WHO) performance status, serous histology, undergone primary debulking surgery, and received more aggressive surgery, with higher rates of no gross residual disease. Median overall survival was 34.0 vs 35.2 months in the no transfusion and transfusion cohorts (p=0.97). The adjusted HR for death was 1.18 (95% CI 0.94 to 1.48) in favor of the transfusion cohort. Median progression-free survival was 13.6 vs 12.6 months in the no transfusion and transfusion cohorts (p=0.96). The adjusted HR for progression was 1.14 (95% CI 0.91 to 1.43). There were no significant differences in global quality of life, fatigue, dyspnea, or physical functioning between the two cohorts at baseline or at any of the four assessment times. Grade 3 and 4 surgical site infections were more common in the transfusion cohort. CONCLUSION Transfusion did not negatively impact progression-free survival or overall survival; however, it was associated with increased peri-operative morbidity without improvements in quality of life.
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Affiliation(s)
- Lauren Shore Prescott
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gergal Gopalkrishna Rao SR, Bugazia S, Dhandapani TPM, Tara A, Garg I, Patel JN, Yeon J, Memon MS, Muralidharan A, Khan S. Efficacy and Cardiovascular Adverse Effects of Erythropoiesis Stimulating Agents in the Treatment of Cancer-Related Anemia: A Systematic Review of Randomized Controlled Trials. Cureus 2021; 13:e17835. [PMID: 34527499 PMCID: PMC8432433 DOI: 10.7759/cureus.17835] [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] [Received: 07/31/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Anemia is a common complication of cancer. Treatment of anemia in cancer is crucial as anemia adversely affects the quality of life, therapeutic outcomes, and overall survival. Erythropoiesis stimulating agents (ESAs) are valuable drugs for treating cancer-related anemia. Cardiovascular adverse effects are a significant concern with ESA therapy, and there is wide variability in therapeutic goals and characteristics of patients who undergo treatment with ESAs. As a result, a careful analysis of the currently available data on the efficacy and safety of these drugs is necessary. This data analysis will aid in the rational use of ESAs for the treatment of anemia in cancer. The objective of this systematic review is to elucidate the pathogenesis of anemia in cancer, assess the effectiveness of ESAs in treating anemia in cancer, and the overall risk of cardiovascular adverse effects associated with the use of ESAs and their impact on prognosis. We searched literature from online databases - PubMed, PubMed Central, MEDLINE, Cochrane Library, and clinical trials register (clinicaltrials.gov) to identify prospective phase II and phase III randomized controlled trials (RCTs). We chose RCTs that directly compared patients with cancer who were treated with ESAs to those who were not treated with ESAs. January 2008 was taken as the lower date limit and May 2021 as the upper date limit. Only English language literature and human studies were included. The quality appraisal was completed using the Cochrane risk bias assessment tool, and data from a total of 10,738 patients with cancer in 17 RCTs were identified and included for systematic review. Our review concludes that ESAs effectively reduce the necessity for blood transfusions and increase mean hemoglobin levels in anemic cancer patients. ESA therapy is associated with cardiovascular adverse effects, including venous thromboembolism, thrombophlebitis, hypertension, ischemic heart disease, cardiac failure, arrhythmia, arterial thromboembolism, and cardiac arrest. Aggressive ESA dosing to achieve higher hemoglobin levels and preexisting uncontrolled hypertension increases these cardiovascular side effects. Venous thromboembolism is the most significant adverse effect attributed to ESA therapy. However, there is no major change in overall survival with ESA therapy, and administration of ESAs can be carried out in anemic cancer patients with careful assessment of thromboembolism risk factors, risk-benefit ratio, and monitoring of hemoglobin levels.
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Affiliation(s)
- Sanjay Rao Gergal Gopalkrishna Rao
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Kasturba Medical College, Manipal, IND
| | - Seif Bugazia
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Faculty of Medicine, University of Benghazi, Benghazi, LBY
| | - Tamil Poonkuil Mozhi Dhandapani
- Internal Medicine/Family Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
- Medicine, Kanyakumari Government Medical College, Nagercoil, IND
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Ishan Garg
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Medicine, Ross University School of Medicine, Miami, USA
| | - Jaimin N Patel
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, St. Martinus University Faculty of Medicine, Curacoa, CUW
| | - Jimin Yeon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- College of Medicine, Hanyang University, Seoul, KOR
| | - Marrium S Memon
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abilash Muralidharan
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, State University of New York (SUNY) Downstate Health Science Center, New York, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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7
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An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, Sekyonda Z, Piccone C, Owusu-Ansah A, Ahuja S, Little JA, Gurkan UA. Emerging point-of-care technologies for anemia detection. LAB ON A CHIP 2021; 21:1843-1865. [PMID: 33881041 PMCID: PMC8875318 DOI: 10.1039/d0lc01235a] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuning Huang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Russell W Valentine
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, IL, USA
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA. and Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Muthanna FMS, Hassan BAR, Karuppannan M, Mohammed AH. Evaluation of the impact of anaemia on quality of life among breast cancer patients undergoing chemotherapy in Malaysia. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Objectives
The purpose of this study was to evaluate the impact of anaemia on the quality of life (QOL) among breast cancer patients.
Methods
A total of 120 anaemic (haemoglobin < 12 g/dL) breast cancer patients were identified through chart review. Patients were followed-up for three cycles of chemotherapy filled in a QOL questionnaire Functional Assessment Chronic Therapy –Anaemia at each follow-up session. Data such as haemoglobin Hb levels and chemotherapy regimens were also recorded on each follow-up. Data were analysed using SPSS.
Key findings
The Hb level and QOL mean scores of all follow-ups were 10.34 ± 0.73 g/dL and 96.37 ± 16.15 g/dL, respectively. QOL was adversely affected by anaemia severity, and the curves declined significantly from the first follow-up to the third follow-up (P < 0.001).
Conclusion
It is crucial to consider developing a guideline for the treatment of anaemia, which is not available currently, and improve the QOL for the wellbeing of cancer patients.
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Affiliation(s)
| | | | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
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9
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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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10
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Yang QY, Li XF, Lin MQ, Xu JH, Yan H, Zhang ZM, Wang SY, Chen HC, Chen XN, Lin KY, Guo YS. Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer. Biomarkers 2020; 25:260-267. [PMID: 32141338 DOI: 10.1080/1354750x.2020.1734860] [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: 12/26/2022]
Abstract
Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan-Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295-2.655, p < 0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426-23.310, p = 0.014).Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.
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Affiliation(s)
- Qing-Yong Yang
- Department of Internal Medicine, Jinshan Branch of Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China.,Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiu-Feng Li
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Mao-Qiang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Jia-Hao Xu
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han Yan
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Zhi-Ming Zhang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Sun-Ying Wang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han-Chuan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Xi-Nan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Kai-Yang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Yan-Song Guo
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
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11
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Weng J, Wei J, Li M, Lu J, Qin Y, Liu F, Xiong W, Qu S. Clinical outcomes of patients with nasopharyngeal carcinoma treated with antibiotics for radiation-induced mucositis: a retrospective study. J Int Med Res 2019; 48:300060519874899. [PMID: 31840546 PMCID: PMC7607210 DOI: 10.1177/0300060519874899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the effects of antibiotic administration on radiation-induced oral
and oropharyngeal mucositis, and on the prognosis of patients with
nasopharyngeal carcinoma (NPC). Methods We retrospectively analyzed data for patients with NPC with grade 1/2 or 3/4
mucositis. Forty-two patients with grade 3/4 mucositis received antibiotics.
Univariate survival analysis was assessed by Kaplan–Meier survival curves,
survival curves were compared using log-rank tests, and multivariate
analysis was carried out by Cox regression. Results A total of 463 patients with NPC were included in the study (194 grade 1/2
mucositis, 269 grade 3/4 mucositis). Univariate analyses identified T-stage,
N-stage, clinical stage, type of treatment, and antibiotic use as factors
affecting overall and disease-free survival. Multivariate analysis also
determined that T-stage, N-stage stage, type of treatment, and antibiotic
usage were independent factors affecting overall and disease-free survival.
Mucositis improved in 32 of the 42 patients who received antibiotics
(76.19%). However, red blood cell count and hemoglobin levels decreased in
all patients after antibiotic treatment. Conclusions Antibiotics may be effective for the treatment of severe radiation-induced
mucositis (grade 3/4) during chemoradiotherapy, but may potentially
adversely affect the prognosis of patients with NPC.
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Affiliation(s)
- JingJin Weng
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jiazhang Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Min Li
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinlong Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yangda Qin
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fei Liu
- Research Center of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Weiming Xiong
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shenhong Qu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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12
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Timilsina S, Karki S, Timalsina S, Gautam A, Sharma S. Does packed red cell transfusion provide symptomatic benefits to cancer palliative patients?: a longitudinal study from a single private oncology center in Nepal. BMC Palliat Care 2019; 18:67. [PMID: 31387568 PMCID: PMC6685247 DOI: 10.1186/s12904-019-0454-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/31/2019] [Indexed: 11/20/2022] Open
Abstract
Background Palliative patients generally present with symptoms of dyspnea, easy fatigability, lethargy and feeling of being unwell which can broadly be attributed to one root cause: cancer-related anemia. So, packed red cell transfusion is often carried out aiming to improve patients’ functional status. Different cut off hemoglobin values have been suggested, with Hb < 9 g/dL the most commonly accepted. The present study aims at evaluating and comparing the benefits in subjective symptoms of fatigue and breathlessness among transfused and non-transfused palliative patients on Day 0 and Day 7. Methods Hemoglobin values, anemia related subjective symptoms of fatigue and breathlessness were recorded from 122 patients. The patients were re-evaluated on day-7 post-transfusion. The pre and post-transfusion symptomatic benefit was compared in both transfused and non-transfused palliative care patients. Results The currently practiced hemoglobin trigger for packed red cell transfusion is 10 g/dL. The units of packed red cell to be transfused was decided according to the hemoglobin values targeting the rise to > 10 g/dL. A mean 1.36 units were transfused. Statistically significant improvement was observed in patient reported symptoms of fatigue and breathlessness among both transfused and non-transfused palliative patients. Conclusion Anemic cancer palliative patients were found to benefit following packed red cell transfusion, suggesting a favorable association between the transfusion and patient-reported fatigue and dyspnea.
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Affiliation(s)
- Sameer Timilsina
- Department of Physiology, Tribhuvan University, Chitwan Medical College, Post Box No.: 42, Bharatpur-5, Chitwan, Nepal.
| | - Sirisa Karki
- Department of Pharmacology, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Santosh Timalsina
- Department of Biochemistry, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Aajeevan Gautam
- Department of Anatomy, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Sabitri Sharma
- Palliative Care Unit, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
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13
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Lavdaniti M, Owens DA, Liamopoulou P, Marmara K, Zioga E, Mantzanas MS, Evangelidou E, Vlachou E. Factors Influencing Quality of Life in Breast Cancer Patients Six Months after the Completion of Chemotherapy. Diseases 2019; 7:diseases7010026. [PMID: 30813488 PMCID: PMC6473656 DOI: 10.3390/diseases7010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/17/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose: To assess breast cancer patients’ quality of life six months after the completion of adjuvant chemotherapy, and to investigate factors affecting this. Methods: The study was conducted in one large hospital located in a major Greek city. A convenience sample of 61 breast cancer outpatients was recruited. A questionnaire, including the SF-36 scale and questions regarding demographic and clinical information, was used to collect data. Results: The mean age of the patients was 51.52 ± 12.10. The effect of age on the physical role was significant (p = 0.003). Τhe effect of menopausal status on physical role was also found to be significant (p = 0.003); this might be explained by age. Regarding the treatment type, patients who received hormone therapy in addition to surgery and chemotherapy reported a significantly higher quality of life in terms of bodily pain (p = 0.04) and vitality (p = 0.04) than patients who underwent only surgery and chemotherapy. Conclusions: Quality of life is affected by factors such as age, menopausal status, and previous therapy. Health care professionals should be more aware of the factors that influence the quality of life domains (physical role, bodily pain, vitality) within this group of cancer patients in order to meet their needs following acute treatment.
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Affiliation(s)
- Maria Lavdaniti
- Nursing Department, Alexander Technological Educational Institute, 57400 Thessaloniki, Greece.
| | | | - Polixeni Liamopoulou
- Nursing Department, Alexander Technological Educational Institute, 57400 Thessaloniki, Greece.
| | - Kalliopi Marmara
- Faculty of Physical Education, Aristotele University of Thessaloniki, 54124 Thermi Thessaloniki, Greece.
| | | | - Michael S Mantzanas
- Department of University Orthopedic, MSc, MHSc, PhD, General Hospital of Nea Ionia "Konstantopouleio-Patision", 14233 Athens, Greece.
| | - Eftychia Evangelidou
- Department of Infection Control, MSc, MHSc, PhD(c), General Hospital of Nea Ionia "Konstantopouleio-Patision", 14233 Athens, Greece.
| | - Eugenia Vlachou
- Nursing Department, University of West Attica, 12243 Athens, Greece.
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14
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Lee SJ, Wang H, Ahn SH, Son MK, Hyun GH, Yoon SJ, Lee J, Park JH, Lim J, Hong SS, Kwon SW. Metabolomics Approach Based on Multivariate Techniques for Blood Transfusion Reactions. Sci Rep 2019; 9:1740. [PMID: 30741955 PMCID: PMC6370787 DOI: 10.1038/s41598-018-37468-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/29/2018] [Indexed: 01/03/2023] Open
Abstract
Blood transfusions temporarily improve the physical state of the patient but exert widespread effects on immune and non-immune systems. Perioperative allogeneic blood transfusions (ABT) are associated with various risks, including coagulopathy, incompatibility, transmission of infectious agents, and allergic reactions. Nevertheless, little is known about the global metabolic alterations that reflect the possible reactions of blood transfusions. In this study, we investigated metabolite changes generated by ABT in a rat model using metabolomics technology. To further profile the “metabolome” after blood transfusions, we used both liquid chromatography-quadrupole time-of-flight high-definition mass spectrometry and gas chromatography-mass spectrometry. ABT promoted a stimulatory microenvironment associated with a relative increase in glucose transporter 1/4 (GLUT1/GLUT4) expression. Supporting this result, glucose metabolism-related enzyme IRS1 and interleukin-6 (IL-6) were abnormally expressed, and levels of lysophosphatidylcholine (LysoPC) and its related enzyme phospholipase A2 (PLA2) were significantly altered in allogeneic groups compared to those in autologous groups. Finally, amino acid metabolism was also altered following ABT. Taken together, our results show a difference between autologous and allogeneic blood transfusions and demonstrate correlations with cancer-associated metabolic changes. Our data provide endogenous information for a better understanding of blood transfusion reactions.
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Affiliation(s)
- Seul Ji Lee
- College of Pharmacy, Seoul National University, Seoul, 08826, Korea
| | - Haiping Wang
- College of Pharmacy, Seoul National University, Seoul, 08826, Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, 16499, Korea
| | - Mi Kwon Son
- College of Medicine, Inha University, Incheon, 22212, Korea
| | - Gyu Hwan Hyun
- College of Pharmacy, Seoul National University, Seoul, 08826, Korea
| | - Sang Jun Yoon
- College of Pharmacy, Seoul National University, Seoul, 08826, Korea
| | - Jeongmi Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Korea
| | - Jeong Hill Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Korea.,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Johan Lim
- Department of Statistics, Seoul National University, Seoul, 08826, Korea
| | - Soon-Sun Hong
- College of Medicine, Inha University, Incheon, 22212, Korea.
| | - Sung Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Korea.
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15
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Busti F, Marchi G, Ugolini S, Castagna A, Girelli D. Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy. Pharmaceuticals (Basel) 2018; 11:E94. [PMID: 30274354 PMCID: PMC6315653 DOI: 10.3390/ph11040094] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (ID) often being a major and potentially treatable contributor. In turn, ID in cancer patients can be due to multiple concurring mechanisms, including bleeding (e.g., in gastrointestinal cancers or after surgery), malnutrition, medications, and hepcidin-driven iron sequestration into macrophages with subsequent iron-restricted erythropoiesis. Indeed, either absolute or functional iron deficiency (AID or FID) can occur. While for absolute ID there is a general consensus regarding the laboratory definition (that is ferritin levels <100 ng/mL ± transferrin saturation (TSAT) <20%), a shared definition of functional ID is still lacking. Current therapeutic options in cancer anemia include iron replacement, erythropoietic stimulating agents (ESAs), and blood transfusions. The latter should be kept to a minimum, because of concerns regarding risks, costs, and limited resources. Iron therapy has proved to be a valid approach to enhance efficacy of ESAs and to reduce transfusion need. Available guidelines focus mainly on patients with chemotherapy-associated anemia, and generally suggest intravenous (IV) iron when AID or FID is present. However, in the case of FID, the upper limit of ferritin in association with TSAT <20% at which iron should be prescribed is a matter of controversy, ranging up to 800 ng/mL. An increasingly recognized indication to IV iron in cancer patients is represented by preoperative anemia in elective oncologic surgery. In this setting, the primary goal of treatment is to decrease the need of blood transfusions in the perioperative period, rather than improving anemia-related symptoms as in chemotherapy-associated anemia. Protocols are mainly based on experiences of Patient Blood Management (PBM) in non-oncologic surgery, but no specific guidelines are available for oncologic surgery. Here we discuss some possible approaches to the management of ID in cancer patients in different clinical settings, based on current guidelines and recommendations, emphasizing the need for further research in the field.
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Affiliation(s)
- Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Giacomo Marchi
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Sara Ugolini
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Annalisa Castagna
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
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16
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Gascón P, Arranz R, Bargay J, Ramos F. Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma. Support Care Cancer 2017; 26:1253-1264. [PMID: 29116407 DOI: 10.1007/s00520-017-3948-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe perceptions of fatigue in anemic patients with lymphoma or multiple myeloma (MM). METHODS This is an observational multicenter study in a prospective cohort of lymphoma and MM patients with hemoglobin ≤ 11 g/dl managed under clinical practice. Fatigue was assessed at baseline and after 3 months using the PERFORM questionnaire, the Functional Assessment of Cancer Therapy-Fatigue, the linear analogue self-assessment, and visual analogue scale (VAS) scales. RESULTS Two hundred and fifty patients (125 with lymphoma, 125 with MM) were included. Only 59.2 and 56.0% of patients received treatment for anemia, respectively. After 3 months, the hemoglobin levels increased significantly compared to baseline from 10.0 ± 1.2 to 11.5 ± 1.8 in the lymphoma group and from 9.9 ± 0.9 to 10.9 ± 1.5 g/dl, in the MM group (P < 0.001, both comparisons). At baseline, 87.2 and 84.8% of patients had fatigue (median intensity (VAS) 60 and 50). The overall PERFORM score decreased from 35.2 ± 15.2 to 32.0 ± 14.6 (P = 0.048), without differences between groups. No statistically significant changes were observed in the other scales. After multivariable adjustment, the only common independent factor associated to improvements in fatigue and health-related quality-of-life (HRQoL) was an increase in hemoglobin levels. The administration of curative intention treatment was also associated with HRQoL improvements. The psychometric properties of the PERFORM questionnaire in MM patients were good (Cronbach's alpha 0.87-0.98; intraclass correlation coefficients 0.84-0.89; effect sizes 0.59-0.96). CONCLUSIONS Almost all patients with lymphoma or MM diagnosed with anemia suffered from fatigue of moderate to severe intensity. Despite similar anemia supportive treatment, better correction of fatigue scores was observed in lymphoma patients after 3 months. Increases in hemoglobin were significantly associated to improvements in fatigue and HRQoL.
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Affiliation(s)
- Pere Gascón
- Hospital Clínic, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Reyes Arranz
- Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Joan Bargay
- Hospital Son Llatzer, Carretera de Manacor, Km. 4, 07198, Palma de Mallorca, Spain
| | - Fernando Ramos
- Hospital Universitario de León, Calle Altos de Nava, s/n, 24008, Leon, Spain
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17
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Dreyer G, Mostert AE, Visser C, Mouton A. The severity and optimal management of iron deficiency and anaemia before radiation for cervical cancer at the University of Pretoria Academic Hospitals. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2017. [DOI: 10.1080/20742835.2017.1321219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Greta Dreyer
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Anna E. Mostert
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Cathy Visser
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Arnold Mouton
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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18
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Douros A, Jobski K, Kollhorst B, Schink T, Garbe E. Risk of venous thromboembolism in cancer patients treated with epoetins or blood transfusions. Br J Clin Pharmacol 2016; 82:839-48. [PMID: 27206325 DOI: 10.1111/bcp.13019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 04/11/2016] [Accepted: 05/14/2016] [Indexed: 11/29/2022] Open
Abstract
AIMS Anaemia is common in cancer patients, with treatments including epoetins and blood transfusions. Although an increased risk of venous thromboembolism (VTE) has been associated with both therapeutics, studies comparing the risk of VTE between epoetins and transfusions in cancer patients are lacking. METHODS A nested case-control study investigated this risk using the German Pharmacoepidemiological Research Database. Cohort members were incident cancer patients receiving first time treatment with epoetin or transfusion. A subcohort including only patients receiving chemotherapy was created, since the formally approved indication of epoetins is chemotherapy-induced anaemia. Cases were defined as patients developing VTE. For each case up to 10 gender- and age-matched controls were selected from the cohort. Multiple confounder adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for VTE and recent treatment with epoetins or transfusions (last 28 days before index date) compared with past anti-anaemic treatment were calculated by conditional logistic regression. RESULTS Among 69 888 patients receiving first time treatment with epoetin or transfusion, 3316 VTE cases were identified. The aOR for VTE was 1.31 (95% CI 1.03, 1.65) for epoetins, 2.33 (95% CI 2.03, 2.66) for transfusions, and 2.24 (95% CI 1.34, 3.77) for epoetins and transfusions. Sensitivity analyses with a stricter VTE definition or an expanded time window yielded similar results. In the chemotherapy only subcohort the risk difference between epoetins and transfusions could not be verified (aOR 1.48, 95% CI 1.10, 1.98 vs. aOR 1.80, 95% CI 1.49, 2.19). Our study confirmed known VTE risk factors including previous VTE (aOR 14.76, 95% CI 12.79, 17.03) or surgery (aOR 1.83, 95% CI 1.67, 2.01). Epoetin-associated risk decreased after a safety warning by the European Medicines Agency setting maximum haemoglobin target values to 12 g dl(-1) . CONCLUSIONS Transfusions could be associated with a higher VTE risk than epoetins in cancer patients. Moreover, current prescribing patterns may have decreased the VTE risk for epoetins.
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Affiliation(s)
- Antonios Douros
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany.,Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Jobski
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Bianca Kollhorst
- Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Tania Schink
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Edeltraut Garbe
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany.,Core Scientific Area 'Health Sciences' at the University of Bremen, Bremen, Germany
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19
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Current trends in the management of anaemia in solid tumours and haematological malignancies. Curr Opin Support Palliat Care 2016; 10:189-94. [DOI: 10.1097/spc.0000000000000209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Thuy TT, Thien DD, Quang Hung T, Tam NT, Anh NTH, Nga NT, Cuc NT, Mai LP, Van Sung T, Delfino DV, Thao DT. In vivo anticancer activity of maesopsin 4-O-β-glucoside isolated from leaves of Artocarpus tonkinensis A. Chev. Ex Gagnep. ASIAN PAC J TROP MED 2016; 9:351-356. [PMID: 27086153 DOI: 10.1016/j.apjtm.2016.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/20/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the antitumor effect of maesopsin 4-O-β-glucoside (TAT2) isolated from the leaves of Artocarpus tonkinensis (A. tonkinensis) A. Chev. ex Gagnep. METHODS The antitumor activity of TAT2 was evaluated in Lewis lung carcinoma (LLC) tumor-bearing mice. BALB/c mice had tumors induced by implantation with 2 × 10(6) LLC cells into the subcutaneous right posterior flank. Tumor-bearing mice were treated orally with a range of doses of TAT2 and a standard drug, doxorubicin. Animals were observed for tumor growth and mortality rate. Blood was collected to determine hematological and biochemical parameters. RESULTS TAT2 was isolated from an ethanolic extract of A. tonkinensis leaves. Its structure was determined by MS and NMR spectroscopy, and identified as TAT2. The compound did not show acute toxicity at the highest dose tested (2000 mg/kg body weight). TAT2 exhibited antitumor activity by decreasing tumor growth, increasing the survival rate, and ameliorating some hematological and biochemical parameters at doses of 100 and 200 mg/kg body weight (P < 0.05). CONCLUSIONS These results indicate that TAT2 possesses clear antitumor activity. Due to its bioavailability and low toxicity, and the fact that it could be isolated in a large scale from A. tonkinensis leaves, the compound shows promise as a potential anticancer drug.
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Affiliation(s)
- Trinh Thi Thuy
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam.
| | - Dao Duc Thien
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Tran Quang Hung
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Nguyen Thanh Tam
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Nguyen Thi Hoang Anh
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Nguyen Thi Nga
- Institute of Biotechnology, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Nguyen Thi Cuc
- Institute of Biotechnology, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Le Phuong Mai
- National Research Council Canada, Measurement Science and Standards, 1200 Montreal Road, Building M-12, Ottawa, Ontario K1A 0R6, Canada
| | - Tran Van Sung
- Institute of Chemistry, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Domenico V Delfino
- Department of Medicine, University of Perugia, Piazzale Gambuli, S.Andrea delle Fratte, 06132 Perugia, Italy
| | - Do Thi Thao
- Institute of Biotechnology, Vietnam Academy of Science and Technology, 18-Hoang Quoc Viet, Nghia Do, Cau Giay, Hanoi, Viet Nam.
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Antianemic Treatment of Cancer Patients in German Routine Practice: Data from a Prospective Cohort Study-The Tumor Anemia Registry. Anemia 2016; 2016:8057650. [PMID: 26966573 PMCID: PMC4757729 DOI: 10.1155/2016/8057650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/03/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022] Open
Abstract
The aim of this prospective cohort study was to assess current antianemic treatment of cancer patients in German routine practice, including diagnostics, treatments, and quality of life (QoL). 88 study sites recruited 1018 patients at the start of antianemic treatment with hemoglobin (Hb) levels <11 g/dL (females) or <12 g/dL (males). Patients were followed up for 12 weeks. 63% of the patients had inoperable solid tumors, 22% operable solid tumors, and 15% hematological malignancies. Over 85% received chemotherapy. Median age was 67 years; 48% were male. Red blood cell transfusions (RBCTx) were given to 59% of all patients and to 55% of the patients with Hb ≥8 g/dL on day 1 of the observation period (day 1 treatment). Erythropoiesis-stimulating agents (ESAs) were the second most frequently applied day 1 treatment (20%), followed by intravenous (IV) iron (15%) and ESA + IV iron (6%). Only about a third of patients were tested for blood serum iron parameters at the start of treatment. Overall, more than half of the patients had long-term responses to antianemic therapy. Our data suggest that in routine practice diagnostics for treatable causes of anemia are underused. A high proportion of cancer patients receive RBCTx. It should be discussed whether thorough diagnostics and earlier intervention could decrease the need for RBCTx. This trial is registered with NCT01795690.
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Chronic Anemia and the Role of the Infusion Therapy Nurse. JOURNAL OF INFUSION NURSING 2015; 38:341-8. [PMID: 26339940 DOI: 10.1097/nan.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic anemia develops over a course of weeks to months and is usually mild to moderate in nature. It is important to understand the etiology of the reduced number of circulating red blood cells to treat the anemia appropriately. Diagnosis is dependent on patient history and laboratory findings, such as complete blood counts, iron studies, a peripheral smear, and occasionally, a bone marrow biopsy. Treatment modalities frequently administered by infusion therapy nurses include treatment of the underlying chronic disease, replacement of deficiencies (iron, vitamin B12, folate, or erythropoietin), or transfusion of red blood cells. Infusion therapy nurses play a vital role in the assessment and delivery of medication therapy to patients with chronic anemia.
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Abstract
SummaryThe challenges of treating malignant disease in the elderly population have gained greater prominence over the last 5–10 years. Developed nations all have ageing populations, and cancer in older people is an increasing physical and financial burden on both healthcare systems and populations.When assessing oncology patients, oncologists have traditionally used the Eastern Cooperative Oncology Group or Karnofsky performance status. However, it has been shown that sometimes this does not detect potential problems in older patients, and that a comprehensive geriatric assessment may be a better tool. However good surgeons and oncologists are at adapting their services for older patients, there is little value if they are inappropriately referred or filtered out by either primary or secondary care.Surgery forms the basis of most curative treatment options. The elderly have more peri-operative risk factors including multiple co-morbidities, poly-pharmacy, malnutrition, frailty, cognitive dysfunction and an increased anaesthetic risk, which can create obstacles.Treating older patients with systemic cytotoxic therapy often relies on extrapolating evidence from younger patients. In previous decades, the majority of trials had upper age limits of 65 or 70 years. More recent trials normally include patients of all ages, and entry is based on performance status. Radiotherapy may be chosen as a potentially curative option in patients with an operable tumour, who are unfit. However, oncologists should not underestimate the burden that multiple frequent visits to hospital for treatment may have on an elderly patient population.This article looks at the assessment of elderly oncology patients, referral patterns, surgery, systemic therapies, radiotherapy, supportive therapies and long-term side-effects from treatment.
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Byelinska IV, Lynchak OV, Rybalchenko TV, Yablonska SV, Bahurynska OM, Rybalchenko VK. Morphofunctional parameters of blood cells of a rat with 1,2-dimethylhydrazine-induced colon carcinogenesis. CYTOL GENET+ 2015. [DOI: 10.3103/s0095452715030044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goksu SS, Gunduz S, Unal D, Uysal M, Arslan D, Tatli AM, Bozcuk H, Ozdogan M, Coskun HS. Use of blood transfusion at the end of life: does it have any effects on survival of cancer patients? Asian Pac J Cancer Prev 2015; 15:4251-4. [PMID: 24935379 DOI: 10.7314/apjcp.2014.15.10.4251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. OBJECTIVE We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. DESIGN Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. RESULTS Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). CONCLUSIONS Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey E-mail :
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Martino M, Lanza F, Demirer T, Moscato T, Secondino S, Pedrazzoli P. Erythropoiesis-stimulating agents in allogeneic and autologous hematopoietic stem cell transplantation. Expert Opin Biol Ther 2014; 15:195-211. [PMID: 25315815 DOI: 10.1517/14712598.2015.971749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Erythropoiesis-stimulating agents (ESAs) are used in treating cancer- and chemotherapy-induced anemia with the aim of accelerating the recovery of red blood cells (RBCs), reduce the risks associated with RBC transfusions and improve quality of life. AREAS COVERED A systematic review has been conducted to examine the current evidence for the efficacy and safety of using ESAs in hematopoietic stem cell transplants (HSCTs). EXPERT OPINION Despite the international recommendations for the use of ESAs in treating different malignancies, there is a lack of guidelines for their use in patients undergoing HSCT. An evaluation of published clinical trials shows that there are no available powerful studies concerning the use of ESAs in this setting, with only heterogeneous and small numbers of patients reported so far. Nevertheless, the more robust and intriguing of these data suggest that the ESA's administration at an appropriate time after the infusion of stem cells may be effective both in autologous and allogeneic HSCTs. New guidelines are required, overseen by an expert in the in the field of stem cell transplantation.
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Affiliation(s)
- Massimo Martino
- Azienda Ospedaliera BMM, Hematology and Stem Cell Transplant Unit , Via Melacrino n.1, 89100 Reggio Calabria , Italy +39 0965393804 ;
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Tyburski EA, Gillespie SE, Stoy WA, Mannino RG, Weiss AJ, Siu AF, Bulloch RH, Thota K, Cardenas A, Session W, Khoury HJ, O'Connor S, Bunting ST, Boudreaux J, Forest CR, Gaddh M, Leong T, Lyon LA, Lam WA. Disposable platform provides visual and color-based point-of-care anemia self-testing. J Clin Invest 2014; 124:4387-94. [PMID: 25157824 DOI: 10.1172/jci76666] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anemia, or low blood hemoglobin (Hgb) levels, afflicts 2 billion people worldwide. Currently, Hgb levels are typically measured from blood samples using hematology analyzers, which are housed in hospitals, clinics, or commercial laboratories and require skilled technicians to operate. A reliable, inexpensive point-of-care (POC) Hgb test would enable cost-effective anemia screening and chronically anemic patients to self-monitor their disease. We present a rapid, stand-alone, and disposable POC anemia test that, via a single drop of blood, outputs color-based visual results that correlate with Hgb levels. METHODS We tested blood from 238 pediatric and adult patients with anemia of varying degrees and etiologies and compared hematology analyzer Hgb levels with POC Hgb levels, which were estimated via visual interpretation using a color scale and an optional smartphone app for automated analysis. RESULTS POC Hgb levels correlated with hematology analyzer Hgb levels (r = 0.864 and r = 0.856 for visual interpretation and smartphone app, respectively), and both POC test methods yielded comparable sensitivity and specificity for detecting any anemia (n = 178) (<11 g/dl) (sensitivity: 90.2% and 91.1%, specificity: 83.7% and 79.2%, respectively) and severe anemia (n = 10) (<7 g/dl) (sensitivity: 90.0% and 100%, specificity: 94.6% and 93.9%, respectively). CONCLUSIONS These results demonstrate the feasibility of this POC color-based diagnostic test for self-screening/self-monitoring of anemia. TRIAL REGISTRATION Not applicable. FUNDING This work was funded by the FDA-funded Atlantic Pediatric Device Consortium, the Georgia Research Alliance, Children's Healthcare of Atlanta, the Georgia Center of Innovation for Manufacturing, and the InVenture Prize and Ideas to Serve competitions at the Georgia Institute of Technology.
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Shu T, Jing C, Lv Z, Xie Y, Xu J, Wu J. Hepcidin in tumor-related iron deficiency anemia and tumor-related anemia of chronic disease: pathogenic mechanisms and diagnosis. Eur J Haematol 2014; 94:67-73. [PMID: 24954786 DOI: 10.1111/ejh.12402] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Anemia is a common hematological abnormality in patients with cancer. Iron deficiency anemia (IDA) and anemia of chronic disease (ACD) are the most prevalent, both characterized by hypochromic microcytic anemia and low serum iron (SI). Their differential diagnosis is difficult in clinical practice, hampering their treatment. Our objective was to evaluate the use of hepcidin to discriminate tumor-related IDA and ACD and to investigate the mechanism of action of hepcidin in these anemias. METHODS Blood samples were collected at Jiangsu Cancer Hospital. Patients were divided into IDA and ACD groups by Prussian blue staining of bone marrow smears. Serum hepcidin was measured by enzyme-linked immunosorbent assay. SI, total iron-binding capacity (TIBC), transferrin saturation (TSAT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) also determined in this study. RESULTS Areas under the curve on receiver operating characteristic analysis indicated the diagnostic sensitivity and specificity of hepcidin to be better than those of SI, TIBC, and TSAT. In ACD, hepcidin was correlated positively with IL-6 (r = 0.81, P < 0.01) and negatively with SI (r = -0.78, P < 0.01). In IDA, no significant relationship between IL-6 and hepcidin was found (r = -0.20, P = 0.17), but hepcidin decreased with decreasing quartiles of SI (r = 0.89, P < 0.01). SI was positively correlated with hemoglobin (r = 0.89, P < 0.01; r = 0.84, P < 0.01) in both groups. CONCLUSIONS Hepcidin is a promising serological marker for the differential diagnosis of tumor-related ACD and IDA, clarifying the pathogenesis of these anemias and guiding corrective treatment.
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Affiliation(s)
- Tingting Shu
- Department of Central Laboratory, Jiangsu Province Official Hospital, Nanjing, China
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Hill JW, Shreay S, McGarvey N, De AP, Hess GP, Corey-Lisle PK. Synchronization of administrations of chemotherapy and erythropoiesis-stimulating agents and frequency of associated healthcare visits. Support Care Cancer 2013; 21:2957-65. [DOI: 10.1007/s00520-013-1830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/21/2013] [Indexed: 12/01/2022]
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Musiychuk K, Sivalenka R, Jaje J, Bi H, Flores R, Shaw B, Jones RM, Golovina T, Schnipper J, Khandker L, Sun R, Li C, Kang L, Voskinarian-Berse V, Zhang X, Streatfield S, Hambor J, Abbot S, Yusibov V. Plant-produced human recombinant erythropoietic growth factors support erythroid differentiation in vitro. Stem Cells Dev 2013; 22:2326-40. [PMID: 23517237 PMCID: PMC3730378 DOI: 10.1089/scd.2012.0489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 03/21/2013] [Indexed: 01/11/2023] Open
Abstract
Clinically available red blood cells (RBCs) for transfusions are at high demand, but in vitro generation of RBCs from hematopoietic stem cells requires significant quantities of growth factors. Here, we describe the production of four human growth factors: erythropoietin (EPO), stem cell factor (SCF), interleukin 3 (IL-3), and insulin-like growth factor-1 (IGF-1), either as non-fused proteins or as fusions with a carrier molecule (lichenase), in plants, using a Tobacco mosaic virus vector-based transient expression system. All growth factors were purified and their identity was confirmed by western blotting and peptide mapping. The potency of these plant-produced cytokines was assessed using TF1 cell (responsive to EPO, IL-3 and SCF) or MCF-7 cell (responsive to IGF-1) proliferation assays. The biological activity estimated here for the cytokines produced in plants was slightly lower or within the range cited in commercial sources and published literature. By comparing EC50 values of plant-produced cytokines with standards, we have demonstrated that all four plant-produced growth factors stimulated the expansion of umbilical cord blood-derived CD34+ cells and their differentiation toward erythropoietic precursors with the same potency as commercially available growth factors. To the best of our knowledge, this is the first report on the generation of all key bioactive cytokines required for the erythroid development in a cost-effective manner using a plant-based expression system.
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Affiliation(s)
| | | | - Jennifer Jaje
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | - Hong Bi
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | - Rosemary Flores
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | - Brenden Shaw
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | - R. Mark Jones
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | - Tatiana Golovina
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
| | | | | | - Ruiqiang Sun
- Celgene Cellular Therapeutics, Warren, New Jersey
| | - Chang Li
- Celgene Cellular Therapeutics, Warren, New Jersey
| | - Lin Kang
- Celgene Cellular Therapeutics, Warren, New Jersey
| | | | | | | | - John Hambor
- Celgene Cellular Therapeutics, Warren, New Jersey
| | | | - Vidadi Yusibov
- Fraunhofer USA Center for Molecular Biotechnology, Newark, Delaware
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Merlini L, Cartenì G, Iacobelli S, Stelitano C, Airoldi M, Balcke P, Keil F, Haslbauer F, Belton L, Pujol B. Anemia prevalence and treatment practice in patients with non-myeloid tumors receiving chemotherapy. Cancer Manag Res 2013; 5:205-14. [PMID: 23946669 PMCID: PMC3739422 DOI: 10.2147/cmar.s45236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To describe the prevalence and management of anemia in cancer patients. METHODS This cross-sectional, observational survey was conducted in Italy and Austria. Centers prespecified one day, during a 4-month enrollment window, to report specific data collected during normal clinical practice for patients with non-myeloid tumors attending for chemotherapy (±radiotherapy) treatment. The primary endpoint was the prevalence of anemia as determined using a prespecified algorithm: hemoglobin (Hb) ≤10 g/dL on/within 3 days prior to visit; ongoing anemia treatment; physician diagnosis of anemia, together with ≥1 anemia symptom. RESULTS Between November 18, 2010 and March 18, 2011, data for 1412 patients were collected (Italy n = 1130; Austria n = 282). Most patients (n = 1136; 80%) had solid tumors; 809 (57%) had received ≤3 chemotherapy cycles. The prevalence of anemia was 32% (95% confidence interval: 29.4%-34.2%); 196 patients (14%) were deemed anemic based on Hb ≤10 g/dL, 131 (9%) on ongoing anemia treatment, and 121 (9%) on physician diagnosis/anemia symptom. Overall, 1153 patients (82%) had Hb data; mean (standard deviation [SD]) Hb levels were 11.7 (1.7) g/dL. In total, 456 patients (32%) had anemia symptoms: fatigue (n = 392; 28%), depression (n = 122; 9%), and dyspnea (n = 107; 8%) were most common. Fifty-one patients (4%) had had their current chemotherapy cycle delayed due to anemia. On visit day, or ≤28 days prior, 91 (6%), 188 (13%), and 81 patients (6%) had evidence of whole blood/red blood cell transfusion, erythropoiesis-stimulating agent use, or iron use, respectively. CONCLUSION On the prespecified study day, one-third of patients with non-myeloid tumors undergoing chemotherapy were found to be anemic and 13% had evidence of erythropoiesis-stimulating agent use then or in the 28 days prior.
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Affiliation(s)
- Laura Merlini
- Department of Medical Oncology, Ospedale Civile S, Bortolo, Vicenza
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Gascón P, Rodríguez CA, Valentín V, Mata JG, Carulla J, Cassinello J, Colomer R, Baró E. Usefulness of the PERFORM questionnaire to measure fatigue in cancer patients with anemia: a prospective, observational study. Support Care Cancer 2013; 21:3039-49. [PMID: 23793142 PMCID: PMC3789890 DOI: 10.1007/s00520-013-1862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PERFORM Questionnaire is a 12-item scale developed for assessing fatigue in cancer patients in the clinical practice. It has advantages over other tools in that it is short and includes beliefs and attitudes of patients about fatigue. It was psychometrically validated in cancer patients with and without anemia. PURPOSE We evaluated the usefulness of the PERFORM scale to measure fatigue in a large study focusing exclusively on anemic patients. METHODS This was an observational, multicenter, prospective, 3-month study in cancer patients with hemoglobin (Hb)≤11 g/dl. Fatigue was assessed using the PERFORM questionnaire. The overall score ranges from 12 (no fatigue) to 60 (maximum fatigue). RESULTS We included 667 patients: 54.1 % women, mean age 60 (standard deviation, 12) years. A highly significant, but mild correlation was observed between low baseline Hb and high patient perception of fatigue (r with PERFORM score=-0.215, p < 0.0001). Of the patients, 65.8 % improved Hb level during follow-up (increase of ≥1 g/dL and/or achieving >11 g/dL), which translated into a significant improvement in the PERFORM score [mean (95 % confidence interval (CI)] change, -1.2 (-0.04 to -2.4), whereas more fatigue was observed in patients without improvement in Hb [change (95 % CI) in PERFORM, +3.3 (1.5 to 5)]. In a multivariate linear regression analysis, the independent factors associated to fatigue at 3 months were a low Hb level, a low Karnofsky index, active chemotherapy, cancer treatment with palliative intention, and transfusion need in the last 3 months. CONCLUSIONS Minimal increases or decreases in Hb of ≥1 g/dL were associated with meaningful changes in patient-perceived fatigue as measured with the PERFORM questionnaire. In addition to anemia severity, other factors such as active chemotherapy and advanced disease contribute to perception of fatigue by cancer patients.
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Affiliation(s)
- Pere Gascón
- Hospital Clínic de Barcelona, Villarroel 170, ES-08036, Barcelona, Spain,
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Lagerlöf JH, Kindblom J, Cortez E, Pietras K, Bernhardt P. Image-based 3D modeling study of the influence of vessel density and blood hemoglobin concentration on tumor oxygenation and response to irradiation. Med Phys 2013; 40:024101. [DOI: 10.1118/1.4773886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Hemoglobin concentration increment is associated with a better prognosis in HIV patients with anemia. Int J Infect Dis 2012; 16:e703. [DOI: 10.1016/j.ijid.2012.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
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Hoff CM. Importance of hemoglobin concentration and its modification for the outcome of head and neck cancer patients treated with radiotherapy. Acta Oncol 2012; 51:419-32. [PMID: 22313317 DOI: 10.3109/0284186x.2011.653438] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hypoxia induced radioresistance has been acknowledged for decades. One of the indirect evidences of the influence of hypoxia on radiation response comes from the observations of a correlation between tumor control and hemoglobin level. This review examines the clinical data on the prognostic and predictive role of hemoglobin level and hemoglobin manipulation in radiotherapy of squamous cell carcinomas of the head and neck, a tumor type where hypoxic radioresistance have been previously documented. THE INFLUENCE OF HEMOGLOBIN CONCENTRATION ON TUMOR OXYGENATION AND OUTCOME The aim is to evaluate the existing literature for information of the influence of hemoglobin concentration and hemoglobin modifications on tumor oxygenation and outcome in head and neck squamous cell cancer patients. The data from several randomized trials show that while most studies have confirmed the prognostic value of hemoglobin, increasing the hemoglobin level through transfusion or erythropoietin stimulation did not result in improved outcome for patients with low initial hemoglobin levels. Clinical studies showed that smoking reduced the oxygen carrying capacity of the blood through formation of carboxyhemoglobin, and lead to poorer response to radiotherapy in smokers compared to non-smokers. Smoking also increased the risk of the development of secondary cancers. CONCLUSION AND FUTURE PERSPECTIVES In conclusion, low hemoglobin is a significant negative prognostic factor for radiotherapy of head and neck cancer. Correction of pre-treatment low hemoglobin by blood transfusion and/or erythropoietin stimulating agents does, however, not improve the outcome. Smoking leads to a decrease in effective hemoglobin and poorer treatment outcome. Smoking should be avoided in order to improve the therapeutic efficacy of radiotherapy and development of other smoking-related diseases and/or secondary cancers.
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Affiliation(s)
- Camilla Molich Hoff
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
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