Cancer Anemia Survey in Division of Medical Oncology at Siriraj Hospital (CAS)
Suthinee Ithimakin MD*, Vichien Srimuninnimit MD*
Affiliation : * Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
Background : Causes of anemia in cancer patients are multifaceted and include such factors as nutritional
deficiency anemia, anemia of malignancy and treatment-related anemia. Chemotherapy, especially a platinum-
based regimen, is well recognized to cause anemia. Anemia results in decrease of functional capacity, lower
performance status, poor compliance and adverse prognosis. Optimal management of anemia in cancer
patients is an essential component of cancer treatment. Previously, there was no information about this
condition available in Thailand.
Objective : 1) To evaluate frequency, characteristics of anemia and treatments of anemia in our cancer patients
who received chemotherapy treatment. 2) To identify the factors that influence hemoglobin (Hb) level in
cancer patients especially chemotherapy regimens.
Material and Method: Patients with diagnosis of solid malignancy who were scheduled to receive chemotherapy
for least 4 cycles between June 2006 and December 2007 were included. All enrolled patients’ data which
included demographics, types and stages of cancer, chemotherapy regimen, Hb at baseline, Hb level before
each cycle of chemotherapy and treatment of anemia, were recorded.
Statistical analysis: Patients’ data were presented in terms of percent, mean or median. Logistic- regression
analysis was performed to identify risk factors of anemia in cancer patients.
Results : Three-hundred and four patients were enrolled, 233 patients were female and 71 were male. The age
of patients varied from 15 to 86 years old. Median age was 52 years old. Hb level at enrollment ranged from 7.7
to 16.1 g/dl, mean baseline Hb was 12.5 g/dl. Incidence of anemia at baseline was 34.5 percent whereas the
incidence increased to 61.1 percent after receiving chemotherapy. The incidence of anemia in all patients was
not significantly different from that of a subgroup of patients with normal baseline Hb. The patients who
received platinum and anthracycline-based chemotherapy developed more anemia than those who received
other chemotherapy regimens, with odd ratios of 9.4 (95% CI; 3.1-28.9, p < 0.001) and 3.5 (95% CI; 1.4-8.5,
p = 0.005), respectively. Most anemic patients were asymptomatic; twenty-one out of 214 anemic patients
(9.8%) received specific treatment for anemia.
Conclusion : Chemotherapy-induced anemia is a common problem found in cancer patients, especially in
those receiving platinum-based chemotherapy. Most of the anemic patients had asymptomatic grade I and II
anemia. Blood transfusion was the treatment of choice for severe, symptomatic anemia in our hospital.
Keywords : Anemia, Chemically induced, Neoplasms, Drug therapy
