Anemia in cancer patients

Anemia is a common feature in c.40% of patients at the time of cancer diagnosis and in more than half of patients undergoing anticancer therapy. Cancer-related anemia does have an unfavourable impact on the functional capacity of the relevant tissue and organs. Its pathogenesis is complex and often difficult to identify. Symptoms related to cancer and chemotherapy-induced anemia may have a negative impact on the quality of life and may influence treatment efficacy, disease progression and even survival. Moreover, anemia causing tumor hypoxia leads to tumor progression through the increase of local tumor expansion and spreading of metastases. Tumor hypoxia directly or indirectly confers resistance to irradiation, some chemotherapeutic drugs, and photodynamic therapy. Therapeutic alternatives in cancer patients with anemia include the substitution of the lacking agents, red blood cell (RBC) transfusions, iron supplementation, and erythropoiesis-stimulating agents (ESAs). Using ESAs reduces the need for red blood cell transfusions, decreases the risk of post-transfusion adverse reactions, and improves the quality of life for cancer patients with chemotherapy-induced anemia. The immediate administration of RBC transfusions is justified in patients with hemoglobin (Hb) under 7–8 g/dL and/or severe anemia-related symptoms (even at higher Hb levels) and who require immediate Hb and symptom improvement. Therefore, clinical evidence supports the need to closely monitor Hb level in cancer patients. Anemia should be corrected to improve chemo- and radiosensitivity and the quality of life.