A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia

Purpose – Patients with cancer frequently experience chemotherapy‐induced anaemia (CIA) and iron
deficiency (ID). Erythropoiesis‐stimulating agents (ESA), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management.
Methods – Medical oncologists and/or haematologists from nine European countries (n=375) were
surveyed on their last five cancer patients treated for CIA (n=1730). Information was collected on
tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin
saturation (TSAT), and applied anaemia therapies.
Results – Diagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94%) and ferritin (48%) measurements. TSAT was only tested in 14%. At anaemia diagnosis, 74% of patients had Hb ≤10g/dL, including 15% with severe (Hb <8g/dL) anaemia.
Low iron levels (ferritin ≤100ng/mL) were detected in 42% of evaluated patients. ESA was the most
commonly used treatment (63%) and 30% of ESA‐treated patients also received iron supplementation. Most iron‐treated patients (74%) received an oral iron; intravenous iron was
administered to 26%. 52% of patients received transfusions and in 76% of these, transfusions formed part of a regular anaemia treatment regimen. Management practices were similar in 2009 and 2011.
Conclusion – Management of anaemia and iron status in patients treated for CIA varies substantially
across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is underutilised and mainly based on oral iron supplementation. Implementation of
guidelines needs to be increased, particularly the minimisation of blood transfusions.