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Recombinant Human Erythropoietin Treatment Provides Quality of Life Benefits for Cancer-Related Anaemia

Administration of recombinant human erythropoietin (rHuEPO) corrects chemotherapy-induced anaemia in cancer patients as well as improves factors associated with quality of life (QOL), such as energy level and the ability to perform daily activities.

rHuEPO is an established therapy for treatment of mild to moderate cancer-related anaemia. Gregoris Iconomou, Ph.D. and colleagues of the University of Patras Medical School in Rion, Greece, studied the effect of rHuEPO in 122 anaemic (haemoglobin concentration < 11.0 g/dL) cancer patients receiving chemotherapy in reported QOL, and the extent to which rHuEPO increases Hgb levels and reduces transfusion requirements.

Patients were randomised into one of two groups, a treatment group receiving subcutaneous injections of rHuEPO 10,000 units (U) 3 times per week for 12 weeks, or a control group receiving no rHuEPO. Patients in both groups received oral elemental iron (200 mg daily) for study duration.

To determine treatment response, investigators evaluated transfusion requirements and measured changes to haemoglobin levels (at weeks 4, 8, and 12), and QOL (at weeks 4 and 12). QOL was determined using the Fatigue subscale of the Functional Assessment of Cancer Therapy-Anemia (FACT-An) and the Cancer Linear Analogue Scale (CLAS measurements for energy, ability, and overall QOL) by a health psychologist blinded to randomisation.

Approximately 91% of patients completed the study. The administration of rHuEPO was well tolerated, and no patient was discontinued from the study based on adverse reaction to rHuEPO therapy.

Haemoglobin levels rose significantly for the rHuEPO treatment group in comparison to the control group (1.7 g/dL versus 0.3 g/dL, P<0.001). Additionally, the rHuEPO treatment group reported a significant increase in QOL by both the FACT-AN instrument and CLAS scales. While positive correlations were found between the rise in haemoglobin and all QOL measurements, the correlation was particularly strong for CLAS ability score (r=0.47, P<0.001).

No significant difference was found in transfusion requirements between the two groups.

Because greater emphasis in research has focused on physical and functional response to rHuEPO treatment in cancer patients, the researchers suggest further research exploring other potential QOL benefits, especially cognitive functioning.

"Promoting QOL is important not only for humanitarian reasons but also for clinical reasons, because a patient with a significant functional and psychological morbidity and poor overall sense of well-being is less likely to continue his or her cancer therapy regardless of the positive treatment outcomes," they note.
J Pain Symptom Manage 2003 Jun;25:6:512-8. "Effect of recombinant human erythropoietin on quality of life in cancer patients receiving chemotherapy. Results of a randomized, controlled trial"

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