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Anemia in Elderly Cancer Patients Should Be Diagnosed and Treated

Anaemia in older patients should not always be ascribed to cancer or aging, concludes a new review article. Instead, the causes of anaemia should be diagnosed and treated, and haemoglobin levels should be maintained at a minimum of 12 g/dL in patients with cancer who are undergoing chemotherapy and who are responsive to erythropoietin.

In his review article, Lodovico Balducci, MD, with the Lee Moffitt Cancer Center Research Institute, Tampa, Florida, United States, explored the clinical consequences and the management of anaemia.

According to Dr. Balducci, anaemia is one of the most common comorbid conditions in older cancer patients, who also have a higher prevalence of cancer compared to younger individuals. The cause of anaemia is unknown in 17% to 32% of cases, while common identifiable causes of anaemia are iron deficiency, chronic disease, renal insufficiency, and vitamin B12 deficiency.

Clinical complications of anaemia include reduced survival, reduced function and quality of life, and increased risk of congestive heart failure, myocardial infarction, dementia, and pharmacological complications.

"In the older population, the diagnosis of anaemia may be delayed by a number of age-related conditions such as decreased perception of symptoms or to the erroneous attribution of fatigue to old age or to pre-existing conditions," Dr. Balducci notes.

He suggests that the causes of anaemia in older cancer patients should be thoroughly pursued and corrected. In the majority of cases, a relative erythropoietin deficiency may be present, which is reversible with erythropoietin, he adds.

According to the author, anaemia appears to be associated with a general condition of poor health that may compromise the outcome and quality of life of older patients with cancer. "Management of anaemia should be a priority in these patients," Dr. Balducci points out.

"The assumption that anaemia is automatically ascribed to cancer or age could lead to overlooking treatable comorbid conditions, delaying their management, diminishing their curability, and compromising the management of cancer," he concludes.

Cancer Control J 2003;10:478-486. "Anemia, Cancer, and Aging"

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