Compliance With NCCN Guidelines for Evaluation and Treatment of Anemia Among Patients With Solid Tumors

Author:

Hufnagel Demetra Hypatia12,Bos Lia Manfredi3,Brown Alaina Johnson4,Prescott Lauren Shore4

Affiliation:

1. Vanderbilt University School of Medicine, Nashville, TN

2. Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA

3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL

4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN

Abstract

Background: NCCN Guidelines for Hematopoietic Growth Factors recommend evaluation and treatment of anemia in patients with cancer. However, a paucity of data exists regarding compliance with these recommendations. Methods: A retrospective cohort study was performed of patients diagnosed with any solid tumor at Vanderbilt University Medical Center from 2008 to 2017. Tumor registry–confirmed cancer cases were identified by ICD-O codes using the Synthetic Derivative database. Anemia was defined as hemoglobin (Hgb) level ≤11 g/dL and graded according to CTCAE version 5.0. Absolute, functional, and possible functional iron deficiency were defined based on NCCN Guidelines. Results: A total of 25,018 patients met inclusion criteria. Median age was 60 years. The most common malignancies were respiratory tract, prostate, and nonprostate urologic (11% each). Among 8,695 patients with Hgb levels available prior to diagnosis, 1,484 (17%) were noted to be anemic proximal to diagnosis. Of the 25,018 patients, 11,019 (44%) were anemic within 6 months of diagnosis. Of these patients, 4,686 (43%) had grade 2 (moderate) anemia and 9,623 (87%) had normocytic anemia. Patients with retroperitoneal/peritoneal cancers had the highest prevalence of anemia (83/110; 75%). A total of 4,125 (37%) underwent any evaluation of their anemia, of whom 1,742 (16%) had iron studies performed and 1,528 (14%) had vitamin B12 or folate studies performed. Fewer than half of patients with anemia received treatment (n=4,318; 39%), including blood transfusion (n=3,528; 32%), oral iron supplementation (n=1,279; 12%), or intravenous iron supplementation (n=97; 1%). Anemia treatment was significantly more frequent as the grade of anemia increased (any treatment among grade 1/mild: 12%; grade 2/moderate: 31%; grade 3/severe: 77%; χ2 [2, n=11,019]=3,020.6; P<.001). Patients with penile and testicular cancers had the highest prevalence of anemia evaluation (n=57; 79%). Conclusions: Anemia is common in patients with solid tumors; yet, compliance with NCCN Guidelines for evaluation and treatment of anemia remains low. There are opportunities to improve compliance with guidelines across the spectrum of cancer care.

Publisher

Harborside Press, LLC

Reference19 articles.

1. Prevalence and outcomes of anemia in cancer: a systematic review of the literature;Knight K,2004

2. Cancer-related anemia: pathogenesis, prevalence and treatment;Birgegård G,2005

3. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review;Caro JJ,2001

4. NCCN Clinical Practice Guidelines in Oncology: Hematopoietic Growth Factors;Becker PS

5. Diagnosis and treatment of cancer-related anemia;Gilreath JA,2014

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