Management of Cancer-Related Anemia in Patients with Breast or Gynecologic Cancer: New Insights Based on Results from the European Cancer Anemia Survey

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Discuss the negative impact of anemia and its sequelae, particularly fatigue, in patients with breast or gynecologic cancer.Describe the results of the European Cancer Anemia Survey (ECAS), which defined the prevalence, incidence, and treatment of anemia in the European cancer community, identified anemia risk factors, and demonstrated that anemia is often suboptimally treated.Explain how the successful management of anemia is associated with patient well-being and improved overall quality of life. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com The incidence, prevalence, and treatment of anemia (hemoglobin [Hb] <12 g/dl) in women with breast cancer and gynecologic cancer were evaluated using data from the European Cancer Anemia Survey (ECAS). Adult patients with newly diagnosed treated or untreated disease, persistent/recurrent disease, and disease in remission were enrolled and followed for up to six chemotherapy cycles or six evaluation points within a 6-month period. At enrollment, 30.4% of breast cancer patients and 49.1% of gynecologic cancer patients were anemic. A significant correlation was shown between low Hb level and poor performance status (World Health Organization criteria) at enrollment for both breast cancer and gynecologic cancer patients. In all, 62.4% of breast cancer patients and 81.4% of gynecologic cancer patients were anemic at some time during the survey. The incidence of anemia, determined in a carefully defined population, was 59.8% for breast cancer patients and 74.8% for gynecologic cancer patients. Despite the high prevalence and incidence of anemia, only 26.3% and 42.7% of patients in the respective groups received anemia treatment. In breast cancer patients, the mean Hb trigger was 10 g/dl for epoetin treatment and 8.6 g/dl for transfusion; corresponding values for gynecologic cancer patients were 10.1 g/dl and 9.1 g/dl. Logistic regression analyses in the overall ECAS population identified five factors as significant and suitable predictors of anemia: lower initial Hb, having lung or gynecologic cancer versus gastrointestinal/colorectal cancer, any other cancer versus gastrointestinal/colorectal cancer, treatment with platinum chemotherapy, and being female. The ECAS data highlight the need for greater awareness of the adverse impact of anemia on cancer patients and for optimal anemia management to ensure maximal patient quality of life.