Significant advances in the treatment of patients with
cancer have occurred over the last decade, as evidenced
by steadily improving cure rates and extended durations
of survival. There is often a critical trade-off, however,
because more intense cytotoxic regimens may result in
increased adverse events, including an increased risk for
anemia . Many clinicians view anemia as an expected
part of cancer treatment that needs to be dealt with when
the anemia becomes severe and the patient experiences
clinically significant sequelae such as tachycardia or dyspnea.
Unfortunately, the anemic patient can experience
significant problems long before these signs and symptoms
emerge. Anemia, even mild anemia (hemoglobin
[Hb] 10–12 g/dl) can result in fatigue and exhaustion that
seriously impairs a patient’s quality of life (QOL) [2–4].
Achieving the best balance between therapeutic efficacy,
acceptable toxicity, and maximum QOL has become an
important priority in the management of patients with
cancer, with increased focus on effective anemia management
in cancer patients.
This supplement to Oncology summarizes the data and
discussions from the Third International Educational
Symposium on Advances in Cancer Anemia Management,
‘Optimizing Hemoglobin Levels and Beyond:
Strength for Living and Meaningful Survival?’ Internationally
recognized specialists, scientists, and cancer survivors
gathered in Vienna, Austria, in March 2003 for this
interactive symposium that focused on the impact of cancer-
related anemia on patient QOL and clinical outcomes.
New developments in chemotherapy regimens for various
malignancies were also presented and discussed.
As noted in this supplement, many factors can contribute
to the development of anemia in cancer patients
including tumor-associated bleeding, hemolysis, nutritional
deficiencies, marrow damage from metastases,
and chemotherapy- or radiotherapy-associated toxicities
. Anemia is frequently the result of complex interactions
between tumor cells and the immune system, resulting
in over-expression of certain inflammatory cytokines,
leading to shortened survival of red blood cells,
suppression of erythroid progenitor cells, impaired iron
utilization, and inadequate endogenous erythropoietin
production. Indeed, cancer-related anemia can be characterized
as a cytokine-mediated disorder of erythropoiesis.