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68: Optimizing Hemoglobin Levels and Beyond: Strength for Living and Meaningful Survival

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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 [1]. 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 [4]. 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.
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