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Role of erythropoiesis-stimulating agents in the treatment of anemia in patients with cancer

Stanley L Schrier, MD
David P Steensma, MD
Charles L Loprinzi, MD
Section Editor
Reed E Drews, MD
Deputy Editor
Diane MF Savarese, MD


Anemia is a common complication in patients with malignancy. Anemia can impair the patient's functional status, diminish physiologic reserve, and cause fatigue that can be disabling. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment" and "Cancer-related fatigue: Treatment" and "Hematologic complications of malignancy: Anemia and bleeding", section on 'WHO grading of anemia'.)

In addition to causing symptoms, the presence of anemia has been linked to an adverse prognosis in several malignancies. This has been attributed in part to a poorer response to anticancer treatment, since ionizing radiation and some forms of chemotherapy are dependent upon adequate tissue oxygen levels for cytotoxicity. These observations were used in the past to provide rationale for aggressively treating anemia in patients receiving cancer therapy. Anemia may also be a marker of more severe disease, however, independent of response to therapy.

Multiple factors can cause or contribute to anemia in patients with malignancy. (See "Hematologic complications of malignancy: Anemia and bleeding".)

As can occur with other chronic inflammatory conditions, some cancer patients have an anemia that is a consequence of the disease and unrelated to treatment. This type of anemia is typically mild (ie, hemoglobin [HGB] level >10 g/dL), and the symptoms may be difficult to distinguish from those caused by the underlying malignancy. Occasionally, anemia may be more severe, impairing functional status, diminishing physiologic reserve, and reducing quality of life. (See "Anemia of chronic disease/inflammation".)

Anemia is often exacerbated by myelosuppressive cancer treatment, particularly in patients who are undergoing intensive chemotherapy or combined modality treatment with both chemotherapy and radiation therapy [1-5].

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Literature review current through: Nov 2017. | This topic last updated: Apr 27, 2017.
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