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CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(02): 093-099
DOI: 10.1055/s-0043-1771445
Original Article

Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries

Purvish Mahendra Parikh 
1   Department of Clinical Hematology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
,
Shyam Aggarwal
2   Department of Medical Oncology, Sir Gangaram Hospital, New Delhi, India
,
Ghanashyam Biswas
3   Department of Medical Oncology, Sparsh Hospitals and Critical Care Private Ltd., Bhubaneswar, Odisha, India
,
Seema Gulia
4   Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
,
Vivek Agarwala
5   Department of Medical Oncology, Narayana Superspeciality Hospital and Cancer Institute, Kolkata, West Bengal, India
,
Maheboob Basade
6   Department of Medical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
,
P.N. Mohapatra
7   Department of Medical Oncology, Apollo Cancer Center, Kolkata, West Bengal, India
,
Krishna Muddu Vamshi
8   Department of Medical Oncology, AIG Hospital, Hyderabad, Telangana, India
,
Arun Warrier
9   Department of Medical Oncology, Aster Medicity, Cochin, Kerala, India
,
Krishna Prasad 
10   Department of Medical Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
,
Partha Roy
11   Department of Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India
,
M.V. Chandrakant
12   Department of Medical Oncology, Narayana Hospital, Howrah, West Bengal, India
,
Hemant Malhotra 
13   Department of Medical Oncology, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
,
Sachin Hingmire 
14   Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
,
Davinder Paul
15   Department of Medical Oncology, Fortis Hospital, Ludhiana, Punjab, India
,
Vashista Maniar
16   Department of Medical Oncology, Mumbai Oncocare Center, Mumbai, Maharashtra, India
,
Alok Gupta
17   Department of Medical Oncology, Medanta Hospital, Lucknow, Uttar Pradesh, India
,
Soumya S. Panda
18   Department of Medical Oncology, The Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India
,
Aseem Samar
19   Department of Medical Oncology, Bhagwan Mahavir Cancer Hospital & Research Center, Jaipur, Rajasthan, India
,
Nitesh Rohatgi
20   Department of Medical Oncology, Fortis Cancer Institute, Delhi, India
,
Satya Dattatreya
21   Department of Medical Oncology, Renova Soumya Hospital, Secundarabad, Telangana, India
,
Manjunath Krishnamurthy
4   Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra, India
,
Raja Thirumalairaj
22   Department of Medical Oncology, Apollo Cancer Center, Chennai, Tamil Nadu, India
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Abstract

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Purvish M. Parikh

Cancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.

Keywords

iron deficiency - ferric carboxymaltose - erythropoietin - quality of life - well-being


Publication History

Article published online:
15 September 2023

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