Study of frequency and causes of anemia in cancer pati̇ents

ABSTRACT Introduction: Anemia is a hematologic clinical presentation that is frequently observed among cancer patients. The effects of the anemia on all systemic functions, emotional and cognitive functions and its negative effects on the life quality and survival of the patients are established. The etiology of anemia in cancer patients is explained via multifactorial reasons that consist of anemia secondary to cancer, systemic chemotherapy (CT), radiotherapy (RT) and the coexistence of chronic diseases. Determining the frequency and the causes of the anemia that accompanies cancer presentation, which includes various symptoms ranging from mild weakness to restricting daily activities, is important to increase the patient's life quality and survival and to determine the treatment management of the anemia. Tools and Method: The study includes 312 patients over the age of 18, who was admitted to the Oncology Clinic of Düzce University between January 2014 and June 2015. We have created data that includes demographic features, chronic illnesses, cancer types, stages, CT and RT for cancer, hematologic and biochemical tests for the etiology of anemia retrospectively in our study. Patients under the age of eighteen and patients with lack of information, such as clinic, laboratory and imaging, were excluded from the study. Patients who have an Hgb value of <12gr/dl were considered as anemic. Their initial Hgb values and their latest outpatient clinic admittance Hgb values over their treatment processes were recorded. For the etiology of anemia, hemogram parameters, serum iron, ferritin, total iron binding capacity (TIBC), mean corpuscular volume (MCV), transferrin saturation (TS) and B12 were evaluated. For the statistical level of significance, 0,05 was taken, p<0,05 was accepted statistically significant and SPSS (ver. PASW 18) program was used for the calculations. Findings: In our study that we have carried out with 312 patients who have cancer with solid tumor, the rate of incidence of anemia was determined as 38,8% (n=115). Mean Hgb level of cancer patients with anemia was 10,6 gr/dl and the presentations with mild anemia (Hgb 10-12gr/dl) was the majority. While the median age of cancer patients with anemia was 65 and found significantly higher than non-anemic patients, mean age of patients with moderate and deep anemia (Hgb<10gr/dl) was found significantly higher than the patients with mild anemia (p=0,002, v p=0,001). Among the presentations with anemia, the rate of metastatis and CT treatment at the point of diagnosis were significantly higher than the presentations without anemia (p=0,04, p=0,006, p=0,01). In the CT treatment process, the frequency of anemia with genitourinary cancers (bladder and gynecologic cancers) that are treated with platinum-containing CT was found significantly higher (p=0,005). While anemia of chronic disease was more frequently observed (n=65) in the screening of the etiology of the anemia, iron deficiency anemia, B12 deficiency and anemia related to renal disease were also observed. The rate of incidence of iron deficiency was found significantly higher in the patients with the diagnosis of breast cancer (p=0,006). Result: In our study, which mentions about analysis of incidence and causes of anemia in cancer patients during the diagnosis and treatment process, we presented that at the time of diagnosis the age and metastatic status and during the treatment process cancer type and receiving chemotherapy significantly affects the anemia in patients. According to our findings we believe that there may be differences in the incidence of anemia in cancer patients. As the result of our study of the etiology of anemia, while the anemia of chronic disease was the most frequent among all cancer patients in their treatment processes, iron deficiency anemia was more frequent in breast and gastrointestinal cancer patients than the patients with genitourinary and lung malignities. For the prevention of the development of anemia and its management, instead of the anemia evaluation only based on Hgb levels, we recommend the examination of etiology-based tests in more detail because of the negative effects of iron deficiency on the cancer patients. KEY WORDS: Anemia, cancer, prevelance, anemia etiology, chemotherapy, iron deficiency