Managing anemia in the cancer patient: old problems, future solutions

Anemia and associated symptoms commonly manifest in cancer patients and may have a considerable impact on outcomes. Preliminary studies suggest that overall survival and locoregional control following radiation therapy may be compromised by anemia, and recent preliminary data also suggest that anemia may be related to poorer outcomes following chemotherapy. Health-related quality of life of cancer patients is also significantly reduced by anemia. Treatment of anemia with recombinant human erythropoietin can improve these health-related quality-of-life outcomes. However, despite this knowledge, anemia remains under-recognized and under-treated in the cancer patient population. A number of issues may be determinants of this suboptimal management of anemia. These include limitations of current therapies for anemia, varying practice strategies, and the lack of guidelines on how to treat anemia. Additionally, clinicians may underestimate the importance of health-related quality of life for their patients. It is vital that these issues are addressed, which, together with the development of novel erythropoietic agents, a review of the guidelines for anemia management, and consideration of further outcomes such as survival and cognitive function, may help to ensure that the cancer patient receives the best possible course of supportive care.