Pre-treatment anemia in head and neck cancer: risk factors, subtypes, and survival outcomes

Anemia in head and neck cancer (HNC) may be due to additive, overlapping or competing causes. Here we aim to investigate the prevalence of pre-therapeutic anemia, associated risk factors, subtypes, and impact on survival among HNC patients, including the clinically relevant subgroups of HPV-associated HNC.

A retrospective chart review of HNC patients diagnosed between 2010 and 2020 identified a study cohort of 921 patients. Every patient was subject to pre-therapeutic laboratory testing which was correlated with clinical data and oncologic outcomes.

Pre-therapeutic anemia was present in 18.1% of patients with advanced age, low BMI, systemic inflammation, and kidney dysfunction being significant risk factors for anemia. For oropharyngeal cancers, p16+ status was associated with lower anemia prevalence and offset the impact of smoking history on anemia risk when compared to all HNC patients. 19.2% of patients were hypochromic-microcytic and 4.2% were hyperchromic-macrocytic, indicative of iron or vitamin B12/folate deficiency, respectively. Even mild anemia (11- 12.9 g/d) was associated with a survival disadvantage compared to non-anemic patients (64% vs. 85% overall survival, <0.001).

Anemia is a significant negative survival predictor in HNC patients, with severity affecting prognosis. A relevant subgroup of patients had potentially reversible anemia subtypes, early identification and treatment of which may improve outcomes.