Managing Cancer-Related Anemia
by Lori Smith, MSN, CRNP
Anemia is a common symptom experienced by people who are receiving chemotherapy or radiation treatment for cancer. It is a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume. There are a multitude of causes for anemia, including pre-existing or current conditions (such as active bleeding), hereditary conditions, renal insufficiency, nutritional deficits, chronic anemia, hemolysis (the abnormal breakdown of red blood cells), and malignancy.
Cancer treatment can also be a cause. Red blood cells grow and divide rapidly and, thus, can be affected by many chemotherapy and radiation regimens used to treat cancer, as these treatments kill rapidly dividing cells.
A protein within the red blood cells, known as hemoglobin, carries oxygen throughout the body. When hemoglobin levels decrease, the body has to work harder to meet its oxygen demands. This can cause varying levels of fatigue. Other signs and symptoms of anemia include dizziness, headaches, shortness of breath, heart palpitations or an increased heart rate, pale skin, and a feeling of being cold, especially in the hands and feet.
To diagnose anemia, your doctor may obtain a complete blood count to evaluate your hemoglobin and hematocrit levels, as well as your total red blood cell count and platelet count. Other lab tests may be ordered, depending on your medical history and treatment regimen. Additionally, your doctor may perform a physical exam to check your heart and lung status. This may include listening with a stethoscope to your heart and lungs, obtaining vital signs (such as heart rate, blood pressure, and respiratory rate), and conducting a pulse oximetry to monitor the oxygenation of your hemoglobin. The physical exam will also allow your doctor to check for other causes of anemia, such as disease progression, recurrence, or active bleeding.
Symptoms of anemia include dizziness, headaches, shortness of breath, heart palpitations, pale skin, and a feeling of being cold.
The treatment of anemia will depend on your current and pre-existing medical conditions, as well as the goal of the cancer treatment being given. Options include observation (“watch and wait”), blood transfusion with packed red blood cells, or taking erythropoiesis-stimulating agents. If you have any vitamin or mineral deficiencies, supplements may also be prescribed.
For cancer survivors with anemia but without symptoms, observation may be recommended. Survivors with symptomatic anemia (for example, those with shortness of breath or fatigue), or those with a high probability of developing symptoms, may undergo transfusion with packed red blood cells. The benefit of receiving a packed red blood cell transfusion is that there is a fast increase in hemoglobin and hematocrit levels. Thus, this is an option for those who need immediate treatment. The risks include transfusion-related complications, congestive heart failure, bacterial or viral infections, and iron overload.
Symptomatic anemia may also be treated with drugs called erythropoiesisstimulating agents, also known as ESAs. Examples of ESAs are epoetin alfa (Procrit, Epogen) and darbepoetin alfa (Aranesp). Although these drugs were used much more frequently in the past, cancer-care providers use them less frequently because of safety concerns, including risk of blood clots and possible tumor growth in some cancers. Talk to your healthcare provider to see if an ESA would be appropriate for you.
Anemia is a common problem faced by people undergoing cancer treatment. It is imperative that you communicate openly with your doctor in order to make an educated decision on how to manage your anemia. Once the risks and benefits of each treatment option are determined, a plan of care can be put into action and your anemia can be successfully managed.
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Lori Smith is a gynecologic oncology nurse practitioner for the Jordan Center for Gynecologic Cancers within the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, PA.
This article was originally published in Coping® with Cancer magazine, September/October 2010.