Symptom burdens related to chemotherapy-induced anemia in stage IV cancer

Abstract

Background Chemotherapy-induced anemia (CIA) is associated with many symptoms that negatively impact quality of life. However, a systematic examination of symptoms in patients with CIA is lacking. Objective To describe the occurrence of a comprehensive list of symptoms in patients with stage IV malignancies by CIA status. Methods Patients diagnosed with stage IV non-Hodgkin lymphoma, breast, and lung cancer at Kaiser Permanente Southern California (2010-2012) were eligible. CIA was defined as hemoglobin <10 g/dL after the initiation of chemotherapy. Standardized record review evaluated the occurrence of symptoms for all patients who developed CIA (n = 402), and a random sample of patients who did not develop CIA (n = 98). The prevalence of each symptom and the distribution of number of symptoms per patient were described overall and by anemia grade. Results Mean number of symptoms during chemotherapy for patients who did and did not develop CIA was 6.8 and 4.1, respectively (P < .01). Fatigue (90%), dyspnea or shortness of breath (58%), nausea or vomiting (56%), and loss of appetite (56%) were documented in >50% of patients who developed CIA, whereas only fatigue (77%) was noted in >50% patients without CIA. Several symptoms, including depression, diarrhea, dizziness or lightheadedness, and dyspnea, particularly demonstrated a clearly increasing prevalence with declining hemoglobin level. The mean number of symptoms per patient increased as CIA grade increased (3.6 symptoms for grade 2, and 5.4 symptoms for grades 3 and 4, respectively). Limitations No causal relationship was examined due to descriptive design. Conclusions High-grade CIA correlates with an increased symptom burden in patients with stage IV malignancies.