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LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 163-164

Cancer-related anemia in Northeast India: Many questions and few answers


1 Department of Medical Oncology, Kasturba Medical College, Manipal, Karnataka, India
2 Laboratory of Sickle Thrombosis and Vascular Biology, Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA

Date of Submission22-Jan-2021
Date of Decision31-Jan-2021
Date of Acceptance01-Feb-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Arun S Shet
National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 6S241, 10, Center Drive, Bethesda, Maryland 20892
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_13_21

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How to cite this article:
Majumdar S, Shet AS. Cancer-related anemia in Northeast India: Many questions and few answers. Cancer Res Stat Treat 2021;4:163-4

How to cite this URL:
Majumdar S, Shet AS. Cancer-related anemia in Northeast India: Many questions and few answers. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:163-4. Available from: https://www.crstonline.com/text.asp?2021/4/1/163/312061



Cancer-related anemia (CRA) is the most common paraneoplastic syndrome, particularly anemia consequent to inflammation. CRA is widely prevalent, adversely affects the quality of life, and is associated with lower overall survival.[1],[2],[3] Thus, it is quite remarkable that the epidemiology of CRA is not well characterized and that less than half of the patients with this diagnosis receive specific anemia-directed therapy. From this perspective, the study by Pandey et al. on the prevalence of anemia in treatment-naïve patients with cancer in northern India is highly appreciated.[4]

Employing a cross-sectional design, Pandey et al. studied 311 consecutive, treatment-naïve patients with newly diagnosed malignancies presenting to an academic medical center in the state of Bihar, India. The associated laboratory factors (serum iron, ferritin, transferrin saturation, and vitamin B12) were measured in this population and interpreted as contributory to the observed low hemoglobin level. About 30% of individuals screened for the study were ineligible for a variety of reasons. The most common malignancies diagnosed were gastrointestinal (GI) (22%), followed by breast (19%) and hematolymphoid (19%). Most patients (78%) were diagnosed with advanced stage cancer (Stage III/IV). Anemia prevalence is influenced by the standard used to define anemia which can vary according to context and geographical region.[5] Anemia in this study was attributed to a deficiency of iron in 71% of the cases and to inflammation in 32% of cases. In addition, a substantial proportion of anemic patients (47%) were found to be vitamin B12 deficient. These results are challenging to interpret given the somewhat similar prevalence of vitamin B12 deficiency in non-anemic patients with cancer (38%).

How do the results from this single-center, observational study from Northeast India compare with reports from this region and the rest of the world? Although the data are limited and the specific incidence of anemia varies with the type and stage of the tumor and age of the patient, about 40%–50% of the patients are reported to have CRA at diagnosis and increases by approximately 40% following chemotherapy.[3],[6] Anemia prevalence in the study by Pandey et al. is notably higher when compared to similar studies performed in India and other adequately resourced countries.[1],[3] Further, the lower threshold used to define anemia (<11 g/dl in adults) in this study suggests an even greater undetected anemia case burden.[7] It is possible that the predominance of GI malignancies and advanced cancer stage may have contributed. While the study is relatively unique in attempting to identify the etiology of anemia in treatment-naïve patients with cancer, several questions remain unanswered. Key among these are the following: (i) what is the relative contribution of nutritional and inflammatory anemia in newly diagnosed patients with cancer using a more widely accepted definition of anemia,[5] (ii) what explains the high prevalence of vitamin B12 deficiency as reflected by low serum cyanocobalamin level, and (iii) what effect does parenteral treatment of nutritional anemia have on symptoms and life expectancy? While there are recognized limitations associated with conducting clinical research in such settings, the authors appear to have missed an opportunity that future studies should seek to capitalize on.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kanuri G, Sawhney R, Varghese J, Britto M, Shet A. Iron deficiency anemia coexists with cancer related anemia and adversely impacts quality of life. PLoS One 2016;11:e0163817.  Back to cited text no. 1
    
2.
Ludwig H, Van Belle S, Barrett-Lee P, Birgegård G, Bokemeyer C, Gascón P, et al. The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 2004;40:2293-306.  Back to cited text no. 2
    
3.
Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: A systematic review of the literature. Am J Med 2004;116 Suppl 7A:11S-26S.  Back to cited text no. 3
    
4.
Pandey A, Raj A, Krishna M, Singh S, Pankaj P. Prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia in treatment-naive patients with cancer: A cross-sectional study. Cancer Res Stat Treat 2020;3:708-15.  Back to cited text no. 4
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5.
Pasricha SR, Colman K, Centeno-Tablante E, Garcia-Casal MN, Peña-Rosas JP. Revisiting WHO haemoglobin thresholds to define anaemia in clinical medicine and public health. Lancet Haematol 2018;5:e60-e62.  Back to cited text no. 5
    
6.
Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: Incidence and treatment. J Natl Cancer Inst 1999;91:1616-34.  Back to cited text no. 6
    
7.
Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet 2011;378:2123-35.  Back to cited text no. 7
    




 

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