|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 167-168
Authors' reply to Gour et al., Majumdar et al., and Goswami
Department of Medical Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
|Date of Submission||08-Feb-2021|
|Date of Decision||22-Feb-2021|
|Date of Acceptance||02-Mar-2021|
|Date of Web Publication||26-Mar-2021|
5D, Department of Medical Oncology, All India Institute of Medical Sciences, Patna, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pandey A. Authors' reply to Gour et al., Majumdar et al., and Goswami. Cancer Res Stat Treat 2021;4:167-8
We are very grateful to Gour and Chawla, Majumdar and Shet, and Goswami for their comments on our article titled, “Prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia in treatment-naive patients with cancer: A cross-sectional study.” Gour et al. have highlighted the lack of information regarding any deworming therapy received by our patients before or after the diagnosis of cancer as one of the limitations of our study. To the best of our knowledge, a widespread, population-based deworming strategy regardless of the age, diagnosis, and geography is not a universally accepted paradigm. It is predominantly performed in schoolgoing children in helminth-endemic regions where mass-scale deworming is more cost-effective than investigating the cause of anemia. The role of deworming as a prophylactic strategy to combat anemia in patients with cancer remains unexplored, and hence, is not the accepted standard of care. We agree that patients with cancer-related anemia if found to be deficient in iron or vitamin B12 should be adequately replenished, but we disagree with Gour et al. about the need for universal screening for anemia, as it has not yet been shown to improve the patient outcomes in any major prospective study. As correctly pointed out by Majumdar and Shet, there was a considerable overlap between iron deficiency, vitamin B12 deficiency, and inflammatory anemia in our study [Figure 3, Venn Diagram]. Hence, it was not feasible to identify which nutritional deficiency or inflammation was the predominant cause of anemia among patients with a mix of both. As we used a cross-sectional study design, the exact cause of the high prevalence of vitamin B12 deficiency could not be determined, and more so because of the lack of dietary information in our study. Regarding Goswami's comment on our use of the term “prevalence” being inappropriate, as a single hospital does not cater to a defined geography, we would like to clarify that our center is the only regional cancer center in the state of Bihar, India, and caters to patients from several districts. Hence, we believe that our study sample was representative of the general adult population with cancer from our state. Expect in case of an obvious hospital-related opportunistic sampling bias, we prefer to use the term “prevalence” as it represents the study population well. As all our patients were aged more than 18 years, our cohort did not have patients with acute lymphoblastic leukemia, as it is predominantly a pediatric malignancy. Concurrent hemoglobinopathies may be associated with high ferritin and transferrin saturation levels, leading to false-positive results for inflammatory anemia. However, the prevalence of beta-thalassemia and sickle cell anemia in large population-based studies has been reported to be between 1% and 5%, with a higher prevalence among tribals., We did not perform any screening tests to rule out confounding hemoglobinopathies in our patients with cancer-related anemia. However, due to their very low prevalence in the healthy population, we believe that their effect on the overall prevalence of cancer-related anemia will be minimal.
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Conflicts of interest
There are no conflicts of interest.
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