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Table of Contents
LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  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 Submission08-Feb-2021
Date of Decision22-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Avinash Pandey
5D, Department of Medical Oncology, All India Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_34_21

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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

How to cite this URL:
Pandey A. Authors' reply to Gour et al., Majumdar et al., and Goswami. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 22];4:167-8. Available from: https://www.crstonline.com/text.asp?2021/4/1/167/312085



We are very grateful to Gour and Chawla,[1] Majumdar and Shet,[2] and Goswami[3] 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.”[4] 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.[5] 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.[1] 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,[2] there was a considerable overlap between iron deficiency, vitamin B12 deficiency, and inflammatory anemia in our study [Figure 3, Venn Diagram].[4] 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[3] 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.[6] 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.[7],[8] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gour N, Chawla S. Prevalence of anemia among patients with cancer: A complex phenomenon. Cancer Res Stat Treat 2021;4:166-7.  Back to cited text no. 1
  [Full text]  
2.
Majumdar S, Shet AS. Cancer-related anemia in Northeast India: Many questions and few answers. Cancer Res Stat Treat 2021;4:163-4.  Back to cited text no. 2
  [Full text]  
3.
Goswami B. Anemia in treatment-naive patients with cancer. Cancer Res Stat Treat 2021;4:164-5.  Back to cited text no. 3
  [Full text]  
4.
Pandey A, Aryan R, Krishna M, Singh S, Pankaj P. Prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia in treatmentnaive patients with cancer: A cross-sectional study. Cancer Res Stat Treat 2020;3:708-15.  Back to cited text no. 4
  [Full text]  
5.
Welch VA, Ghogomu E, Hossain A, Riddle A, Gaffey M, Arora P, et al. Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta-analysis. Campbell Syst Rev 2019;15:e1058.  Back to cited text no. 5
    
6.
Pandey A, Raj S, Madhawi R, Devi S, Singh RK. Cancer trends in Eastern India: Retrospective hospital-based cancer registry data analysis. South Asian J Cancer 2019;8:215-7.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Dolai TK, Dutta S, Bhattacharyya M, Ghosh MK. Prevalence of hemoglobinopathies in rural Bengal, India. Hemoglobin 2012;36:57-63.  Back to cited text no. 7
    
8.
Patel AP, Naik MR, Shah NM, Sharma NP, Parmar PH. Prevalence of common hemoglobinopathies in Gujarat: An analysis of a large population screening program. Natl J Community Med 2012;3:112-7.  Back to cited text no. 8
    




 

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