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According to an article published in the journal Acta Oncologica, women with lower hemoglobin levels (anemia) during chemotherapy for breast cancer have shorter survival times than women with higher hemoglobin levels.

Anemia is a condition where circulating red blood cells (RBCs) fall below normal levels. Red blood cells are responsible for delivering oxygen to tissues throughout the entire body. Bone marrow (spongy material inside large bones) is stimulated to produce RBCs by a chemical substance called erythropoietin, which is secreted by the kidneys. Each RBC contains many molecules of hemoglobin, a protein-iron complex responsible for delivering oxygen to the cells and carbon dioxide to the lungs.

Common symptoms of anemia include severe fatigue, shortness of breath, greatly diminished activity levels, and a reduced overall feeling of well-being. Severe anemia often requires blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may diminish chances of a cure or optimal long-term survival when its side effects cause a delay in the dose of cancer treatment. Anemia may be caused by treatment for cancer or by the disease itself.

Erythropoietin can be manufactured outside the body and administered to patients. Recombinant human erythropoietin, or epoetin alfa, is comprised of manufactured erythropoietin and is commonly used for cancer patients receiving treatment. Epoetin alfa has been shown to reduce the severity of anemia and reduce symptoms of fatigue by stimulating the bone marrow to produce more RBCs. The two forms of epoetin alfa most often utilized for the treatment of anemia in the United States are Aranesp® (darbepoetin alfa) and Procrit® (epoetin alfa). Aranesp, which requires less frequent dosing than Procrit, has been approved by the FDA for the treatment of anemia caused by chemotherapy in non-myeloid cancers (cancers that do not originate in blood cells).

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In the current study, researchers evaluated hemoglobin levels and their possible association to patient outcomes before surgery, before chemotherapy, and during chemotherapy among 129 women with breast cancer. Hemoglobin levels before surgery and before chemotherapy were not associated with subsequent survival. However, low levels of hemoglobin during chemotherapy were associated with shorter survival times.

The researchers conclude that anemia during chemotherapy may be associated with shorter survival among women with breast cancer. They note that clinical trials to evaluate the effect of treating anemia during chemotherapy would provide valuable information. Patients with breast cancer may wish to speak with their physician regarding the risks and benefits of treatment with an agent such as Aranesp to maintain hemoglobin levels during treatment or the participation in a clinical trial further evaluating the effects of anemia on treatment outcomes. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( and

Reference: Peters-Engl C, Cassik P, Schmidt I et al. Impact of haemoglobin levels during adjuvant chemotherapy on the survival of patients with primary breast cancer. Acta Oncologica. 2005;44:129-133.

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