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According to results published in the journal Cancer, low levels of hemoglobin during treatment may affect long-term outcomes in patients with nasohparyngeal cancer undergoing chemotherapy and radiation therapy.

Nasopharyngeal cancer is a type of head and neck cancer. It originates in the nasal passages and/or the top part of the throat. Patients with advanced nasopharyngeal (NPC) cancer are often treated with a combination of chemotherapy and/or radiation with different treatment schedules. Researchers have been evaluating different patient and disease characteristics and their effects on treatment outcomes in patients with cancer, including anemia.

Anemia is a term that refers to low levels of circulating red blood cells (RBCs) in the blood. 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 that is responsible for the delivery of oxygen to the cells and carbon dioxide to the lungs.Common symptoms caused by anemia include severe fatigue, shortness of breath, greatly diminished activity levels and a reduced overall feeling of well-being. Severe anemia often necessitates blood transfusions, which have associated risks of infection, rejection and increased medical costs. Anemia may also cause a delay in the dose of optimal cancer treatment. Researchers have recently been evaluating the effects of anemia on treatment outcomes, as some data indicates that patients with anemia may be less responsive to treatment.

Researchers from Hong Kong recently conducted a clinical trial to evaluate hemoglobin (Hb) levels on long-term outcomes in patients with advanced NPC. This trial included 286 patients who had been treated with chemotherapy first followed by radiation therapy. Patients had their Hb levels taken prior to treatment, after chemotherapy and prior to radiation therapy, as well as in the middle of their radiation treatment. With several other variables taken into account, data indicated that patients with low levels of Hb either prior to any treatment, or prior to radiation therapy following chemotherapy did not have significant differences in outcomes compared to patients with normal Hb levels at those points. However, patients with lower Hb levels during the middle of radiation therapy had significantly lower 5-year local recurrence-free survival (60% vs.80%, respectively) and had a signficantly higher rate of death from cancer at 5 years (49% vs. 32%, respectively).

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The researchers concluded that patients with advanced NPC undergoing chemotherapy followed by radiation therapy had a higher death rate from cancer at 5 years if their Hb levels were low during radiation, compared to those with a normal Hb level. Proper maintenance of anemia during treatment, including the use of agents such as Aranesp®, may ultimately provide patients with advanced NPC improved survival. Future clinical trials further evaluating anemia and its effects on long-term outcomes are necessary to provide data on the true clinical benefit of maintaining Hb levels during treatment for patients with NPC.

Reference: Chua D, Sham J, Choy D, et al. Prognostic impact of hemoglobin levels on treatment outcome in patients with nasopharyngeal carcinoma treated with sequential chemoradiotherapy or radiotherapy alone. Cancer. 2004; 101:307-316.

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