According to a recent article published in the International Journal of Radiation Oncology Biology Physics, patients with head and neck cancer who have anemia exhibit reduced anti-cancer responses to treatment with chemotherapy and radiation therapy.
Approximately 40,000 people in the United States are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancer, including the nasal cavity and sinuses, oral cavity, nasopharynx, oropharynx, and other sites located in the head and neck area. Standard treatment approaches for head and neck cancer include surgery, chemotherapy and/or radiation therapy.
Anemia is a condition characterized by low levels of red blood cells and/or hemoglobin. Red blood cells are blood cells that start as immature cells in the bone marrow (spongy material inside bones) and ultimately become mature cells in circulating blood. Red blood cells contain a substance called hemoglobin that is responsible for carrying oxygen to all tissues in the body. Anemia can be a result of a chronic disease, such as cancer, or a side effect of treatment, such as chemotherapy and/or radiation. Anemia may significantly decrease the quality of life of a patient, with common symptoms including severe fatigue, shortness of breath, diminished activity level, reduced overall feeling of well-being, and possible mental dysfunction. Anemia may also exacerbate existing medical conditions. Furthermore, if anemia becomes severe, treatment may be delayed or doses reduced, possibly compromising optimal outcomes for the patient. Some recent research has also indicated that anemia may reduce the anti-cancer effects of radiation and/or some chemotherapy agents in some types of cancer, and the effect of anemia on a patient’s overall survival is still being evaluated.
Researchers from Duke University recently analyzed data to better understand the effects of anemia on long-term outcomes in patients with head and neck cancer. The data included 159 patients with head and neck cancer who were treated with radiation therapy and the chemotherapy drug Platinol® (cisplatin). The outcomes of patients with anemia (hemoglobin 13.0 g/dL and below) were compared with the outcomes of patients who did not have anemia (hemoglobin 13.0 g/dL or above). Overall, at 5 years, 75% patients who were not anemic (higher hemoglobin levels) were free from cancer progression compare to 50% for patients with anemia (lower hemoglobin levels). However, a variable that makes these results difficult to interpret with certainty is that the patients with anemia appeared to have, on average, more extensive disease at the time of treatment.
The authors concluded that anemia is associated with poorer outcomes for patients with head and neck cancer who are treated with chemotherapy and radiation therapy. However, future trials evaluating the correction of anemia with agents such as Procrit® or Aranesp® and its effects on outcomes is necessary to help understand the correlation between anemia and long-term outcomes in this group of patients.
Reference: Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. International Journal of Radiation Oncology Biology Physics. 2005;61:1087-1095.