Clinical Significance of Symptom Burden and Quality of Life Decrement in Cancer Patients with Mild Anemia.

Background. Cancer related anemia (CRA) is associated with increased symptom burden and reduced quality of life (QoL) compared to non-anemic subjects. Standard treatment guidelines for CRA recomend treatment when hemoglobin (Hb) declines to ≤ 10 g/dl. We compared patients with mild anemia to those with normal Hb level to assess clinical significance of mild anemia. Methods. 3416 patients from a large community oncology database sorted by gender and Hb were retrospectively reviewed.

Patients receiving chemotherapy (<30 days) and/or growth factor (< 60 days) were excluded. Each case provided one Hb determination and same day self reported scores on the Cancer Care Monitor (CCM), a validated measure of symptom burden, functioning, and health related QoL comprising 6 scales. All CCM items are rated for symptom severity on a 0–10 scale. Effect sizes for male groups are calculated relative to normal males (Hb > 14), and effect sizes for females are calculated relative to normal females (Hb > 12). Positive effect size (Cohen’s exact d) values indicate greater symptom burden, and negative effect size values indicate lower quality of life.

Results. Group differences on CCM measures were not accounted for by demographic, cancer diagnosis, and chemotherapy history differences. Table 1 shows a pattern of greater symptom burden, lower functioning, and worse QOL for males and females with mild anemia (p < .05). As compared to standards for minimal clinically important differences such as found with SF-36 (0.09 < Cohen’s d < 0.28). patients with mild anemia showed clinically significant differences in terms of effect size (0.11 < Cohen’s d < 0.61).

Conclusions. The QoL impact of mild CRA is significant and failure to treat mild anemia may result in unnecessary symptom burden and noteworthy decrements in health related quality of life.

Differences in QoL for Patients with Mild Anemia