Usage of Patient-Centered Outcomes in the Management of Anemia: A Systematic Review

Background: Patient-centered outcomes (PCOs) evaluate the physical, social, and psychological impact of disease on patient wellbeing. Patient-centred tools are critical for improving physician-patient communication, managing chronic disease, and optimizing novel therapies. Anemia is a diagnosis that affects all ages, sexes, and ethnicities, and is a frequent consequence of both acute and chronic conditions. Treatments for anemia, including iron supplementation, erythropoietin-stimulating agents, and blood transfusion may be associated with improvements in hematological parameters, but the impact of treatments for anemia on quality of life remains poorly understood.Objective: To critically assess published studies that have measured PCOs to investigate the effects of anemia management on quality of life and patient wellbeing.Methods: We searched PUBMED, EMBASE, PsychInfo, and CINAHL for relevant studies published from 1980 to January 2017. Eligibility criteria included full-text observational studies, case series (N >10), and randomized-controlled trials (RCTs) published in English. We included studies with anemic patients undergoing any intervention for treatment of anemia that reported hemoglobin levels and PCOs before and after anemia intervention. Risk of bias was assessed in interventional and observational cohort studies using the Cochrane Risk of Bias Tool and Newcastle Ottawa Scale, respectively. Study methodological and patient characteristics, PCOs, and additional outcomes will be qualitatively synthesized, and meta-analysis will be performed for PCOs. Subgroup analysis will be performed by disease category, and by type of intervention for anemia. The efficacy of PCO tools will be assessed, and this analysis will be performed separately for studies where the anemia intervention improved hemoglobin levels versus studies where hemoglobin levels did not increase following treatment. Finally, the prevalence of individual PCO tool use will be reported, both overall and for each disease category. The PROSPERO registration number for this systematic review is CRD42017056290.Results: Of the 2230 articles found during database and reference list searching, 406 were read in full text and 111 met all inclusion criteria. Preliminary analysis found that 45.9% (51/111) eligible articles pertained to anemia in oncology, 8.1% (9/111) to malignant hematological disorders, 15.3% (17/111) to benign hematological disorders, 12.6% (14/111) to anemia in renal disease, 4.5% (5/111) to anemia in cardiovascular disease, 3.6% (4/111) to anemia in gastrointestinal disease, and 9.9% (11/111) to other anemia diagnoses. Furthermore, 53.2% (59/111) articles utilized more than one PCO tool to assess quality of life. While the majority of studies used various combinations of PCO tools, we found that 20.7% (23/111) incorporated the Short Form Health Survey (SF-36) tool, 52.3% (58/111) incorporated the Functional Assessment of Cancer Therapy (FACT-G) tool or a FACT subscale tool (i.e. FACT-Anemia and/or FACT-Fatigue), 32.4% (36/111) incorporated the Linear Analog Self-Assessment (LASA) tool, and 5.4% (6/111) incorporated the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQC30) tool. Final descriptive analysis, meta-analysis, and disease-specific subgroup analysis results are forthcoming.Conclusions: From our preliminary results, oncology studies comprised over half of all included studies. The most commonly utilized PCO tool was the FACT tool or a FACT tool subscale. Further analyses will focus on the efficacy of these PCO tools in evaluating quality of life based on type of anemia intervention and disease category.