The International Agency for Research on Cancer of the World Health Organization has recently emphasized the escalating global burden of cancer. In 2022, there were 19.96 million new cases of cancer and 9.74 million deaths globally. Among them, tumor-related anemia has become one of the "drivers" exacerbating disease progression and seriously affecting patient prognosis.
"Anemia caused by chemotherapy is very common. In solid tumors, the incidence of chemotherapy-related anemia is about 89.5%, which significantly harms the quality of life for cancer patients," said Professor Ma Jun from the Harbin Institute of Hematology and Oncology Research in an interview with China Science Report.
Anemia undermines the effectiveness of chemotherapy
Tumor-related anemia refers to the anemia that occurs in cancer patients during disease progression or treatment, manifested by a decrease in the number of red blood cells per unit volume of peripheral blood, a decrease in hemoglobin concentration, or a decrease in hematocrit below normal levels. Chemotherapy-related anemia is one of the common types of tumor-related anemia.
"In the past, the treatment rate of chemotherapy-related anemia was very low, but now, we demand symptomatic treatment for chemotherapy-related anemia after diagnosis to ensure the quality of life for cancer patients," Ma Jun said. If anemia after chemotherapy in cancer patients is not treated, severe fatigue symptoms will occur, and some patients may even lose their ability to care for themselves. "The most critical issue is that the response rate of patients to subsequent chemotherapy will decrease. Because patients with hemoglobin levels below 8g/dL will have problems with their oxygen-carrying capacity, leading to a significant reduction in chemotherapy effectiveness."
So, how is anemia diagnosed? Ma Jun explained that clinically, the main reference is the hemoglobin concentration, red blood cell count, hematocrit, and red blood cell morphology in a complete blood count. Based on the hemoglobin index, anemia is classified into four levels: mild, moderate, severe, and extremely severe. Mild anemia is generally in the range of 10 to 12 g/dL, moderate anemia is in the range of 8 to 10 g/dL, and less than 8 g/dL is considered severe anemia. If the hemoglobin concentration is less than 2 g/dL, the patient is in a critically severe anemia condition.
"After determining the degree and type of anemia, other auxiliary examinations such as bone marrow examination and serum ferritin examination are needed to clarify the cause of anemia," Ma Jun pointed out. Due to the inadequate blood supply in China, drug treatment is mainly used for patients with mild to moderate anemia, while patients with severe anemia undergo combined treatment with blood transfusion and drugs.
Standardizing treatment is the biggest challenge
Although cancer is daunting, with the development of medical science and technological progress, most patients can achieve long-term survival. However, once anemia occurs and is not promptly and effectively treated, the survival period and cure rate of cancer patients will be affected. Therefore, Ma Jun emphasized the importance of paying attention to the complications of anemia caused by chemotherapy. If the hemoglobin level is ≤10g/dL, anemia treatment should be initiated promptly to help cancer patients improve their quality of life and achieve higher clinical cure rates.
"Our biggest challenge now is standardizing treatment," Ma Jun said. So far, the popularity of treatment for chemotherapy-related anemia is still insufficient. Data from a 2012 cross-sectional survey in China showed that the treatment rate of cancer-related anemia in China was only 7.16%. In addition, the current treatment methods for chemotherapy-related anemia are relatively limited, and there are still significant unmet needs among patients. Therefore, it is necessary to vigorously promote the standardized treatment of chemotherapy-related anemia, especially timely intervention with combined treatment for patients with moderate and severe chemotherapy-related anemia, to avoid adverse effects on their prognosis.
The main goal of the "Healthy China Action - Cancer Prevention and Control Action Plan (2023-2030)" is to further improve the cancer prevention and control system by 2030, significantly enhance the comprehensive control of risk factors, the capacity for cancer screening and early diagnosis and treatment, and steadily improve the standardization of diagnosis and treatment, thereby curbing the upward trend in cancer incidence and mortality rates, and achieving an overall 5-year cancer survival rate of 46.6%, effectively controlling the disease burden of patients.
"According to this goal, it is imperative to vigorously promote the standardized treatment of chemotherapy-related anemia and innovate its treatment methods. We still have a long way to go," Ma Jun said.
