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Impact and Outcomes of Postoperative Anaemia in Colorectal Cancer Patients: A Systematic Review
Moncur A, Chowdhary M, Chu Y, Francis N
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2020
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Editor's Choice
Abstract
OBJECTIVES Preoperative anaemia is common in colorectal cancer patients. Little attention has been given to the prevalence and consequences of postoperative anaemia. The aim of this study was to systematically review the published literature and determine the knowledge of prevalence and impact of postoperative anaemia in colorectal cancer patients. METHODS Databases, CINAHL and Medline, via EBSCO Host, were systematically searched to identify suitable articles published between 2004-2020. After an initial search, articles were screened and all eligible articles reported on prevalence of postoperative anaemia, clinical and long-term outcomes data in colorectal cancer patients undergoing surgery were included. The Risk of Bias 2.0 tool for the assessment of Randomised Controlled Trials and Risk of Bias in Non-randomised studies 1.0 tool were used for the assessment of bias in the studies selected in our review. RESULTS Six studies, one randomised control trial and five cohort studies were included with a total population size of 1714. The prevalence of anaemia at discharge of 76.6% was reported as the primary endpoint in only one study. The rate of Red Blood Cell Transfusion and length of hospital stay were found to be significantly increased in anaemic patients, while postoperative infection rate results were variable. Quality of life scores and overall survival at 5 years were significantly affected among anaemic patients as reported in two papers. CONCLUSION The available limited evidence on postoperative anaemia indicates its high prevalence with negative impact on clinical and long-term outcomes. Further research is required to standardise the measurement and address the true impact of correcting postoperative anaemia on functional and oncological outcomes.
PICO Summary
Population
Colorectal cancer patients undergoing surgery (6 studies, n= 1,714).
Intervention
Systematic review to determine the prevalence and consequences of postoperative anaemia.
Comparison
Outcome
The prevalence of anaemia at discharge of 76.6% was reported as the primary endpoint in only one study. The rate of red blood cell transfusion and length of hospital stay were found to be significantly increased in anaemic patients, while postoperative infection rate results were variable. Quality of life scores and overall survival at 5 years were significantly affected among anaemic patients as reported in two papers.
2.
Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
Bohlius J, Bohlke K, Castelli R, Djulbegovic B, Lustberg MB, Martino M, Mountzios G, Peswani N, Porter L, Tanaka TN, et al
Blood advances. 2019;3(8):1197-1210
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Free full text
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Editor's Choice
Abstract
PURPOSE To update the American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs in patients with cancer published from January 31, 2010, through May 14, 2018. For biosimilar ESAs, the literature search was expanded to include meta-analyses and RCTs in patients with cancer or chronic kidney disease and cohort studies in patients with cancer due to limited RCT evidence in the cancer setting. ASCO and ASH convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The primary literature review included 15 meta-analyses of RCTs and two RCTs. A growing body of evidence suggests that adding iron to treatment with an ESA may improve hematopoietic response and reduce the likelihood of RBC transfusion. The biosimilar literature review suggested that biosimilars of epoetin alfa have similar efficacy and safety to reference products, although evidence in cancer remains limited. RECOMMENDATIONS ESAs (including biosimilars) may be offered to patients with chemotherapy-associated anemia whose cancer treatment is not curative in intent and whose hemoglobin has declined to < 10 g/dL. RBC transfusion is also an option. With the exception of selected patients with myelodysplastic syndromes, ESAs should not be offered to most patients with nonchemotherapy-associated anemia. During ESA treatment, hemoglobin may be increased to the lowest concentration needed to avoid transfusions. Iron replacement may be used to improve hemoglobin response and reduce RBC transfusions for patients receiving ESA with or without iron deficiency. Additional information is available at www.asco.org/supportive-care-guidelines and www.hematology.org/guidelines.
PICO Summary
Population
Patients with cancer or chronic kidney disease (17 studies).
Intervention
Erythropoiesis-stimulating agents (ESAs) including biosimilars.
Comparison
Addition of iron to an ESA, placebo or best standard therapy.
Outcome
A growing body of evidence suggested that adding iron to treatment with an ESA may improve hematopoietic response and reduce the likelihood of red blood cell transfusion. The biosimilar literature review suggested that biosimilars of epoetin alfa have similar efficacy and safety to reference products, although evidence in cancer remained limited.