Anemia in cancer patients: Are you aware?

Anemia in cancer patients: Are you aware?

Anemia is a common problem among the cancer patients, with noticing negative impacts on overall prognosis and quality of life. The reasons are multifactorial, however the iron deficiency is the major cause and possibly the treatable contributor.

Nutrition is found to be an important part of all the cancer association events, from reducing cancer risk to diagnosis, during chemotherapeutic treatments, and recovery. Your body definitely needs more nutrients to fight and get ready against cancer.

There are many anti-cancer foods which help cancer patients to maintain their immunity and stable health during cancer treatments. Other than these, many spices also help to reduce the risk of getting cancer.

However, along with good anti-cancer foods and spices, you also need a balanced diet. Diets enriched with iron foods are very essential for a cancer patient. This helps to maintain the iron levels in the body and prevent patients from being anemic.

Sometimes, doctors also recommend having cancer supplements to get recovered from an anemic state.

What is anemia and how it can be treated? Let's take a look at it -

  • What is anemia?
  • What is iron?
  • Iron deficiency in cancer patients
  • Impact of iron deficiency on cancer patients' health
  • Dietary sources of iron

What is anemia?

It is a health problem, involving a decrease in the number of  red blood cells or reduction in required hemoglobin levels in the body. This means your body produces not enough blood. It affects the overall body functioning.
One of the major causes of anemia is iron deficiency. When iron deficiency is severe to reduce erythropoiesis (the process of red blood cell production), it leads to iron deficiency anemia (IDA), one of the common types of anemia.

What is iron?

Iron is an essential trace element, which performs a pivotal role in oxygen uptake, oxygen metabolism, energy metabolism, electron transportation in mitochondria, hematopoiesis, and muscle function. You can say, iron is an important element for overall well being.
However, iron metabolism is a precisely controlled process to regulate the free iron levels and keep it as low as possible.

Iron deficiency in cancer patients

According to the ECAS (European Cancer Anemia Survey), “Around 39 percent of cancer patients were anemic at the stage they took part in the survey. Also, during chemotherapy, about 67% of patients showed an incidence of anemia during the 6 months surveillance period”.
According to the reports of the recently done study, "patients suffering from different cancers exhibited significant incidence of iron deficiency, viz, pancreatic cancer patients (63%), colorectal patients (52%), and lung cancer patients (51%).

Practically, there are two types of iron deficiencies:

The absolute iron deficiency (AID): Characterized by depleted iron stores and insufficient iron supply along with <20% TSAT and <100 ng/ml ferritin levels (normal levels: <30 ng/ml).

The functional iron deficiency (FID): Characterized by only insufficient iron supply along with <20% TSAT and >100 ng/ml ferritin levels.

In healthy people, ferritin shows the status of iron stores. However, other parameters (TSAT (transferrin saturation), soluble transferrin receptor, and Hb-content of reticulocytes) show the biologically available iron. Unfortunately, most of these parameters get altered within cancer patients and it becomes a challenge to diagnose iron deficiency.

If talking about anemia in cancer patients, FID is the leading cause. Here the inadequate iron supply is characterized by upregulation of hepcidin by inflammatory and pro-inflammatory cytokines. Also, the reduced erythropoietic activity due to insufficient iron supply also contributes to enhancing hepcidin levels.

There are also other mechanisms through which the body gets anemic. For instance:

  • Hemolysis, bleeding, or chemotherapy or radiotherapy associated factors. Vitamin B12 and folic acid deficiency also contribute to cause anemia.
  • Keep your body vitamins levels up-to-date. Must add anti-cancer vitamins in your diet to keep cancer at bay.

Impact of iron deficiency on cancer patients' health

This leads to degradation of the patient's performance status, inability to adhere to scheduled chemotherapy, and associated with impaired outcomes.

Other side effects of iron deficiency are: cold skin, reduced physical fitness, fatigue, weakness, cold skin, insomnia, brittle nails, headaches, restless legs syndrome, loss of libido, depression, tachycardia, dyspnea, impaired cognitive function, alopecia, and many other ailments.

How can we tackle this issue?

Different therapies to tackle iron deficiency:

For treating anemia among cancer patients, there are majorly three treatment options:

  • Red blood transfusions
  • ESA (erythropoiesis-stimulating agents)
  • Iron supplements

There are various guidelines on the treatment of cancer patients with iron deficiency, either as monotherapy to improve anemia or with ESA to improve response towards these agents. Refer table 1. for the present guidelines (Source: Brazilian Journal of Hematology and Hemotherapy):

National Comprehensive Cancer Network (NCCN)Monotherapy with iron (preferably IV) is recommended for absolute iron deficiency (ferritin <30 ng/mL and TS <20%) and in patients using ESAs with ferritin between 30 and 800 ng/mL and TS between 20 and 50%. IV iron can reduce the number of transfusions in patients with functional iron deficiency.
American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH)Iron profile monitoring is recommended. Iron replacement is recommended if there is iron deficiency, but there is not enough evidence for greater details regarding the form of replacement and periodicity of monitoring.
European Society for Medical Oncology (ESMO)Iron profile monitoring is recommended. IV iron replacement in patients with iron deficiency produces increments in Hb and reduces the need for transfusion.
European Organization for Research and Treatment of Cancer (EORTC)Iron replacement should be restricted to patients with absolute or functional iron deficiency.

Dietary sources of iron

Keep your body enriched with necessary levels of iron by adding dietary sources of iron in your diet.
"As an adult, the average daily recommended amount for a man should be 8 mg and for a woman should be 18 mg"
Sources of iron:
• Poultry, seafood, and lean meat.
• Spinach, lentils, peas, white beans, and kidney beans.
• Nuts and dried fruits like raisins.
• Iron-fortified bread or cereals.

Iron is necessary for overall health care and therefore, get your body iron levels up to date and consult your doctor in case of any deficiency. Also, keep your vitamins and mineral levels up-to-mark to reduce the risk of anemia, iron deficiency and associated chronic diseases. Take a healthy diet and reduce the risk of developing cancer.

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