Clinical characterization of 602 older patients with cancer related anemia received multi-line anti-tumor treatment

To analyze the clinical characteristics of cancer related anemia (CRA) in older cancer patients undergoing multi-line anti-tumor treatment.

A cross-sectional study was conducted, including patients with CRA who were ≥65 years old and had received or were currently undergoing multi-line treatment at 9 hospitals in Beijing from June 1, 2018 to September 30, 2023. Data on gender, age, past history, family history, tumor type, metastasis site, clinical symptoms, blood routine, specialized examination for anemia, anti-tumor and anemia correction treatment were collected. The basic characteristics of the included patients, clinical symptoms, the status of blood cell reduction, treatment conditions, and the distribution of traditional Chinese medicine (TCM) syndrome characteristics were analyzed.

A total of 602 patients were included. The tumor types included lung cancer, colorectal cancer, gastric cancer, esophageal cancer, breast cancer, gynecological tumors, lymphoma. The overall median hemoglobin (HGB) level was 99.00 (88.00, 107.00) g/L. The HGB levels of patients with different tumor types showed significant differences (P < 0.001). The HGB levels of patients with gynecological tumors were significantly lower than those of patients with colorectal cancer, lung cancer and esophageal cancer (P < 0.05). The most common clinical symptoms were fatigue, loss of appetite, irregular bowel movements and pain. In terms of anti-tumor treatment, 405 patients were receiving multi-line anti-tumor treatment (including combined chemotherapy, combined radiotherapy, combined targeted therapy, and combined immunotherapy), 197 patients were receiving symptomatic supportive treatment after multi-line anti-tumor treatment. In terms of anemia correction treatment, 183 patients received erythropoietin, folic acid, iron, vitamin B₁₂, or blood transfusion, while 293 patients received TCM for correcting anemia (including Chinese patent medicines, Chinese herbal decoctions, combinations of Chinese patent medicines and Chinese herbal decoctions). Specialized tests for anemia, such as serum iron, total iron binding capacity, transferrin saturation, transferrin, erythropoietin et al, have a detection rate of only 3.65%~27.91%. In terms of the characteristics of TCM syndromes, the main TCM syndrome types of the patients were as follows: syndrome of spleen-stomach weakness, syndrome of qi and blood deficiency, syndrome of heart-spleen deficiency, syndrome of spleen-kidney yang deficiency, syndrome of liver and kidney yin deficiency. Some patients also have the accompanying symptoms of internal binding of static blood and poison, phlegm dampness retention. Further comparison revealed that the HGB level of older patients with CRA who had syndrome of spleen-stomach weakness was significantly lower than patients with other symptom types (P < 0.001). The HGB level of patients with syndrome of qi and blood deficiency was significantly lower than patients with syndrome of spleen-kidney yang deficiency (P < 0.01) and syndrome of liver and kidney yin deficiency (P < 0.001). Patients with symptoms of internal binding of static blood and poison, or symptoms of phlegm dampness retention had significantly lower HGB levels compared to those without accompanying symptoms (P < 0.01).

The rate of specialized blood test for anemia in older patients with CRA was relatively low. The most common TCM syndrome types were syndrome of spleen-stomach weakness and syndrome of qi and blood deficiency. The overall treatment rate was also low. The screening, specialized diagnosis and monitoring of older patients with CRA need to be given more attention, and treatment methods such as TCM, Western medicine, and integrated TCM-Western medicine should be selected based on the patient’s condition.