Association between Iron Deficiency and Survival in Older Patients with Cancer

SIMPLE SUMMARY: Iron deficiency is common in individuals with cancer. The aim of our study was to determine whether iron deficiency is associated with survival in older patients with solid tumors. We found that iron deficiency in the absence of anemia is associated with better survival. However, when combined with anemia, iron deficiency is associated with increased mortality. This study questions the value of iron supplementation therapy in older patients with cancer. ABSTRACT: Background: iron deficiency (ID) is frequent in older patients. Purpose: to evaluate the association between ID and survival in patients ≥ 75 years old with confirmed solid tumors. Methods: a retrospective monocentric study including patients between 2009 and 2018. ID, absolute ID (AID) and functional ID (FID) were defined according to the European Society for Medical Oncology (ESMO) criteria. Severe ID was defined by a ferritin level < 30 µg/L. Results: in total, 556 patients were included, the mean age was 82 (±4.6) years, 56% were male, the most frequent cancer was colon cancer (19%, n = 104), and metastatic cancers were found in 38% (n = 211). Median follow-up time: 484 [190–1377] days. In anemic patients, ID and FID were independently associated with an increased risk of mortality (respectively, HR 1.51; p = 0.0065 and HR 1.73; p = 0.0007). In non-anemic patients, FID was independently associated with better survival (HR 0.65; p = 0.0495). Conclusion: in our study, ID was significantly associated with survival, and with better survival for patients without anemia. These results suggest that attention should be paid to the iron status in older patients with tumors and raise questions about the prognostic value of iron supplementation for iron-deficient patients without anemia.