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Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries

Cancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting imp...

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Autores principales: Parikh, Purvish Mahendra, Aggarwal, Shyam, Biswas, Ghanashyam, Gulia, Seema, Agarwala, Vivek, Basade, Maheboob, Mohapatra, P.N., Vamshi, Krishna Muddu, Warrier, Arun, Prasad, Krishna, Roy, Partha, Chandrakant, M.V., Malhotra, Hemant, Hingmire, Sachin, Paul, Davinder, Maniar, Vashista, Gupta, Alok, Panda, Soumya S., Samar, Aseem, Rohatgi, Nitesh, Dattatreya, Satya, Krishnamurthy, Manjunath, Thirumalairaj, Raja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical and Scientific Publishers Pvt. Ltd. 2023
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635760/
https://www.ncbi.nlm.nih.gov/pubmed/37969669
http://dx.doi.org/10.1055/s-0043-1771445
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author Parikh, Purvish Mahendra
Aggarwal, Shyam
Biswas, Ghanashyam
Gulia, Seema
Agarwala, Vivek
Basade, Maheboob
Mohapatra, P.N.
Vamshi, Krishna Muddu
Warrier, Arun
Prasad, Krishna
Roy, Partha
Chandrakant, M.V.
Malhotra, Hemant
Hingmire, Sachin
Paul, Davinder
Maniar, Vashista
Gupta, Alok
Panda, Soumya S.
Samar, Aseem
Rohatgi, Nitesh
Dattatreya, Satya
Krishnamurthy, Manjunath
Thirumalairaj, Raja
author_facet Parikh, Purvish Mahendra
Aggarwal, Shyam
Biswas, Ghanashyam
Gulia, Seema
Agarwala, Vivek
Basade, Maheboob
Mohapatra, P.N.
Vamshi, Krishna Muddu
Warrier, Arun
Prasad, Krishna
Roy, Partha
Chandrakant, M.V.
Malhotra, Hemant
Hingmire, Sachin
Paul, Davinder
Maniar, Vashista
Gupta, Alok
Panda, Soumya S.
Samar, Aseem
Rohatgi, Nitesh
Dattatreya, Satya
Krishnamurthy, Manjunath
Thirumalairaj, Raja
author_sort Parikh, Purvish Mahendra
collection PubMed
description Cancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.
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spelling pubmed-106357602023-11-15 Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries Parikh, Purvish Mahendra Aggarwal, Shyam Biswas, Ghanashyam Gulia, Seema Agarwala, Vivek Basade, Maheboob Mohapatra, P.N. Vamshi, Krishna Muddu Warrier, Arun Prasad, Krishna Roy, Partha Chandrakant, M.V. Malhotra, Hemant Hingmire, Sachin Paul, Davinder Maniar, Vashista Gupta, Alok Panda, Soumya S. Samar, Aseem Rohatgi, Nitesh Dattatreya, Satya Krishnamurthy, Manjunath Thirumalairaj, Raja South Asian J Cancer Cancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA. Thieme Medical and Scientific Publishers Pvt. Ltd. 2023-09-15 /pmc/articles/PMC10635760/ /pubmed/37969669 http://dx.doi.org/10.1055/s-0043-1771445 Text en MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Parikh, Purvish Mahendra
Aggarwal, Shyam
Biswas, Ghanashyam
Gulia, Seema
Agarwala, Vivek
Basade, Maheboob
Mohapatra, P.N.
Vamshi, Krishna Muddu
Warrier, Arun
Prasad, Krishna
Roy, Partha
Chandrakant, M.V.
Malhotra, Hemant
Hingmire, Sachin
Paul, Davinder
Maniar, Vashista
Gupta, Alok
Panda, Soumya S.
Samar, Aseem
Rohatgi, Nitesh
Dattatreya, Satya
Krishnamurthy, Manjunath
Thirumalairaj, Raja
Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title_full Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title_fullStr Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title_full_unstemmed Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title_short Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries
title_sort practical clinical consensus guidelines for the management of cancer associated anemia in low- and middle-income countries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635760/
https://www.ncbi.nlm.nih.gov/pubmed/37969669
http://dx.doi.org/10.1055/s-0043-1771445
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