Treating Anemia

One of the most problematic side effects of many chemotherapy drugs is the lowering of blood counts. The bone marrow produces three important blood components: red blood cells, which carry oxygen to cells throughout the body; white blood cells, which fight infection; and platelets, which help blood clot and stop bleeding.

Chemotherapy treatments destroy some of the bone marrow cells, so fewer blood cells are produced. When there are too few red blood cells, body tissues don't get enough oxygen to do their work. This condition is called anemia, which can show up as fatigue, dizziness, paleness, a tendency to feel cold, and even shortness of breath.

Standard treatments for anemia in cancer patients may include red blood cell transfusions and epoetin-alfa.

Blood transfusions can be immediately effective in correcting anemia and are obviously the treatment of choice in patients when the condition is extremely serious. If used infrequently and only temporarily, transfusions are also less costly than epoetin-alfa treatments. For patients who do not respond to epoetin-alfa therapy, transfusions are essential.

However, there are risks involved with blood transfusions, including possible infection and immune suppression. Also, antibodies are produced against the new blood in up to 10% of patients receiving blood transfusions. Repeated transfusions may also cause iron overload and require iron chelation therapy. And then there are limitations in blood supply itself.

Epoetin-alfa, on the other hand, has been proven to be a safe and effective alternative to blood transfusions for the treatment of anemia in most cancer patients. Side effects do occur, but they are infrequent. They include hypertension and a condition called epoetin-alfa-induced iron deficiency, which can corrected with iron supplements.

New Treatment

In a study presented at the recent annual meeting of the American Society of Hematology, Dr. Dusan Kotasek of the Ashford Cancer Centre in Adelaide, Australia reported on a promising new treatment regimen to combat anemia in cancer patients.

Specifically, Kotasek documented findings involving the drug darbepoiten-alpha, which is manufactured by Amgen. The new treatment can be administered once every three weeks to fight anemia, Kotasek said, instead of the current standard regimen requiring multiple doses each week. "The results are exciting," he told the gathering, "since cancer patients with treatment-related anemia are usually treated for their anemia with once-weekly or thrice-weekly injections." His study involved 163 patients with solid tumors who were undergoing chemotherapy treatments for their cancer.

Anemia-Related Fatigue

General fatigue, including fatigue caused by anemia, affects more than three-quarters of patients undergoing cancer treatment. It can include feeling tired, weak, exhausted, slow, or simply lethargic.

A recent telephone survey published in the Proceedings of the American Society of Clinical Oncology examined how fatigue impacts the quality of life of cancer patients. The survey included 406 cancer patients, slightly more than half (53 percent) of them had chemotherapy alone, with the balance undergoing both chemotherapy and radiation.

When asked what side effects they experienced during treatment, 76 percent of the patients indicated fatigue as the most common symptom-more than nausea (54 percent), depression (23 percent), or pain (20 percent).

More than half of the patients (54 percent) also ranked fatigue as the longest-lasting side effect, ahead of nausea (27 percent), depression (12 percent), and pain (6 percent). In terms of side effects that affected their everyday activities, 60 percent of the patients again ranked fatigue as the most common symptom, well ahead of the next most debilitating symptom, nausea (22 percent).

In fact, 90% of the patients reported that fatigue had either a "significant impact" or "somewhat of an impact" on nearly every aspect of daily living, resulting in lower energy levels, insomnia, and even impaired thinking.

Fatigue also had economic consequences. Patients reported many work-related difficulties that were directly attributable to fatigue, including change of employment status (71 percent), missing one or more days of work (71 percent), being forced to reduce work-related responsibilities (35 percent), and even discontinuing work altogether (28 percent).

Importantly, almost a third of the patients who reported fatigue were also found to be anemic.

Helping Yourself Overcome Fatigue

The American Cancer Society offers the following suggestions for overcoming cancer-related fatigue:

• Get enough rest. Plan your day so you have time to rest. Take short naps or breaks, rather than one long rest period. However, while sleep and rest are important, don't overdo it. Too much rest can decrease your energy levels. If you have trouble sleeping, talk to your health care professional.
• Stay as active as you can. Regular exercise-especially walking-has been found to be a wonderful remedy for fatigue.
• Save your energy. Spread your activities throughout the day. Take rest breaks between activities to save your strength for the things you want to do. Most of all, prioritize. Decide which activities are really important to you and which ones aren't.
• Don't hesitate to ask for help. Ask your family or friends to help with tasks you find difficult or tiring, like mowing the lawn, preparing meals, doing housework, or running errands. Don't force yourself to do more than you can manage.
• Get support. Join a support group. Sharing your feelings with others can ease the burden of fatigue. And you can learn valuable coping hints from others in your similar situation.
• Eat as nutritiously as you can. Try to eat at least five servings of fruits and vegetables each day. Drink plenty of water and juices.

SOURCES:
Annual Meeting of the American Society of Hematology, December 4, 2000, San Francisco, California
Ninth World Conference on Lung Cancer, Tokyo, Japan, September 12, 2000
Proceedings of the American Society of Clinical Oncology, 1999; 18:573A
The National Cancer Institute (http://www.nci.nih.gov)
The American Cancer Society (http://www.cancer.org)

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