1510P - Anemia as an explanatory factor for fatigue in patients treated with chemotherapy

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Complications/Toxicities of Treatment
Supportive Measures
Presenter Reza-Thierry Elaidi
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors R. Elaidi1, F. Scotte2, E. Fabre3, J. Medioni4, Y. Vano5, P. Combe5, A. Angelergues6, S. Oudard7
  • 1Medical Oncology, Association pour la Recherche sur les Therapeutiques Innovantes en Cancerologie, 75015 - Paris/FR
  • 2Oncology, hospital G.Pompidou, 75015 - paris/FR
  • 3Medical Oncology, Hopital Européen Georges Pompidou, 75015 - Paris/FR
  • 4Medical Oncology Service, Hopital Europ, FR-75015 - Paris/FR
  • 5Medical Oncology Service, European Georges Pompidou hospital, FR-75015 - Paris/FR
  • 6Medical Oncology Service, Georges Pompidou Hospital and Rene Descartes University, 75015 - Paris/FR
  • 7Medical Oncology Service, Hopital European George Pompidou, 75015 - Paris/FR



Fatigue (F) and anemia (A) are common adverse reactions in patients (pts) treated with chemotherapy. The relationship between fatigue and anemia is complex and still unexplained. This study aimed to investigate the time dependant relationship between hemoglobin (Hb) levels and patient's reported fatigue.


Patients (pts) included in the PROCHE program between 2008 and 2011 at the Georges Pompidou hospital (Paris, France) were eligible. Pts were contacted before each chemotherapy (CT), and data for F (patient's reported outcome according to CTC-NCI grading: 0=none, 1=mild, 2=moderate, 3=severe, 4=3+long-term condition) and A (hemoglobin (Hb) level (g/dl): 0= >12, 1=[10-12[, 2=[10-8], 3=[9; 8[ and 4=<8) were recorded from the first to the last cycle. A linear mixed model was used to assess the longitudinal relationship between Hb and F. CT cycle, age, primary tumor type and disease stage were introduced as fixed effects. We also investigated introduction of random effects.


5585 records of F and Hb were collected at the same time point in 661 pts who had at least 1 F and 1 Hb assessments. Median age=64.9y, sex-ratio=1.1, most frequent tumor type (%): lung: 25, breast: 21, urogenital: 21, gynecological: 13, H&N: 12. Localized disease=467 (70.6%), metastatic=194 (29.4%). Median number of cycles received=4 (IQR: 4). Median follow-up was 26.7m (25.5-27.9). Patient's reported F grade (%): 0=24.7, 1=45.2, 3=24.2, >3=5.9. Hb (g/dl)(%): >12=31.5, [10-12[=53.7, <10=14.9. Fatigue and Hb trajectories were strongly related and Hb was the strongest predictor for occurrence of F. Significant covariates were (“Type 3” tests of fixed effects): Hb: F=81.3 (p < 0.0001), age: F=39.8 (p < 0.0001), cycle order: F=3.0 (p < 0.0001). This model was both internally (bootstrap resampling) and externally validated on 197 new patients.


Conclusion: This study confirmed through internal and external validation the longitudinal relationship between fatigue and anemia over the chemotherapy period. Anemia was found to be the main explanatory factor of fatigue.


All authors have declared no conflicts of interest.