Globally, gastric cancer is highly prevalent amongst men and women. While many studies have identified the prevalence and association of iron deficiency anemia (IDA) in all cancer patients, few have focused on the gastric population. We aimed to determine the proportion of patients with gastric cancer who developed IDA, chemotherapy induced anemia (CIA), and to identify types and frequencies of IDA therapies.
A retrospective study was carried out in 127 consecutive gastric cancer patients from 2006 to 2016 at St. Michael’s Hospital, Toronto, Canada. Patient demographics, previous history of IDA, and IDA-based therapies were reviewed. IDA was defined as hemoglobin (Hb)
Of the 127 patients (median age 70 [interquartile range (IQR): 59-77]), 64.6% (82/127) were male. Most patients were diagnosed as stage III with a mean Hb of 119 g/L (standard deviation (SD): 20.2 g/L). Only 18.1% (23/127) patients had a history of IDA, 44.4% (20/45) had IDA at the time of gastric cancer diagnosis, and 59.1% (75/127) were anemic. Of the 127 patients, 16.5% had open surgery, while 45.7% had laparoscopic surgery. A total of 78 patients received chemotherapy, and of these 61 (78.2%) developed CIA. At last follow-up, 38.7% (24/62) patients developed IDA, and 79.5% (101/127) were anemic. Red blood cell (RBC) transfusions were most frequently prescribed (49.1%; median 4 units, IQR: 2-6.5), compared to oral (31.5%) or IV iron (16.5%) therapy.
There was a high proportion of IDA (38.7%) in our gastric cancer population despite inconsistent screening for ID. The incidence of anemia increased by 20% from the time of gastric cancer diagnosis to last follow-up. Approximately half of the patients received a RBC transfusion during their care. Our findings highlight the need for targeted therapy for ID to reduce RBC transfusion risk and to improve health-related quality of life. In response to our findings, we have implemented a quality improvement initiative that involves screening of iron status and provision of IV iron given limited oral absorption of iron in gastric cancer patients.
Clinical trial identification
Legal entity responsible for the study
St. Michael's Hospital
All authors have declared no conflicts of interest.