Abstract 1586P
Background
Anaemia affects up to two-thirds of cancer patients during chemotherapy. It is associated with impaired quality of life and worse overall survival, but is significantly under-treated. 35% of these patients have underlying functional iron deficiency (FID). ESMO guidelines recommend haematinic monitoring and consideration of intravenous iron and erythropoiesis-stimulating agents (ESAs) to reduce red blood cell (RBC) transfusions. Studies have shown that liberal rather than restrictive transfusion policies are associated with negative outcomes in patients with and without cancer. However, evidence from a recent European survey of clinical practice among Oncologists shows that UK practice still relies heavily on RBC transfusions with minimal use of transfusion-sparing agents.
Methods
A pre-intervention audit was performed of all solid tumour patients who started chemotherapy during September and October 2019 at University Hospital Southampton. Electronic patient records were interrogated to identify how anaemia was treated over the following six months. Results were interpreted against the following audit standard: ESMO Clinical Practice Guidelines - Management of Anaemia and Iron Deficiency. This was followed by a series of interventions including a new anaemia treatment protocol based on the ESMO algorithm, and education sessions for all prescribers. An identical post-intervention audit was then performed of all patients who started chemotherapy during March and April 2021.
Results
Table: 1586P
| Pre-intervention | Post-intervention | |
| Total patients | 108 | 106 |
| Iron status assessed (%) | 1.9 | 37.5 |
| Patients prescribed darbepoetin if Hb≤100g/L (%) | 3 | 30.8 |
| Total IV iron doses given | 1 | 12 |
| Total RBC units given | 44 | 27 |
| Anaemic patients given ≥1 RBC transfusion (%) | 26.8 | 20.8 |
| RBC units per anaemic patient | 0.79 | 0.38 |
Conclusions
Our ‘real world’ data has shown that even with a limited improvement in guideline adherence, using ESAs and correcting FID anaemia can significantly reduce RBC transfusions. For patients this means less time spent in hospital, and less exposure to adverse outcomes of RBC transfusions. This change in practice was also cost-efficient for our centre, with extrapolated annual savings of €24,000 and 180 hours of treatment time for the chemotherapy unit.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.