Anemia is a frequent complication in patients with breast cancer (BC), gastrointestinal tumors (GC), lung cancer (LC) and malignant lymphomas (ML). Guidelines (GL) on anemia management (ESMO, DGHO) provide dedicated algorithms for diagnosis and treatment of anemia. GL adherence (GLAD) was analyzed.
This was a retrospective sample analysis representative for practices and hospitals in Germany. Data on tumor treatments and anemia management was collected from records of cancer patients (pts) with grade ≥ 2 anemia diagnosed between January and June 2021. Definition of diagnosis GLAD score (GLAD-D): 2 points (pt) for full adherence, 1 pt for a lack in differential diagnosis on iron metabolism. 0 pt if differential diagnosis is missing. Treatment GLAD score (GLAD-T): 2 pt for full adherence to GL recommendation in relation to diagnosis. 1 pt for indicated red blood cells (RBC) as only anemia therapy or no therapy in pts with Hb ≥8g/dl. 0 pt for RBC without indication, p.o. iron substitution under inflammatory conditions (CRP>5mg/l) or vitamin B12 or folate deficiency without substitution.
Data from 1046 pts (311 BC, 371 GC, 260 LC, 104 ML) were collected from 143 centers. Hb-values at diagnosis of anemia were 8-10 g/dl in 899 (85.9%) pts, 6-8g/dl in 135 (12.9%) and <6g/dl (1.2%) in 12 pts. 456 pts were treated with RBC (43.6%), 198 (18.9%) with iron substitution, 106 (10.1%) with ESA and 60 (5.7%) with vitamin B12. 60.6% of the pts with iron substitution were treated i.v. and 39.4% p.o. 37.5% of pts with RBC had no indication in the sense of the restrictive RBC policy recommended by the GLs. GLAD was poor in diagnosis and treatment: GLAD-D was 2 pt in 310 pts (29.6%) of pts, 1 pt at 168 (16.1%) and 0 pt in 568 (54.3%) pts. GLAD-T was 2 pt in 270 pts (25.8%), 1 pt in 310 (29.6%) and 0 pt in 466 (44.6%). Higher GLAD-D correlated significantly to a higher GLAD-T (τ B 0.262, p<0.001). Full GLAD-T (2 pt) was significantly associated with a greater Hb increase (p<0.001) at 28 days (10.2 vs. 9.7 g/dl) and at 2 months (10.4 vs 9.9 g/dl).
GLAD is insufficient in Germany, especially concerning liberal transfusion policy and the lack of differential diagnostics of iron metabolism. Pts with anemia management as per GL had a significantly greater Hb-increase.
Clinical trial identification
Legal entity responsible for the study
AIO-Studien-gGmbH on behalf of the Working Groups Medical Oncology (AIO) and Supportive Care (AGSMO) of the German Cancer Society (DKG).
The study was supported by unrestricted grants from Pharmacosmos to the AIO-Studien-gGmbH of the German Cancer Society, AIO-SUP-01121. The funding source did not have any access to the data and was not involved in data analysis.
H. Link: Financial Interests, Personal, Advisory Board: Pharmacosmos, Servier Deutschland GmbH, SIGAL SMS GmbH, Takeda, Hogg Robinson Germany, Teva, Apogepha, G1 Therapeutics; Financial Interests, Personal, Expert Testimony: Samsung Bioepis; Financial Interests, Personal, Invited Speaker: Teva, Vision Plus Mailand, MMF GmbH, Teva - Xcenda; Financial Interests, Personal, Ownership Interest, onkopti.de: Onkodin GmbH; Financial Interests, Institutional, Invited Speaker, Onkodin GmbH, onchemo.com: Viatris; Financial Interests, Institutional, Research Grant, Study with German Cancer Society: AMGEN; Financial Interests, Institutional, Research Grant, Grant to German Cancer Society: Pharmacosmos; Non-Financial Interests, Project Lead, Digitized Oncological Treatment Protocols - onkopti.de, onchemo.com: Onkodin GmbH; Other, Expert Testimony: Ethics Committee at the Rhineland-Palatinate Medical Association, Mainz. M. Kerkmann: Financial Interests, Personal, Full or part-time Employment: MMF GmbH; Financial Interests, Institutional, Research Grant: AstraZeneca, Roche, Amgen, Bristol-Myers Squibb, Janssen-Cilag, Pharmacosmos, MSD, Takeda; Non-Financial Interests, Member: Working Group Medical Oncology (AIO) of the German Cancer Society (DKG), Working Group Supportive Care (AGSMO) of the German Cancer Society (DKG), German Cancer Society (DKG). L. Holtmann: Financial Interests, Personal, Full or part-time Employment: MMf GmbH; Financial Interests, Institutional, Research Grant: Amgen, AstraZeneca, Bristol Myers-Squibb, Janssen-Cilag, MSD, Pharmacosmos, Roche, Takeda.