Seminars in hematology
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Seminars in hematology · Jul 1997
Clinical TrialThe impact of epoetin alfa on quality of life during cancer chemotherapy: a fresh look at an old problem.
Untreated anemia is common in cancer patients. Previous studies have demonstrated that both the existence of cancer and treatment with chemotherapy can suppress the normal endogenous erythropoietic response to anemia, making some cancer patients transfusion cadidates. In placebo-controlled phase III studies, administration of recombinant human erythropoietin (epoetin alfa) increased hemoglobin (Hb) levels and decreased transfusion requirements in patients undergoing cancer chemotherapy. ⋯ Statistically significant improvement in energy scores, daily activity, and overall QOL (P < .05) were observed, regardless of tumor response. These observations require confirmation on placebo-controlled trials, but the implications for oncology practice are important. They suggest that in cancer patients undergoing chemotherapy, the tradition of leaving anemia untreated may compromise patients' ability to function and their QOL.
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Seminars in hematology · Jul 1997
ReviewAllogeneic transfusion and infection: economic and clinical implications.
An increased incidence of postoperative infection and risk of cancer recurrence in patients who have received allogeneic blood transfusions suggests that such transfusions may be associated with clinically significant immunomodulatory effects. Allogeneic transfusion increase humoral immunity and decrease cell-mediated immunity. The mechanism of allogeneic transfusion-induced immunomodulation may involve altered cytokine regulation with a shift toward a type-2 (Th2) immune response. ⋯ Multiple linear regression analyses demonstrated that the number of units of allogeneic blood transfused, rather than surgeon and type of surgery, was the most statistically significant predictor of length of stay and hospital charges. Using data reported in the literature, we estimate that the death rate from allogeneic transfusion-related postoperative infection and cancer recurrence combined (215 deaths with 1% causality to 21,500 with 100% causality) may exceed the death rate due to all other transfusion risks combined. Improved clinical outcomes may result from techniques that minimize allogeneic blood use or its immunologic effects (e.g., autologous transfusion or other blood-sparing approaches in surgery, leukodepletion of allogeneic blood, and the use of growth factors [eg, epoetin alfa]).
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Seminars in hematology · Jul 1997
The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue.
Anemia, frequently associated with cancer and cancer treatment, can use a variety of symptoms that diminish overall quality of life (QOL). Fatigue is the most commonly reported symptom among cancer patients and can significantly affect their daily lives. Using the Functional Assessment of Cancer Therapy-General (FACT-G) instrument, which measures general QOL, as a core questionnaire, 20 new questions related to the impact of fatigue and other anemia-related symptoms on patients with cancer were developed. ⋯ The FACT-An, FACT-F, and Fatigue Subscale were found to successfully discriminate patients based on hemoglobin (Hb) level and Eastern Cooperative Oncology Group (ECOG) performance status. When patients were divided into two groups by Hb levels, patients with Hb levels greater than 12 g/dL reported significantly less fatigue, fewer nonfatigue anemia symptoms, better physical well-being, better functional well-being, and higher general QOL. The FACT-An, the FACT-F, and the Fatigue Subscale are useful measures of QOL in cancer patients and add focus to the widespread clinical problems of anemia and fatigue.