Management of Cancer-Related Anemia

Cancer-related anemia is a frequent and multifactorial complication affecting more than a third of patients at diagnosis and rising sharply during treatment. It manifests through reduced haemoglobin levels, diminished red blood cell production and heightened erythrocyte destruction, driven by chronic inflammation, nutrient deficiencies and tumour-associated factors. Central to its pathogenesis are cytokine-mediated suppression of erythropoiesis, hepcidin-induced iron sequestration and impaired erythropoietin synthesis. Management strategies encompass iron replacement—both oral and intravenous—erythropoiesis-stimulating agents (ESAs), judicious blood transfusion and emerging immunomodulatory approaches. Individualised care demands regular assessment of iron status, inflammatory markers and symptom burden, with the aim of alleviating fatigue, improving quality of life and optimising the efficacy of anticancer therapies. Multidisciplinary protocols integrate nutritional support, targeted pharmacological interventions and patient blood management principles to minimise transfusion reliance and to tailor therapy according to the underlying mechanism of anemia.

Research from Nature Portfolio

Recent studies have quantified the high prevalence of anemia before treatment in patients with gynaecological malignancies, reporting rates nearing 60%. Analyses of demographic and biochemical parameters identified advanced age, low educational attainment and deficiencies in iron, folate and vitamin B12 as significant contributors. These findings underscore the need for routine pre-treatment haemoglobin screening and a personalised management plan that addresses both nutritional and disease-related factors to prevent complications during surgery and chemotherapy.

Management of Cancer-Related Anemia publication trend

The graph below shows the total number of articles in management of cancer-related anemia across all publications each year (not limited to Nature Index journals).

Technical terms

Absolute iron deficiency (AID): Depletion of iron stores, reflected by low ferritin and transferrin saturation, leading to inadequate substrate for haemoglobin synthesis.

Functional iron deficiency (FID): Normal or elevated iron stores with insufficient iron mobilization for erythropoiesis, often driven by hepcidin-mediated sequestration.

Erythropoiesis-stimulating agents (ESAs): Drugs that mimic erythropoietin to stimulate red blood cell production in the bone marrow.

Hepcidin: A liver-derived hormone regulating systemic iron homeostasis by inhibiting iron export from macrophages and enterocytes.

References

1. Synergistic immunotherapy targeting cancer-associated anemia: prospects of a combination strategy. Cell Communication and Signaling (2023).
2. Prevalence and contributing factors of anemia in patients with gynecological cancer: a retrospective cohort study. Scientific Reports (2024).
3. The ICaRAS randomised controlled trial: Intravenous iron to treat anaemia in people with advanced cancer – feasibility of recruitment, intervention and delivery. Palliative Medicine (2023).
4. Pathogenesis and Treatment Options of Cancer Related Anemia: Perspective for a Targeted Mechanism-Based Approach. Frontiers in Physiology (2018).