Anemia prevalence and treatment practice in patients with non-myeloid tumors receiving chemotherapy

Figures & data

Table 1 Population summary by country (Italy, Austria, and overall)

	Italy (n = 1130)	Austria (n = 282)	Overall (n = 1412)
Male sex – n (%)	563 (50)	126 (45)	689 (49)
Age – median (Q1, Q3)	65.0 (56.0, 72.0)	65.0 (53.0, 71.0)	65.0 (55.0, 72.0)
Solid tumor – n (%)	914 (81)	222 (79)	1136 (80)
Breast	188 (17)	67 (24)	255 (18)
Lung	162 (14)	35 (12)	197 (14)
Prostate	32 (3)	4 (1)	36 (3)
Colorectal	222 (20)	34 (12)	256 (18)
Other solid tumor	310 (27)	82 (29)	392 (28)
Hematological malignancy – n (%)	216 (19)	60 (21)	276 (20)
Non-Hodgkin’s lymphoma	108 (10)	31 (11)	139 (10)
Other hematological malignancy	108 (10)	29 (10)	137 (10)
Number of chemotherapy cycles completed since initiation – n (%)
In first cycle	154 (14)	54 (19)	208 (15)
1–3	475 (42)	126 (45)	601 (43)
4–6	302 (27)	71 (25)	373 (26)
>6	199 (18)	31 (11)	230 (16)
Current chemotherapy regimen containsa – n (%)
Platinum	386 (34)	91 (32)	477 (34)
Anthracycline	176 (16)	59 (21)	235 (17)
Taxane	158 (14)	58 (21)	216 (15)
Missingb	469 (42)	100 (35)	569 (40)
Currently undergoing radio-chemotherapy – n (%)	42 (4)	15 (5)	57 (4)

Notes:

a Patients may be recorded in multiple chemotherapy type categories;

b An unexpected number of patients had therapies other than those listed on the case report form and were therefore categorized as ‘missing’.

Table 2 Population summary by tumor type (solid tumor or hematologic malignancy)

	Solid tumors (n = 1136)	Hematological malignancy (n = 276)
Male sex – n (%)	548 (48)	141 (51)
Age – median (Q1, Q3)	64.0 (55.0, 71.0)	68.0 (56.5, 74.0)
Number of chemotherapy cycles completed since initiation – n (%)
In first cycle	163 (14)	45 (16)
1–3	477 (42)	124 (45)
4–6	304 (27)	69 (25)
>6	192 (17)	38 (14)
Current chemotherapy regimen containsa – n (%)
Platinum	457 (40)	20 (7)
Anthracycline	134 (12)	101 (37)
Taxane	216 (19)	0 (0)
Missingb	414 (36)	155 (56)
Currently undergoing radio-chemotherapy – n (%)	54 (5)	3 (1)

Notes:

a Patients may be recorded in multiple chemotherapy type categories;

b An unexpected number of patients had therapies other than those listed on the case report form and were therefore categorized as ‘missing’.

Table 3 Key primary and secondary outcome measures by country (Italy, Austria, and overall)

	Italy (n = 1130)	Austria (n = 282)	Overall (n = 1412)
Prevalence
Anemic – n (%)	347 (31)	101 (36)	448 (32)
95% CI	28.1, 33.5	30.4, 41.6	29.4, 34.2
Type of visit – n (%)
Outpatient	517 (46)	168 (60)	685 (49)
Hospitalized	613 (54)	114 (40)	727 (51)
Reason for visita – n (%)
Chemotherapy administration	698 (62)	193 (68)	891 (63)
Anemia treatment	43 (4)	9 (3)	52 (4)
Other cancer or chemotherapy-related reason	398 (35)	86 (30)	484 (34)
Other reason not related to cancer	14 (1)	6 (2)	20 (1)
Hemoglobin results
n (%)	905 (80)	248 (88)	1153 (82)
Mean (SD) – g/dL	11.7 (1.7)	11.7 (1.7)	11.7 (1.7)
Hemoglobin category – n (%)
≤10 g/dL	155 (17)	41 (17)	196 (17)
>10 g/dL	750 (83)	207 (83)	957 (83)
Physician’s diagnosis of anemia – n (%)	419 (37)	135 (48)	554 (39)
Patients with anemia symptoms – n (%)	368 (33)	88 (31)	456 (32)
Type of symptoma – n (%)
Fatigue	321 (28)	71 (25)	392 (28)
Headaches	53 (5)	8 (3)	61 (4)
Dyspnea	85 (8)	22 (8)	107 (8)
Loss of libido	45 (4)	6 (2)	51 (4)
Depression	112 (10)	10 (4)	122 (9)
Dizziness	31 (3)	11 (4)	42 (3)
Cold skin	66 (6)	10 (4)	76 (5)
Palpitations	59 (5)	3 (1)	62 (4)
Pulmonary edema	0 (0)	0 (0)	0 (0)
Heart failure	2 (<1)	2 (1)	4 (<1)
Severe impairment of cognitive function	10 (1)	2 (1)	12 (1)
Other symptoms possibly related to anemia	6 (1)	6 (2)	12 (1)
Current chemotherapy cycle delayed due to anemia – n (%)	37 (3)	14 (5)	51 (4)

Note:

a Patients may be included in more than one category.

Abbreviations: CI, confidence interval; SD, standard deviation.

Table 4 Key primary and secondary outcome measures by tumor type (solid tumor or hematologic malignancy)

	Solid tumors						Hematological malignancy
	Breast (n = 255)	Lung (n = 197)	Prostate (n = 36)	Colorectal (n = 256)	Other (n = 392)	Total (n = 1136)	NHL (n = 139)	Other (n = 137)	Total (n = 276)
Prevalence
Anemic – n (%)	58 (23)	59 (30)	15 (42)	55 (21)	161 (41)	348 (31)	50 (36)	50 (36)	100 (36)
95% CI	18.0, 28.3	24.0, 36.7	27.1, 57.8	16.9, 26.9	36.3, 46.0	28.0, 33.4	28.5, 44.2	28.9, 44.8	30.8, 42.1
Type of visit – n (%)
Outpatient	131 (51)	89 (45)	24 (67)	121 (47)	184 (47)	549 (48)	65 (47)	71 (52)	136 (49)
Hospitalized	124 (49)	108 (55)	12 (33)	135 (53)	208 (53)	587 (52)	74 (53)	66 (48)	140 (51)
Reason for visita – n (%)
Chemotherapy administration	155 (61)	142 (72)	24 (67)	180 (70)	248 (63)	749 (66)	70 (50)	72 (53)	142 (51)
Anemia treatment	5 (2)	8 (4)	2 (6)	2 (1)	26 (7)	43 (4)	1 (1)	8 (6)	9 (3)
Other cancer- or chemotherapy-related reason	96 (38)	50 (25)	10 (28)	73 (29)	128 (33)	357 (31)	68 (49)	59 (43)	127 (46)
Other reason not related to cancer	2 (1)	1 (1)	1 (3)	3 (1)	6 (2)	13 (1)	2 (1)	5 (4)	7 (3)
Hemoglobin results
n (%)	214 (84)	171 (87)	30 (83)	205 (80)	320 (82)	940 (83)	105 (76)	108 (79)	213 (77)
Mean (SD) – g/dL	11.8 (1.4)	11.7 (1.8)	11.8 (1.9)	12.4 (1.7)	11.4 (1.6)	11.8 (1.7)	11.3 (1.6)	11.4 (1.9)	11.3 (1.8)
Hemoglobin category – n (%)
≤10 g/dL	24 (11)	26 (15)	5 (17)	18 (9)	71 (22)	144 (15)	23 (22)	29 (27)	52 (24)
>10 g/dL	190 (89)	145 (85)	25 (83)	187 (91)	249 (78)	796 (85)	82 (78)	79 (73)	161 (76)
Physician’s diagnosis of anemia	75 (29)	84 (43)	16 (44)	72 (28)	182 (46)	429 (38)	68 (49)	57 (42)	125 (45)
Patients with anemia symptoms – n (%)	74 (29)	68 (35)	16 (44)	70 (27)	159 (41)	387 (34)	33 (24)	36 (26)	69 (25)
Type of symptoma – n (%)
Fatigue	64 (25)	57 (29)	15 (42)	62 (24)	138 (35)	336 (30)	27 (19)	29 (21)	56 (20)
Headaches	15 (6)	9 (5)	3 (8)	6 (2)	24 (6)	57 (5)	3 (2)	1 (1)	4 (1)
Dyspnea	17 (7)	31 (16)	4 (11)	9 (4)	32 (8)	93 (8)	5 (4)	9 (7)	14 (5)
Loss of libido	13 (5)	10 (5)	3 (8)	4 (2)	21 (5)	51 (5)	0 (0)	0 (0)	0 (0)
Depression	22 (9)	20 (10)	3 (8)	21 (8)	52 (13)	118 (10)	1 (1)	3 (2)	4 (1)
Dizziness	9 (4)	7 (4)	2 (6)	3 (1)	15 (4)	36 (3)	1 (1)	5 (4)	6 (2)
Cold skin	13 (5)	12 (6)	2 (6)	15 (6)	33 (8)	75 (7)	0 (0)	1 (1)	1 (<1)
Palpitations	14 (5)	11 (6)	3 (8)	7 (3)	22 (6)	57 (5)	2 (1)	3 (2)	5 (2)
Pulmonary edema	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Heart failure	1 (<1)	1 (<1)	0 (0)	0 (0)	1 (<1)	3 (<1)	0 (0)	1 (1)	1 (<1)
Severe impairment of cognitive function	1 (<1)	1 (<1)	0 (0)	3 (1)	6 (2)	11 (1)	0 (0)	1 (1)	1 (<1)
Other symptoms possibly related to anemia	1 (<1)	1 (<1)	1 (3)	1 (<1)	4 (1)	8 (1)	1 (1)	3 (2)	4 (1)
Current chemotherapy cycle delayed due to anemia – n (%)	9 (4)	10 (5)	4 (11)	5 (2)	19 (5)	47 (4)	1 (1)	3 (2)	4 (1)

Note:

a Patients may be included in more than one category.

Abbreviations: CI, confidence interval; NHL, non-Hodgkin’s lymphoma; SD, standard deviation.

Table 5 Transfusions (red blood cell or whole blood), erythropoiesis-stimulating agent use and iron supplementation by country (Italy, Austria, and overall)

	Italy (n = 1130)	Austria (n = 282)	Overall (n = 1412)
Patients with evidence of transfusion at visit – n (%)	62 (5)	29 (10)	91 (6)
Transfusion dataa – n (%)
Within 28 days before visit	52 (5)	20 (7)	72 (5)
Ordered at visit	13 (1)	11 (4)	24 (2)
No transfusion/transfusion >28 days ago	1068 (95)	253 (90)	1321 (94)
Patients with evidence of ESA use at visit – n (%)	158 (14)	30 (11)	188 (13)
ESA data – n (%)
No ESA prescribed	951 (84)	249 (88)	1200 (85)
Ongoing (without change)	115 (10)	20 (7)	135 (10)
Initiated at visit	35 (3)	8 (3)	43 (3)
Dose or schedule changed	4 (<1)	1 (<1)	5 (<1)
Stopped temporarily	19 (2)	2 (1)	21 (1)
Stopped permanently	6 (1)	2 (1)	8 (1)
Patients with ESA stop or change – n (%)	29 (3)	5 (2)	34 (2)
Reason for ESA stop or change – n (%)
Anemic, but not responding	5 (<1)	2 (1)	7 (<1)
Anemic but experienced AE	3 (<1)	0 (0)	3 (<1)
Anemia resolved	16<(1)	2 (1)	18 (1)
Other	5 (<1)	1 (<1)	6 (<1)
Patients with evidence of iron (IV and/or oral) use at visit – n (%)	74 (7)	7 (2)	81 (6)
IV iron data – n (%)
No iron prescribed	1048 (93)	275 (98)	1323 (94)
Ongoing (without change)	20 (2)	0 (0)	20 (1)
Initiated at visit	10 (1)	0 (0)	10 (1)
Dose or schedule changed	3 (<1)	0 (0)	3 (<1)
Stopped temporarily	2 (<1)	0 (0)	2 (<1)
Stopped permanently	0 (0)	0 (0)	0 (0)
Missing	47 (4)	7 (2)	54 (4)
Oral iron data – n (%)
No iron prescribed	1048 (93)	275 (98)	1323 (94)
Ongoing (without change)	31 (3)	4 (1)	35 (2)
Initiated at visit	10 (1)	3 (1)	13 (1)
Dose or schedule changed	0 (0)	0 (0)	0 (0)
Stopped temporarily	3 (<1)	0 (0)	3 (<1)
Stopped permanently	0 (0)	0 (0)	0 (0)
Missing	38 (3)	0 (0)	38 (3)
Patients with iron (IV and/or oral) stop or change – n (%)	8 (1)	0 (0)	8 (1)
Reason for iron stop or change – n (%)
Anemic, but not responding	3 (<1)	0 (0)	3 (<1)
Anemic but experienced AE	0 (0)	0 (0)	0 (0)
Anemia resolved	3 (<1)	0 (0)	3 (<1)
Other	2 (<1)	0 (0)	2 (<1)

Note:

a Patients may be recorded in multiple categories.

Abbreviations: AE, adverse event; ESA, erythropoiesis-stimulating agent; IV, intravenous.

Table 6 Transfusions (red blood cell or whole blood), ESA use and iron supplementation by tumor type (solid tumor or hematologic malignancy)

	Solid tumor						Hematological malignancy
	Breast (n = 255)	Lung (n = 197)	Prostate (n = 36)	Colorectal (n = 256)	Other (n = 392)	Total (n = 1136)	NHL (n = 139)	Other (n = 137)	Total (n = 276)
Patients with evidence of transfusion at visit – n (%)	7 (3)	11 (6)	3 (8)	3 (1)	30 (8)	54 (5)	20 (14)	17 (12)	37 (13)
Transfusion dataa – n (%)
Within 28 days before visit	6 (2)	6 (3)	2 (6)	3 (1)	25 (6)	42 (4)	20 (14)	10 (7)	30 (11)
Ordered at visit	2 (1)	5 (3)	1 (3)	0 (0)	5 (1)	13 (1)	3 (2)	8 (6)	11 (4)
No transfusion/transfusion >28 days ago	248 (97)	186 (94)	33 (92)	362 (92)	362 (92)	1082 (95)	119 (86)	120 (88)	239 (87)
Patients with evidence of ESA use at visit – n (%)	20 (8)	34 (17)	8 (22)	10 (4)	72 (18)	144 (13)	22 (16)	22 (16)	44 (16)
ESA data – n (%)
No ESA prescribed	231 (91)	160 (81)	27 (75)	243 (95)	312 (80)	973 (86)	113 (81)	114 (83)	227 (82)
Ongoing (without change)	15 (6)	19 (10)	4 (11)	6 (2)	53 (14)	97 (9)	18 (13)	20 (15)	38 (14)
Initiated at visit	4 (2)	11 (6)	2 (6)	3 (1)	17 (4)	37 (3)	4 (3)	2 (1)	6 (2)
Dose or schedule changed	2 (1)	1 (1)	0 (0)	1 (<1)	0 (0)	4 (<1)	1 (1)	0 (0)	1 (<1)
Stopped temporarily	2 (1)	4 (2)	2 (6)	3 (1)	6 (2)	17 (1)	3 (2)	1 (1)	4 (1)
Stopped permanently	1 (<1)	2 (1)	1 (3)	0 (0)	4 (1)	8 (1)	0 (0)	0 (0)	0 (0)
Patients with ESA stop or change – n (%)	5 (2)	7 (4)	3 (8)	4 (2)	10 (3)	29 (3)	4 (3)	1 (1)	5 (2)
Reason for ESA stop or change – n (%)
Anemic, but not responding	1 (<1)	3 (2)	1 (3)	0 (0)	2 (1)	7 (1)	0 (0)	0 (0)	0 (0)
Anemic but experienced AE	0 (0)	1 (1)	1 (3)	1 (<1)	0 (0)	3 (<1)	0 (0)	0 (0)	0 (0)
Anemia resolved	3 (1)	0 (0)	1 (3)	3 (1)	7 (2)	14 (1)	3 (2)	1 (1)	4 (1)
Other	1 (<1)	3 (2)	0 (0)	0 (0)	1 (<1)	5 (<1)	1 (1)	0 (0)	1 (0)
Patients with evidence of iron (IV and/or oral) use at visit – n (%)	15 (6)	11 (6)	4 (11)	11 (4)	38 (10)	79 (7)	2 (1)	0 (0)	2 (1)
IV iron data – n (%)
No iron prescribed	240 (94)	186 (94)	32 (89)	244 (95)	347 (89)	1049 (92)	137 (99)	137 (100)	274 (99)
Ongoing (without change)	2 (1)	5 (3)	3 (8)	0 (0)	10 (3)	20 (2)	0 (0)	0 (0)	0 (0)
Initiated at visit	0 (0)	2 (1)	0 (0)	3 (1)	5 (1)	10 (1)	0 (0)	0 (0)	0 (0)
Dose or schedule changed	2 (1)	1 (1)	0 (0)	0 (0)	0 (0)	3 (<1)	0 (0)	0 (0)	0 (0)
Stopped temporarily	0 (0)	0 (0)	0 (0)	0 (0)	2 (1)	2 (<1)	0 (0)	0 (0)	0 (0)
Stopped permanently	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Missing	11 (4)	3 (2)	1 (3)	9 (4)	28 (7)	52 (5)	2 (1)	0 (0)	2 (1)
Oral iron data – n (%)
No iron prescribed	240 (94)	186 (94)	32 (89)	244 (95)	347 (89)	1049 (92)	137 (99)	137 (100)	274 (99)
Ongoing (without change)	7 (3)	3 (2)	0 (0)	5 (2)	19 (5)	34 (3)	1 (1)	0 (0)	1 (<1)
Initiated at visit	4 (2)	0 (0)	1 (3)	3 (1)	4 (1)	12 (1)	1 (1)	0 (0)	1 (<1)
Dose or schedule changed	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Stopped temporarily	0 (0)	0 (0)	0 (0)	1 (<1)	2 (1)	3 (<1)	0 (0)	0 (0)	0 (0)
Stopped permanently	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Missing	4 (2)	8 (4)	3 (8)	3 (1)	20 (5)	38 (3)	0 (0)	0 (0)	0 (0)
Patients with iron (IV and/or oral) stop or change – n (%)	2 (1)	1 (1)	0 (0)	1 (<1)	4 (1)	8 (1)	0 (0)	0 (0)	0 (0)
Reason for iron stop or change – n (%)	2 (1)	1 (1)	0 (0)	1 (<1)	4 (1)	8 (1)	0 (0)	0 (0)	0 (0)
Anemic, but not responding	2 (1)	1 (1)	0 (0)	0 (0)	0 (0)	3 (<1)	0 (0)	0 (0)	0 (0)
Anemic but experienced AE	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Anemia resolved	0 (0)	0 (0)	0 (0)	1 (<1)	2 (1)	3 (<1)	0 (0)	0 (0)	0 (0)
Other	0 (0)	0 (0)	0 (0)	0 (0)	2 (1)	2 (<1)	0 (0)	0 (0)	0 (0)

Note:

a Patients may be recorded in multiple categories.

Abbreviations: AE, adverse event; ESA, erythropoiesis-stimulating agent; IV, intravenous; NHL, non-Hodgkin’s lymphoma.