Anemia Linked to Functional Disability in Older Patients With Cancer

Anemia is common and associated with functional disability (FD) in patients with cancer aged ≥65 years, according to the results of a study presented at ASCO 2012.

Cynthia Owusu, MD, MSc, Case Western Reserve University, Cleveland, Ohio, and her coauthors conducted the study because they wanted information on the relationship between anemia and FD for such patients, specifically in an oncology setting.

“While anemia is associated with functional disability in older adults in general, this relationship has not been well characterized in older adults with cancer,” the authors wrote.

Ultimately, the results could spark further studies aimed at correcting anemia in these patients in order to improve their quality of life, the authors suggested.

Presented during a poster session at ASCO, the team’s investigation was a secondary analysis of baseline data from a multicenter prospective study that identified predictors of chemotherapy toxicity in 500 patients aged 65 to 91 years. The patients had lung, gastrointestinal, gynecologic, breast, genitourinary, or other cancers, with 61% having stage IV disease.

In the study, Owusu et al focused on the association between FD, anemia, and other pretreatment variables: age; tumor/treatment variables; lab results, including hemoglobin (Hb); social support; comorbidity; and assessments of functional, psychological, cognitive, and nutritional status. FD was defined as the need for assistance with one or more instrumental activities of daily living.

The mean Hb was 11.7 g/dL for patients with FD and 12.6 g/dL among patients without that condition. Based on World Health Organization criteria, anemia was defined in the study as Hb <12 g/dL for women and Hb <13 g/dL for men.

The investigators found that patients with anemia were more likely to report FD (53% vs 46%, P <.01). Of the variables studied that were associated with FD, anemia had the highest odds ratio (2.06; 95% CI, 1.39-3.05). Other variables associated with FD were increased age, increased comorbidity, advanced stage, and unintentional weight loss. The investigators concluded that anemia is not only “highly prevalent” in older adults with cancer, but that it is associated with FD in these patients.

To help this population of patients maintain their quality of life, the authors wrote, researchers should conduct “a prospective study to look for a causal link between anemia and FD; a correlative study to identify common biological and molecular pathways that underpin the relationship between anemia and FD; and a randomized, controlled trial to evaluate the correction of anemia as a modifiable strategy for improving functional status in older patients with cancer.”

The investigators conducted the study on behalf of the Cancer and Aging Research Group, a coalition of geriatric-oncology researchers from across the country who design and implement clinical trials aimed at improving the care of older adults with cancer.

Owusu C, Tew WP, Hardt M, et al. Anemia and functional disability in older adults with cancer. J Clin Oncol. 2012;30(suppl; abstr 9109).