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NICE publishes guidance on treating anaemia for cancer patients on chemotherapy

written by

Leukaemia Care, Charity

  • carer

The National Institute for Health and Care Excellence (NICE) have today issued guidance on the treatment of anaemia in cancer patients. The guidance recommends the use of Erythropoiesis-stimulating agents epoetin and darbepoetin for treating anaemia in people with cancer having chemotherapy. NICE reviewed Epoetins (alfa, beta, theta and zeta) and Darbepoetin (alfa), all of which stimulate red blood cell production (erythropoiesis). Erythropoiesis-stimulating agents should be available on the NHS within 3 months of the guidance being issued.

Anaemia is defined as ‘a reduced haemoglobin concentration, reduced red cell count, or packed cell volume below normal levels’; leading to a reduced amount of oxygen carried around in the bloodstream. Anaemia can compromise the effectiveness of cancer treatment by disrupting treatment cycles, reduce survival and cause symptoms that affect quality of life.

Whilst there are a variety of potentially non-cancer related causes of anaemia such as low iron levels, certain systemic problems, poor diet or heavy blood loss, cancer patients are particularly at risk of developing anaemia from either the cancer itself (depending on tumour type) or particular cancer treatments.

Cancer itself can cause anaemia indirectly through a number of mechanisms. For example, infiltration of the bone marrow by cancer cells impairing red blood cell production; reduced appetite associated with cancer can lead to anaemia through nutritional deficiencies (particularly low levels of iron and folate, both of which are essential for healthy red blood cell production); blood loss into or from tumours; and cancer-associated kidney damage. Treatments can also cause anaemia by suppressing the production of red blood cells in the bone marrow. This is usually temporary, but cumulative damage can occur over several chemotherapy cycles.

Anaemia symptoms vary depending on its severity, but the most common symptom is severe fatigue. Fatigue can have a striking impact on a patient’s quality of life, and that patient’s ability to function in day to day living, and with chemotherapy induced anaemia in blood cancer patients the fatigue is usually very severe. Other symptoms range from headaches, shortness of breath, palpitations and tachycardia (increased heart rate) in mild anaemia, to severe organ damage in chronic anaemia.

A full copy of the NICE guidance ‘Erythropoiesis-stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy (including review of TA142)’ is available on the NICE website here.