Anemia and Cancer

This chapter explores the management of anemia in older cancer patients. Cancer is a disease of aging: more than 50% of all malignancies currently occur in the 12% of the population aged 65 and over; by the year 2030 older individuals are expected to account for 20% of the population and 70% of all cancer cases (1). Though not unique of older individuals, anemia is a common manifestation of cancer, especially of advanced cancer (2). The elderly are expected to suffer disproportionately of cancer-related anemia, because cancer becomes more common with age and because age itself is a risk factor for anemia (1–3).

Anemia is detrimental to cancer patients, because it compromises patient well-being, and it may increase the complications and reduce the benefits of antineoplastic treatment (2). Anemia of chronic inflammation (ACI) and of chemotherapy are the most common forms of anemia in cancer patients and both respond to pharmacological doses of erythropoietin (2, 4). The availability of a number of synthetic erythropoiesis-stimulating factors (ESF) that mimic the action of erythropoietin has allowed the correction of anemia in the majority of cancer patients.

After reviewing the pathogenesis of anemia we will examine the consequences of anemia for the older cancer patients and the benefits and potential risks of treatment with ESF.