Abstract
Introduction and background
Epoetin alfa is known to produce a hematological response in anemic cancer patients. A concomitant reduction in fatigue as well as an improvement of depression and anxiety and of quality of life has been reported. However, these effects are discussed controversially. Psychological variables may have a moderating effect on fatigue reduction.
Materials and methods
Fifty-four anemic cancer outpatients were treated with epoetin alfa over 26 weeks with an initial dose of 3×10,000 IU/week and further individually adapted dosage. Hemoglobin level, fatigue, depression, anxiety, and health-related quality of life were measured every 4 weeks.
Results
The hematological response rate was 50%, with 1/3 occurring after more than 8 weeks of treatment. Fatigue, depression, and quality of life improved significantly. Reduction in fatigue was associated with response, but the correlations between fatigue and hemoglobin were weak. Less depression and higher quality of life before treatment correlated with a better fatigue reduction when controlling for hemoglobin increase and initial fatigue level.
Conclusion
Psychological variables influence the reduction of fatigue during therapy with epoetin alfa in anemic cancer patients and should therefore be assessed at the beginning of treatment.
Similar content being viewed by others
References
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Barnes EA, Bruera E (2002) Fatigue in patients with advanced cancer: a review. Int J Gynecol Cancer 12:424–428
Bohlius J, Langensiepen S, Schwarzer G, Seidenfeld J, Piper M, Bennet C, Engert A (2004) Erythropoietin for patients with malignant disease (Cochrane review). In: The Cochrane library, Issue 3. Wiley, Chichester
Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Osterborg A, Repetto L, Soubeyran P (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40:2201–2216
Cella D, Jin-Shei L, Chih-Hung C, Peterman A, Slavin M (2002) Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94:528–538
Cella D, Zagari MJ, Vandoros C, Gagnon DD, Hurtz HJ, Nortier JWR (2003) Epoetin alfa treatment results in clinically significant improvements in quality of life in anemic cancer patients when referenced to the general population. J Clin Oncol 21:366–373
Cella D, Kallich J, McDermott A, Xu X (2004) The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986
Glaus A (1998) Fatigue in patients with cancer—analysis and assessment. Recent results in cancer research. Springer, Berlin Heidelberg New York 145:54–76
Herrmann C, Buss U, Snaith RP (1993) HADS-D: hospital anxiety and depression scale (German version). Huber, Bern
Kallich JD, Tchekmedyian NS, Damiano AM, Shi J, Black JT, Erder MH (2002) Psychological outcomes associated with anemia-related fatigue in cancer patients. Oncology (Williston Park) 16(9 Suppl 10):117–124
Lipman AJ, Lawrence DP (2004) The management of fatigue in cancer patients. Oncology (Williston Park) 18:1527–1535
Littlewood TJ, Zagari M, Pallister C, Perkins A (2003) Baseline and early treatment factors are not clinically useful for predicting individual response to erythropoietin in anemic cancer patients. Oncologist 8:99–107
Ludwig H, Fritz E (1998) Anemia in cancer patients: patient selection and patient stratification for epoetin treatment. Semin Oncol 25:2–6
Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, Donnelly J, Eisenberger MA, Escalante C, Hinds P, Jacobsen PB, Kaldor P, Knight SJ, Peterman A, Piper BF, Rugo H, Sabbatini P, Stahl C, National Comprehensive Cancer Network (2000) NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park) 14:151–161
Nowrousian M, Kasper C, Oberhoff C (1996) Pathophysiology of cancer-related anemia. In: Smyth JF, Boogaerts MA, Ehmer BRM (eds) rhErythropoietin in cancer supportive treatment. Marcel Dekker, New York
Osterborg A, Boogaerts MA, Cimino R, Essers U, Holowiecki J, Juliusson G, Jager G, Najman A, Peest D for The European Study Group of Erythropoietin (Epoetin Beta) Treatment in Multiple Myeloma and Non-Hodgkin’s Lymphoma (1996) Recombinant human erythropoietin in transfusion-dependent anemic patients with multiple myeloma and non-Hodgkin’s lymphoma—a randomized multicenter study. Blood 87:2675–2682
Simon AN, Zittoun R (1999) Fatigue in cancer patients. Curr Opin Oncol 11:244–249
Stone P, Richards M, Hardy J (1998) Fatigue in patients with cancer. Eur J Cancer 34:1670–1677
Tchekmedyian NS, Kallich J, McDermott A, Fayers P, Erder MH (2003) The relationship between psychologic distress and cancer-related fatigue. Cancer 98:198–203
Vogelzang N, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK (1997) Patient, caregiver and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. Semin Hematol 34:4–12
Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes 1:79
Acknowledgments
We wish to thank Mrs. Susanne Herz for her effective work in patient coordination and data collection. The Leukämie-Initiative Bonn e.V. supports the research work of the group continuously. The study was supported by an unrestricted research grant from Ortho-Biotech/Janssen-Cilag, Germany.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geiser, F., Hahn, C., Conrad, R. et al. Interaction of psychological factors and the effect of epoetin alfa treatment in cancer patients on hemoglobin and fatigue. Support Care Cancer 15, 273–278 (2007). https://doi.org/10.1007/s00520-006-0132-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-006-0132-8