(019) Incidence, Treatment Pattern, and Implications of Chemotherapy-Related Anemia in Patients with Solid Tumors in China: A Multicenter Retrospective Cohort Study

Background: Chemotherapy-related anemia (CRA) is prevalent in cancer patients, potentially impacting quality of life and tumor treatment outcomes. Data on the incidence and treatment of chemotherapy-related anemia in China, and its impact on chemotherapy are limited.

Objectives: To assess CRA incidence, current treatment patterns, and its association with chemotherapy dose delay or reduction (DDR) in Chinese solid tumor patients.

Methods: A retrospective cohort study was conducted using pooled data from 12 top-tier hospitals across China. Adult patients with solid tumors who started chemotherapy after April 2020 and completed at least 3 cycles of the same chemotherapy regimen were consecutively included, with follow-up until the termination of chemotherapy, change of chemotherapy regimen, completion of 8 chemotherapy cycles, or March 2022. Patients with existing anemia before chemotherapy initiation were excluded. Descriptive statistical analysis methods were used to analyze the incidence of anemia and the treatment pattern of anti-anemia medications during chemotherapy. Anemia was classified into 4 grades based on hemoglobin (Hb) levels, with higher grade indicating more severe anemia. Generalized linear mixed models were used to analyze the impact of CRA occurrence on DDR in the subsequent cycle, with adjustment of potential confounders.

Results: A total of 9294 eligible patients were included. Of these, 4187 (45.1%) were female; the median age (IQR) was 59 (52-67) years. During chemotherapy, the overall anemia incidence was 43.8%, with the mean lowest Hb level at 102.2 ± 12.7 g/L. The incidence rates of Grades 1 to 4 anemia were 29.1%, 12.1%, 2.1%, and 0.6%, respectively, with corresponding mean lowest Hb levels of 109.3 ± 5.6, 92.1 ± 5.4, 73.6 ± 4.2, and 54.4 ± 12.7 g/L.
Among patients with anemia, only 4.1%, 3.9%, 2.9%, and 3.0% received treatment with erythropoiesis-stimulating agents, oral iron, intravenous iron, and red blood cell transfusions, respectively. The treatment rate increased with the severity of anemia, with the highest being 53.8% in Grade 4 anemia.
During the study, the incidence rate of DDR was 59.1%. Compared to patients without anemia, Grade 1 anemia increased the risk of DDR by 26.7% (OR=1.27, 95%CI: 1.14-1.40), and Grades 2-4 anemia increased the risk of DDR by 75.6% (OR=1.76, 95%CI: 1.48-2.08).

Conclusions: Our study reveals a high incidence of CRA in patients with solid tumors in China, which can lead to subsequent chemotherapy delays or dose reductions, potentially affecting the efficacy of tumor treatment. However, the current anti-anemia treatment rate for CRA patients remains low, necessitating further investigation into the reasons and enhancement of anemia management in cancer chemotherapy patients.