The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients☆
Introduction
Cancer-associated anaemia decreases patients’ quality of life (QOL) and may affect clinical treatment [1], [2], [3]. Anaemia is independently associated with shorter survival times in patients with cancer [4], and correction of anaemia may have a positive impact on treatment outcomes [5], [6], [7], [8]. Therefore, optimal management of anaemia appears to be a critical component of cancer treatment [1].
To date, information on the prevalence and effects of anaemia have come from clinical trials of anaemia treatments [5], [9], [10], [11], [12] or cytotoxic agents [13] that present results from protocol-defined patient populations and often have very low haemoglobin definitions for anaemia that are based on blood transfusion data. Sorely lacking has been a survey of cancer-related anaemia as it occurs in the overall cancer population, i.e., the prevalence and incidence of mild and moderate anaemia, as well as severe anaemia. The European Cancer Anaemia Survey (ECAS) was conducted to document the prevalence, incidence, evolution, severity and management of anaemia in a large, representative population of European cancer patients. Especially important is the effect of mild-to-moderate anaemia on patients who might not be treated according to the American Society of Hematology/American Society of Clinical Oncology (ASH/ASCO) guidelines, i.e., patients with haemoglobin between 10.0 g/dL and 12.0 g/dL [14].
This report describes the methodology of ECAS and provides patient data that focuses on the population enrolled, the prevalence of anaemia, the effect of mild, moderate and severe anaemia on performance status, the incidence of anaemia during the survey, and anaemia treatment patterns.
Section snippets
Survey design
ECAS was a prospective, epidemiological, observational survey conducted in 24 European countries. There were no controlled conditions except that only cancer treatment centres participated. Because the protocol specified that only oncology centres be included, all cancers are well represented except prostate cancer, which in Europe frequently is treated by the urologist. Data were collected by convenience sampling defined overall by EUCAN Sampling Distribution for prevalence of tumour types by
Results
Results are reported for data from 748 cancer centres in 24 European countries with over 1000 physicians participating. Fig. 1 summarises the disposition of the patient population. For the enrollment population of 15 367 patients, only enrollment demographics are reported. Of patients enrolled, 10 476 (68.2%) finished the survey and had an end-of-survey form, 1431 (9.3%) died, 1470 (9.6%) were lost to follow-up or withdrew, 1858 (12.1%) were missing an end-of-survey form, and 132 (0.9%) had an
Discussion
ECAS has revealed a high prevalence and incidence of anaemia in cancer patients in Europe. At ECAS enrollment, 39.3% of patients had haemoglobin levels <12.0 g/dL. The prevalence of anaemia increased to 67.0% for patients in whom low haemoglobin values (<12.0 g/dL) were recorded at least once during the survey. Most patients who began chemotherapy during ECAS became anaemic, most likely a reflection of the type and intensity of cancer therapy. The incidence of anaemia in a well-defined
Conflict of interest statement
Peter Barrett-Lee, Gunnar Birgegård, Carsten Bokemeyer, Pere Gascón, Paris Kosmidis, Maciej Krzakowski, Heinz Ludwig, Johan Nortier, Patrizia Olmi, Maurice Schneider, Dirk Schrijvers and Simon Van Belle do not have any financial interests, such as owning stock, consulting or performing contracted work for any company.
Gunnar Birgegård, Carsten Bokemeyer and Heinz Ludwig have received honoraria from Amgen.
Peter Barrett-Lee, Gunnar Birgegård, Carsten Bokemeyer, Maciej Krzakowski and Heinz Ludwig
References (25)
- et al.
Symptomatology of anemia
Semin. Oncol.
(2001) - et al.
Impact of haemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx
Int. J. Radiat. Oncol. Biol. Phys.
(2001) - et al.
Estimates of cancer incidence and mortality in Europe in 1995
Eur. J. Cancer
(2002) - et al.
Appraisal of methods of study of chemotherapy in cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide
J. Chronic. Disease
(1960) BEST Investigators and Study Group. Breast cancer trial with erythropoietin terminated unexpectedly
Lancet Oncol.
(2003)- et al.
Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial
Lancet
(2003) Guidelines for the use of epoetin in cancer patients: a much-needed step forward in standardizing anemia treatment
Blood
(2003)Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy
Br. J. Cancer
(2001)Anemia and fatigue in cancer patients
Cancer
(2001)- et al.
Anaemia is an independent prognostic factor for survival in patients with cancer
Cancer
(2001)
Effects of epoetin alfa on haematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial
J. Clin. Oncol.
The importance of haemoglobin levels during radiotherapy for carcinoma of the cervix
Cancer
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Sponsored by an educational grant from Ortho Biotech Europe, a division of Janssen-Cilag.