Prevalence of Anemia and Compliance With NCCN Guidelines for Evaluation and Treatment of Anemia in Patients With Gynecologic Cancer

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  • 1 Vanderbilt University School of Medicine;
  • | 2 Department of Obstetrics and Gynecology, Vanderbilt University Medical Center;
  • | 3 Meharry Medical College School of Medicine; and
  • | 4 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and
  • | 5 Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Background: NCCN recommends evaluation and treatment of all patients with cancer who have anemia. Few studies have evaluated the prevalence of anemia among patients with gynecologic cancer and compliance with the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Hematopoietic Growth Factors. Methods: We performed a single-institution retrospective cohort study of patients diagnosed with primary gynecologic cancer between 2008 and 2018. We identified tumor registry–confirmed patients using ICD-O codes from the Synthetic Derivative database, a deidentified copy of Vanderbilt’s electronic medical records. Patients were included if they were between ages 18 and 89 years, received initial care at Vanderbilt University Medical Center, and had a hemoglobin measurement within the first 6 months of diagnosis. Anemia was defined as a hemoglobin level ≤11 g/dL and was graded using CTCAE version 5.0. Results: A total of 939 patients met inclusion criteria, with a median age of 60 years. The most common malignancy was uterine cancer. At the time of cancer diagnosis, 186 patients (20%) were noted to have anemia. Within 6 months of diagnosis, 625 patients (67%) had anemia, of whom 200 (32%) had grade 3 anemia and 209 (33%) underwent any evaluation of anemia, including 80 (38%) with iron studies performed. Of the patients with iron studies performed, 7 (9%) had absolute iron deficiency and 7 (9%) had possible functional iron deficiency. Among those with anemia within 6 months of diagnosis, 260 (42%) received treatment for anemia, including blood transfusion (n=205; 79%), oral iron (n=57; 22%), intravenous iron (n=8; 3%), vitamin B12 (n=37; 14%), and folate supplementation (n=7; 3%). Patients with ovarian cancer were significantly more likely to have anemia and undergo evaluation and treatment of anemia. Conclusions: Anemia is pervasive among patients with gynecologic cancer, but compliance with the NCCN Guidelines is low. Our data suggest that there are opportunities for improvement in the evaluation and management of anemia.

Submitted May 1, 2020; accepted for publication August 11, 2020. Published online February 1, 2021.

Author contributions: Study concept and design: Brown, Prescott. Data collection and assembly: Hufnagel, Mehta, Ezekwe. Data analysis and interpretation: Hufnagel, Beeghly-Fadiel, Prescott. Writing – original draft: Hufnagel, Prescott. Table preparation: Hufnagel, Beeghly-Fadiel, Prescott. Writing – review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: The project described was supported by CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health

Correspondence: Lauren Shore Prescott, MD, MPH, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, B1100 Medical Center North, Nashville, TN 37232-2516. Email: lauren.prescott@vumc.org

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