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Erythropoietin May Worsen Mortality in Cancer Patients

Last Updated: May 01, 2009.

The use of erythropoiesis-stimulating agents to treat anemia in cancer patients worsens mortality, according to two separate reviews of past clinical studies.

FRIDAY, May 1 (HealthDay News) -- The use of erythropoiesis-stimulating agents to treat anemia in cancer patients worsens mortality, according to two separate reviews of past clinical studies.

In one review reported in the May 2 issue of The Lancet, Julia Bohlius, M.D., of the University of Bern in Switzerland, and colleagues conducted a meta-analysis of 53 randomized trials enrolling 13,933 cancer patients that compared erythropoiesis-stimulating agents plus red blood cell transfusion with transfusion alone. The analysis found that erythropoiesis-stimulating agents increased mortality during the study period in comparison to transfusion alone (combined hazard ratio, 1.17) and in follow-up (cHR, 1.06). For patients on chemotherapy, mortality also was increased during the study period (cHR, 1.10) and in follow-up (cHR, 1.04).

In the other review published online April 30 in CMAJ, the journal of the Canadian Medical Association, Marcello Tonelli, M.D., of the University of Alberta in Edmonton, Canada, and colleagues conducted a review of 52 randomized trials enrolling 12,006 patients that compared the use of erythropoiesis-stimulating agents for anemia with controls receiving placebo or nothing. The authors found that all-cause mortality was significantly higher for those receiving erythropoiesis-stimulating therapy compared to controls (relative risk, 1.15), as was risk of thrombosis (RR, 1.69) and adverse events (RR, 1.16). However, erythropoiesis-stimulating agents were associated with reduced blood transfusions (RR, 0.64) and significantly improved quality of life.

"Our findings suggest that such therapy not be used routinely as an alternative to blood transfusion in patients with anemia related to cancer," Tonelli and colleagues conclude.

Abstract - Bohlius (The Lancet)
Full Text (subscription or payment may be required)
Full Text - Tonelli (CMAJ)


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