“The NCCN Cancer and Treatment-Related Anemia Guidelines were developed to assist clinicians in making decisions about when and how to treat cancer and treatment-related anemia. In particular, these guidelines focus on the type of anemia associated with chronic disease and review the available data guiding the use of erythropoietin in these patients. ” said Paul Sabbatini, MD, Assistant Attending Physician in the Developmental Chemotherapy Service at Memorial Sloan-Kettering Cancer Center and chairman of the NCCN Anemia Guidelines Panel.
Anemia may be caused by a variety of factors. In cancer patients, it often occurs in the setting of normal serum iron levels and is associated with inappropriately low serum erythropoietin production. Symptoms of anemia in patients range from shortness of breath, rapid heartbeat, and dizziness to inability to concentrate, weakness and fatigue. Available data support the concept that fatigue in patients with cancer is a multifactorial entity, and anemia represents a treatable subset of a very complex problem. Prior to the development of erythropoietin, the only way to treat patients with cancer and treatment-related anemia was with transfusion. The availability of erythropoietin provides a transfusion alternative in certain settings, and provides the ability to maintain hemoglobin in the normal range.
The NCCN guidelines recommend that patients with hemoglobin levels of < 11 g/dl enter the screening portion of the algorithm. If immediate correction with transfusion is not necessary, the pathways guide the clinician through an assessment of the potential risk of requiring transfusion, as well as an assessment of patient symptoms which may be anemia related. The data addressing the impact of erythropoietin in regards to transfusion reduction and the potential for symptom improvement is reviewed, and guidelines for erythropoietin use based on the available evidence are provided.
Recognizing the multifactorial nature of cancer-related fatigue, the NCCN and the American Cancer Society (ACS) have also released a complementary patient information resource. “The NCCN/ACS Cancer-Related Fatigue Treatment Guidelines for Patients are an important tool to help patients discuss their fatigue with their physicians,” stated William T. McGivney, Ph.D., Chief Executive Officer of the NCCN. “These guidelines also address treatment options for other causes of cancer-related fatigue including pain, emotional distress, sleep problems and decreased thyroid function.”
The NCCN/ACS Cancer-Related Fatigue Treatment Guidelines for Patients are part of a series to help patients and their families make more informed decisions regarding their treatment. Available in both English and Spanish, the series covers other supportive care topics such as nausea and vomiting and cancer pain and provides information on cancer of the prostate, breast, colon and rectum, and lung. These materials are all available on-line at www.nccn.org or by sending a letter to NCCN, 50 Huntingdon Pike, Suite 200, Rockledge, PA 10946, or faxing a letter of request to 215-728-3877. Patient Guidelines may also be ordered by calling NCCN (1-888-909-NCCN) or ACS (1-800-ACS-2345).
Founded in 1995, the NCCN is dedicated to advancing the missions of its member institutions in education, research and patient care. As part of its mission, the NCCN serves as the most authoritative source of cancer care information for health professionals based upon the expertise and input of its world-renowned clinicians. The NCCN member institutions are:
The Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at Ohio State University - Columbus, Ohio
City of Hope Cancer Center - Los Angeles, California
Dana-Farber Cancer Institute - Boston, Massachusetts
Duke Comprehensive Cancer Center - Durham, North Carolina
Fox Chase Cancer Center - Philadelphia, Pennsylvania
Fred Hutchinson Cancer Research Center - Seattle, Washington
H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida - Tampa, Florida
Huntsman Cancer Institute at the University of Utah - Salt Lake City, Utah
Memorial Sloan-Kettering Cancer Center - New York, New York
Robert H. Lurie Comprehensive Cancer Center of Northwestern University - Chicago, Illinois
Roswell Park Cancer Institute - Buffalo, New York
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins - Baltimore, Maryland
St. Jude Children's Research Hospital - Memphis, Tennessee
Stanford Hospital and Clinics - Stanford, California
University of Alabama at Birmingham Comprehensive Cancer Center - Birmingham, Alabama
UCSF Comprehensive Cancer Center - San Francisco, California
University of Michigan Comprehensive Cancer Center - Ann Arbor, Michigan
UNMC/Eppley Cancer Center at the University of Nebraska Medical Center - Omaha, Nebraska
University of Texas M. D. Anderson Cancer Center, Houston, Texas