The clinical manifestation and severity of anaemia vary considerably among individual patients and is associated with its own set of debilitating signs and symptoms it can have a significant effect on morbidity and mortality, as well as on the level of care that patients require. Chronic anaemia can result in severe organ damage affecting the cardiovascular system, immune system, lungs, kidneys and the central nervous system. In addition to physical symptoms, the subjective impact of cancer-related anaemia on quality of life (QoL), mental health and social activities may be substantial. A common anaemia-related problem is fatigue, which impairs the patient’s ability to perform normal daily activities.
Tumour Hypoxia and Anaemia,the Impact on Treatment Efficacy
Another aspect of anaemia in patients with malignant disease is the effect on the tumour itself, and in several cancers such as cervical carcinoma, head and neck cancer, prostate and lung cancer it is associated with poor prognosis. Hypoxia is a characteristic pathophysiological property of solid tumours that occurs across a wide range of experimental and human malignancies. Hypoxic regions have been identified in locally advanced breast and cervical tumours, head and neck cancer, prostate cancer, pancreatic cancer, rectal cancer, brain tumours, soft tissue sarcoma and malignant melanoma. Tumour hypoxia, acting through direct or indirect mechanisms, or both, may contribute to resistance to radiotherapy, some chemotherapy regimens and chemo-radiation which can lead to a poorer clinical outcome.
Tumour cells can become resistant to cancer treatments because of hypoxia; this is due to decreased oxygen transport capacity as a result of tumour-associated anaemia, which can contribute to the development of hypoxia. Owing to an abnormal microenvironment, solid tumour tissue is often hypoxic. Hypoxia may be more prevalent in anaemic patients than in patients with normal haemoglobin (Hb) levels.