Erythropoiesis-stimulating agents in older adults with cancer
Introduction The prevalence of anemia in older persons is higher than in the general population and is associated with significant clinical symptoms and poorer prognosis in this group. An increased incidence of cancer and the use of cytotoxic agents in this population also places patients at increased risk of development of anemia and consequently may also increase their morbidity/mortality risk. Since the introduction of erythropoiesis-stimulating agents (ESAs), clinicians have sought potential uses of these agents to treat cancer-related anemia. Though studies demonstrated an improvement in anemia, reduction in blood transfusion, and improved quality of life, there was hope that mortality would also be improved. However, some recent reports have shown possible adverse effects of ESAs on tumor progression and survival in patients being treated for cancer. In this chapter, we review the effects of anemia on the prognosis of geriatric cancer patients, consider the rationale for use of ESAs versus other therapies for cancer-related anemia, and discuss some of the recent reports regarding potential adverse effects of ESAs, resulting in current guidelines of usage of ESAs. Prevalence and morbidity/mortality associated with anemia in the aged Anemia is significantly more prevalent in the aged population, and there are ample data to suggest that this is associated with poor outcomes. The prevalence of anemia by World Health Organization criteria (hgb less than 13 gm/dL in men and hgb less than 12 gm/dL in women) in the geriatric population has been reported to be approximately 11–28 percent in persons over 65 years of age.
