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Oncologists often do not comply with National Comprehensive Cancer Network (NCCN) guidelines that recommend evaluating and treating anemia, including in patients with urologic cancers, researchers reported in a study presented at the

Lauren Prescott, MD, and colleagues at Vanderbilt University Medical Center in Nashville examined the records of patients with solid malignancies treated at their institution from 2008 to 2017; among the data on 25,018 patients, the most common tumors were urologic and respiratory cancers. Of these, 17% of the patients had been anemic at diagnosis and 44% were within 6 months of diagnosis. However, only 37% of patients underwent any kind of evaluation for anemia, and just 39% of those with the condition received any kind of treatment for it, the researchers reported.

"Anemia is common in patients with solid tumors, yet compliance with NCCN guidelines for evaluation and treatment of anemia remains low. There are opportunities to improve compliance with NCCN guidelines for management of anemia across the spectrum of cancer care," the authors concluded.

In the following interview, Prescott elaborated on the team's findings.

What led you to investigate this issue?

Prescott: I am a gynecologic oncologist who provides both surgical and medical management for patients with gynecologic cancers. We had previously investigated this topic in just gynecologic cancers and found similarly high rates of anemia and low compliance with the NCCN guidelines on evaluation of anemia. Given the significant impacts of anemia on quality of life and oncologic outcomes, we were very interested to see if this problem was unique to gynecologic oncology or was pervasive among all patients with cancer.

Why do you think compliance with the NCCN anemia guidelines remains low?

Prescott: I think the answer is multifactorial. First, patients care is often siloed with numerous providers caring for patients with cancer. It could be that this division makes providers less likely to take responsibility for anemia management.

Second, there is a sense of urgency to get patients treated, and often optimization of medical co-morbidities such as anemia may be overlooked. Third, perhaps providers do not realize that this is an important issue or they think that all anemia in cancer patients is related to anemia of chronic disease and not treatable.

For patients with kidney and bladder cancers, what are the potential consequences of untreated anemia?

Prescott: Anemia has been associated with increased morbidity and mortality, and decreased quality of life among cancer patients including those with kidney and bladder cancers. Preoperative anemia is a modifiable risk factor that is associated with poor surgical outcomes including increased transfusion rate, increased length of stay, and increased perioperative morbidity.

What can be done to improve compliance with the guidelines?

Prescott: We have embarked on a quality improvement initiative to improve compliance with the NCCN guidelines for patients with gynecologic cancers. At our institution there are simultaneous efforts to improve perioperative morbidity by treating anemia preoperatively.

We are utilizing a multidisciplinary team of anesthesiologists, hematologists, and surgeon leaders through our enhanced recovery after surgery program to optimize perioperative care. We believe there are similar opportunities at other institutions, either through enhanced recovery programs or multidisciplinary patient blood management programs.

Do you plan any additional research in this area?

Prescott: Yes, we are planning further research on the impact of our quality improvement initiative on compliance and outcomes.

Read the study here.