Introduction: Anemia and anemia related symptoms are common in patients with advanced cancer. The most common reasons are anti cancer therapy, haemorrhage, insufficient amounts of B12, Fe and folic acid and the cancer itself including bone marrow involvement of metastases. Blood transfusion is standard treatment for anemia related symptoms in palliative care and Hb concentration is rarely in itself an indication for transfusion in this setting. EPO may be an alternative to transfusion but indications and cost effectiveness is not sufficiently studied. The aim of the present study was to follow patient symptoms and Hb concentrations after EPO treatment.
Methods: Patients treated with EPO (darbopoetin) at our home care unit were prospectively followed. All patients had a prognosis > 2 months and a Hb concentration of less than 100 g/l (n=9) or less than <110 (n=12). Quality of life (QL) was assessed through Visual Analogue Scales (VAS) for fatigue and well-being.
Results: A total of 21 patients were included. 4/9 patients receiving EPO at Hb<100 g/l reported a positive QL response to treatment. The mean increase in Hb was 58% (mean 13% for non responders). 10/12 patients receiving EPO at HbB/110 reported a positive QL response at a mean Hb increase of 34% (9% for non responders). None of the patients that died <7 weeks after start of EPO treatment had an increase in QL irrespective of Hb increase. No severe side effects were reported.
Conclusion: EPO treatment may give an increase in Hb and a subsequent better QL in palliative care patients with end stage cancer. In the last weeks of life no positive effect was seen. Possible positive indications for EPO in this setting and costs will be discussed.