Date Published: 
Thursday, 2 October, 2014

How does iron deficiency affect clinical outcomes in patients with cancer?

Iron deficiency can have a significant, deleterious effect on quality of life in patients with specific types of cancer. Evidence suggests a correlation between iron deficiency and poor Eastern Cooperative Oncology Group (ECOG) performance status in patients with solid tumours; however no such correlation is observed in patients with haematological malignancies1.

Iron deficiency also correlates with significant impairment of physical, immunological and cognitive function, and fatigue, in patients with non-malignant tumours1,2.

Iron deficiency without anaemia

There are few studies available on the clinical consequences of iron deficiency in non-anaemic cancer patients. However, studies in non-cancer populations have demonstrated that correction of iron deficiency – in the absence of anaemia – can significantly increase quality of life2. It has also been shown that successful treatment of iron deficiency before the onset of anaemia can reduce the need for more intensive treatments, such as blood transfusions or ESA therapy3.

Iron deficiency anaemia in cancer patients

Evidence from studies in iron deficient cancer patients with anaemia highlights the importance of monitoring blood iron parameters4,5. There is a direct correlation between quality of life and haemoglobin levels in cancer patients receiving chemotherapy. Furthermore, treatment of chemotherapy-related iron deficiency anaemia with intravenous iron and ESA therapy significantly increases haemoglobin levels, with consequential increases in energy, activity, and overall quality of life compared with baseline6.

Iron deficiency anaemia is also correlated with a lower performance status, a marker of disease severity assessed using the World Health Organization Performance Score (an older equivalent of the ECOG score)4,5.