Date Published: 
Tuesday, 11 March, 2014

Iron deficiency in oncology

Iron deficiency is a frequent complication associated with cancer. In a single-centre study of 1528 patients presenting sequentially between 1 October 2009 and 20 January 2010, more than 40% had iron deficiency, defined as a transferrin saturation (TSAT) level of <20% (see figure below)1. Of these patients, 82% had functional iron deficiency (TSAT <20%, ferritin ≥30 ng/mL) and 18% had absolute iron deficiency (TSAT <20%, ferritin <30 ng/mL)1 (see 'Identification and diagnosis of iron deficiency' section of 'Iron Essentials').

The results show a high prevalence of iron deficiency across different tumour types, greater frequency in patients with a poor performance status, in those who have recently undergone chemotherapy treatment, and in those who have more persistent or progressive disease status. Additionally, iron deficiency positively correlated with tumour stage in patients with solid tumours. Iron deficiency was shown to occur in a greater proportion of patients than anaemia, highlighting the necessity to test for both individually1 (see 'Identification and diagnosis of iron deficiency' section of 'Iron Essentials').

Routine assessment of iron status in cancer patients may help improve patient outcomes for iron deficiency, such as impaired physical function, weakness and fatigue. Timely commencement of iron therapy may prevent the occurrence of iron deficiency, correct existing iron deficiency and anaemia, and ameliorate symptoms of iron deficiency1.

Figure 1. Prevalence of iron deficiency across tumour types for solid tumours (top) and haematological malignancies (bottom)1


Copyright permission obtained from Ludwig et al, 2013. Available here. By permission of Oxford University Press on behalf of the European Society for Medical Oncology.

© Not to be included under a Creative Commons license, or any other open-access license allowing onward reuse.

Iron deficiency with differing tumour type

Epidemiological evidence suggests that there is notable variation in the prevalence of iron deficiency between tumour types (see figure below)1,2. Iron deficiency has been shown to be more common than anaemia with almost all types of cancer, reinforcing the importance of screening for iron deficiency independently of anaemia in oncology patients.

Figure 2. Prevalence of iron deficiency and anaemia across different tumour types1

Copyright permission obtained from Ludwig et al, 2013.