Significant Relationship Between Hemoglobin (Hb) Levels and Quality of Life (QOL) During Chemoradiation: Findings From an Incremental Analysis of a 442-Patient, Prospective, Community-Based Epoetin Alfa Study

Reviewer: Heather Jones, MD
Last Modified: October 7, 2002

Presenter: D. Shasha
Presenter's Affiliation: The Charles & Bernice Blitman Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, USA
Type of Session: Scientific


    Anemia is a frequent complication of cancer and its associated treatment. Its prevalence and severity are well documented in the medical and radiation oncology literature. The positive effect of the use of Epoetin Alfa is well documented in the medical oncology setting but, less so in the radiation oncology setting. This study evaluates data from a prospective, 16-week, community-based study of once-weekly epoetin alfa in 442 eligible (ie, Hb <=11 g/dL) solid tumor patients receiving curative-intent concomitant or sequential chemoradiation, an incremental (marginal) analysis. The analysis was conducted to examine the relationship between Hb and QOL and to identify the change in Hb level associated with the greatest QOL gain.

Materials and Methods

  • QOL was evaluated using a 100-mm linear analog scale assessment (LASA) of Activity, Energy, and Overall QOL.
  • Correlation analysis was used to evaluate the relationship between Hb and LASA scores. Data were further evaluated to determine the Hb level at which a 1-g/dL increase produced the greatest QOL benefit.
  • Control variables for the incremental analysis included age, gender, ethnicity, tumor type, transfusion status, number of units transfused, presence of radiation therapy, presence of chemotherapy, and baseline QOL.


  • There was a positive correlation between higher Hb levels and higher Activity, Energy, and Overall QOL scores, with correlation coefficients of 0.33, 0.32, and 0.29, respectively (p<0.05 for each value).
  • Increases in linear analog scale assessment were noted across the clinically relevant Hb range of 8-14 g/dL.
  • The greatest linear analog scale assessment increase on all scales per 1-g/dL change in Hb occurred when the Hb level increased from 11-12 g/dL.

Author's Conclusions

    There is a significant correlation between Hb and QOL at all Hb levels assessed in patients receiving combined or sequential radiation and chemotherapy. Improvement in QOL is seen with each 1-g/dL increase in Hb, with maximal incremental gain in QOL achieved when Hb is increased from 11-12 g/dL. QOL and functional status in anemic cancer patients receiving radiation and chemotherapy is improved with use of Epoetin alfa. QOL and functional status improvements can be attributed to Hb increases, demonstrating the importance of early (ie, Hb <=12 g/dL) and aggressive treatment of anemia in these patients. Treatment of anemia commonly encountered in irradiated cancer patients provides an opportunity to improve postradiation outcomes and well-being.

Clinical/Scientific Implications

    Anemia occurs in a significant number of patients with cancer, and is associated with symptoms of fatigue, dizziness, headache and decreased health-related quality of life. Clinical trials have demonstrated the ability of epoetin alfa to increase hemoglobin concentrations and reduce transfusion requirements in patients with cancer. This well done prospective study demonstrates the utility of Epoetin alfa in the radiation oncology population. Given the frequency of adverse sequelae associated with anemia, its aggressive management should become an integral and routine part of cancer treatment.

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