A survey of the current status of cancer-related anemia in 1006 advanced cancer patients undergoing third-line or higher anti-cancer treatment: a multicenter retrospective study in nine tertiary hospitals in Beijing area

Abstract Objective To clarify the incidence and current status of anemia related to third-line or higher anti-cancer treatments in advanced tumors, providing a basis for clinical practice and medication strategies for Cancer-Related Anemia (CRA). Methods A retrospective cross-sectional study was conducted from June 2018 to June 2023, analyzing the medical records of 1006 patients with anemia related to advanced malignant tumors of the third line or above who visited nine tertiary hospitals in the Beijing area. We determined the incidence of anemia, analyzed anemia grading and anti-anemia treatment status, and performed regression analysis to identify risk factors for severe anemia. Results The study surveyed 1546 patients with advanced tumors of the third line or above, of which 1006 had anemia, with an incidence rate of 65.1%. The average hemoglobin (HGB) level of the 1006 anemic patients was 96.85 ± 14.32 g/L, with mild anemia accounting for 51.3%, moderate anemia for 35.8%, severe anemia for 10.2%, and extremely severe anemia for 2.7%. In terms of red blood cell morphology, normocytic anemia was predominant (75.3%), followed by macrocytic anemia (20.7%), with microcytic anemia being the least common (4.0%). In terms of anemia severity across tumor types, advanced lung cancer and gastrointestinal tumors had the highest proportions of mild anemia, at 56.2% (205/365) and 55.4% (215/388), respectively, while the incidence of severe anemia in gynecologic tumors was 18.2% (20/110), significantly higher than that in advanced lung cancer (6.3%) and breast cancer (6.0%) ( P < 0.05). Regarding anemia treatment, 22.4% (225/1,006) of patients received anti-anemia therapy, with treatment rates of only 10.1% (52/516) for mild anemia, compared with 59.2% (61/103) for severe anemia and 96.3% (26/27) for very severe anemia. Multivariate logistic regression analysis demonstrated that a KPS score ≥ 60 was associated with an approximately 62% reduction in the incidence of severe anemia (OR = 0.38, 95% CI: 0.20–0.70, P = 0.002). Among cancer types, both gynecologic tumors (OR = 3.33, 95% CI: 1.49–7.45, P = 0.003) and gastrointestinal tumors (OR = 1.83, 95% CI: 1.01–3.30, P = 0.046) were associated with a significantly higher risk of severe anemia compared with lung cancer. In addition, a prior history of blood transfusion was associated with a 76% increase in the risk of severe anemia (OR = 1.76, 95% CI: 1.03–3.02, P = 0.040). Age, gender, history of prior tumors, third-line antineoplastic treatment regimen, stage IV disease at initial diagnosis, liver metastasis, and lung metastasis were not independently associated with the development of severe anemia in patients with advanced cancer (all P > 0.05). Conclusions The incidence of anemia related to third-line and subsequent anti-tumor therapies in patients with advanced malignancies is relatively high, whereas the overall treatment rate remains low. Favorable physical performance status may reduce the risk of severe anemia in cancer patients. Patients with gynecological or gastrointestinal tumors carry a higher risk of severe anemia compared to those with lung cancer. Greater attention and standardized management of anemia should be implemented among cancer patients.