Relationship between anemia, fatigue, and quality of life in cancer patients


Anemia is a common cause of morbidity among patients with malignancies, especially in those receiving aggressive chemotherapy and in patients with advanced stages of cancer (Groopman and Itri 2000; Khayat 2000). The clinical symptoms of anemia, such as fatigue, dyspnoea, vertigo, loss of appetite, and inability to concentrate impair the patients physical functioning and subjective sense of well-being (Groopman and Itri 2000). By relieving these symptoms, effective treatment of anemia should significantly help to maintain patients’ quality of life (QoL) and also to improve the possibility to complete the antitumor therapy as intended.


Visual Analogue Scale Anemic Cancer Patient Advanced Gastrointestinal Cancer Recombinant Human Erythro Patient Physical Functioning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aaronson NK (1991) Methodological issues in assessing the quality of life of cancer patients. Cancer 67: 844–850PubMedCrossRefGoogle Scholar
  2. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85: 365–376PubMedCrossRefGoogle Scholar
  3. Aaronson NK, Cull A, Kaasa S et al (1994) The European Organization for Research and Treatment of Cancer ( EORTC) modular approach to quality of life assessment in oncology. Int J Ment Health 23: 75–96Google Scholar
  4. Abels RI, Larholt KM, Krantz KD, Bryant EC (1996) Recombinant human erythropoietin (rHuEPO) for the treatment of anemia in cancer. Oncologist 1: 140–150PubMedGoogle Scholar
  5. Andersson RT, Aaronson NK, Willen D (1993) Critical review of the international assessments of health-related quality of life. Quality of Life Res 2: 369–395CrossRefGoogle Scholar
  6. Case DC, Bukowski RM, Carey RW et al (1993) Recombinant human erythropoietin therapy for anemic cancer patients on combination chemotherapy. J Natl Cancer Inst 85: 801–806PubMedCrossRefGoogle Scholar
  7. Cella DF (1997) The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: A new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34 (Suppl 2): 13–19PubMedGoogle Scholar
  8. Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. J Clin Oncol 11: 570–579PubMedGoogle Scholar
  9. Cleeland CS, Demetri GD, Glaspy J et al (1999) Identifying hemoglobin level for optimal quality of life: results of an incremental analysis. [Abstr] Proc Am Soc Clin Oncol 18: 574aGoogle Scholar
  10. Cull AM (1997) Cancer-specific quality of life questionnaires: The state of the art in Europe. Eur J Cancer 33 (Suppl 6): S3 - S7PubMedCrossRefGoogle Scholar
  11. Demetri GD, Kris M, Wade J et al (1998) Quality of life benefit in chemotherapy patients treated with epoetin alpha is independent of disease response and tumor type: results from a prospective community oncology study. J Clin Oncol 16: 3412–3425PubMedGoogle Scholar
  12. Glaspy J, Bukowski R, Steinberg D et al (1997) Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 15: 1218–1234PubMedGoogle Scholar
  13. Glimelius B, Linné T, Hoffman K et al (1998) Epoetin beta in the treatment of anemia in patients with advanced gastrointestinal cancer. J Clin Oncol 16: 43–40Google Scholar
  14. Groopman JE, Itri JE (2000) Chemotherapy induced anemia in adults: Incidence and treatment. J Natl Cancer Inst 91: 1616–1634Google Scholar
  15. de Haes H, Curran D, Young T et al (2000) Quality of life evaluation in clinical trials — the EORTC model. Eur J Cancer 36: 821–825PubMedCrossRefGoogle Scholar
  16. Irvine D, Vincent L, Graydon JE, Bubela N, Thompson L (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. Cancer Nurs 17: 367–378PubMedCrossRefGoogle Scholar
  17. Khayat D (2000) Is anemia a problem for European cancer patients and treating oncologists? Semin Oncol 27 (Suppl 4): 9–11PubMedGoogle Scholar
  18. Kurz C, Marth C, Windbichler G et al (1997) Erythropoietin treatment under polychemotherapy in patients with gynecologic malignancies: a prospective, randomized, double-blind placebo-controlled multicenter study. Gynecol Oncol 65: 461–466PubMedCrossRefGoogle Scholar
  19. Langer CJ (1997) Anemia, fatigue and quality of life in advanced malignancy: Potential therapeutic role for epoetin. Erythropoiesis: New dimensions in the treatment of anemia 8: 63–73Google Scholar
  20. Leitgeb C, Pecherstorfer M, Fritz E, Ludwig H (1994) Quality of life in chronic anemia of cancer during treatment with recombinant human erythropoietin. Cancer 73: 2535–2542PubMedCrossRefGoogle Scholar
  21. Littlewood TJ, Bajetta E, Nortier J et al (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: Results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19: 2865–2874PubMedGoogle Scholar
  22. Ludwig H, Fritz E, Leitgeb C et al (1993) Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors. Ann Oncol 4: 161–167PubMedGoogle Scholar
  23. Richardson A (1995) Fatigue in cancer patients: a review of the literature. Eur J Cancer Care 4: 20–32CrossRefGoogle Scholar
  24. Thatcher N, De Campos ES, Bell DR et al (1999) Epoetin alpha prevents anaemia and reduces transfusion requirements in patients undergoing primarily platinum-based chemotherapy for small cell lung cancer. Br J Cancer 80: 396–402PubMedCrossRefGoogle Scholar
  25. Vogelzang NJ, Breitbart W, Cella D et al (1997) Patient, caregiver and oncologist perceptions of cancer-related fatigue: Results of a tripart assessment survey. Semin Hematol 34 (Suppl 2): 4–12PubMedGoogle Scholar
  26. Yellen SB, Cella DF, Webster K et al (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy ( FACT) measurement system. J Pain Symptom Manage 13: 63–74PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2002

Authors and Affiliations

  1. 1.Department of OncologyKarolinska HospitalStockholmSweden

Personalised recommendations