Treatment Pathway
Treatment of Anemia
Anemia is a condition where there are insufficient healthy red blood cells to carry adequate oxygen to body tissues. It has many causes including nutritional deficiencies, chronic disease, and blood loss.
ESMO (European Society of Medical Oncology)ASCO (American Society of Clinical Oncology)NCCNASH (Hematology)NICE Oncology Guidance
Anemia is a condition where there are insufficient healthy red blood cells to carry adequate oxygen to body tissues. It has many causes including nutritional deficiencies, chronic disease, and blood loss.
First-Line Treatment Principles
- ✓Multidisciplinary team (MDT) approach: oncology, surgery, radiotherapy, pathology, palliative care
- ✓Stage-appropriate intent: curative vs. palliative — informs treatment intensity and goals
- ✓Systemic therapy: chemotherapy, targeted therapy, immunotherapy (checkpoint inhibitors), hormone therapy
- ✓Surgical resection: primary curative approach for solid tumours when localised
- ✓Radiotherapy: definitive, adjuvant, or palliative depending on tumour type and stage
Non-Pharmacological Management
- •Nutritional support: maintain weight and muscle mass; dietitian involvement
- •Physiotherapy and exercise oncology: reduced fatigue, improved outcomes
- •Psychological support: validated cancer-specific interventions (CBT, supportive psychotherapy)
- •Smoking cessation and alcohol reduction: reduces treatment toxicity and second primary cancers
- •Palliative care integration from diagnosis: symptom management, advance care planning
- •Fertility preservation: discuss before gonadotoxic therapy in reproductive age patients
- •Sun protection post-treatment: radiation-sensitised skin; immunosuppressed skin cancer risk
Treatment Goals
🎯Cure or long-term remission in localised and haematological malignancies
🎯Disease control: stable or partial response in metastatic/advanced settings
🎯Symptom palliation and quality of life preservation
🎯Overall survival and progression-free survival improvement
🎯Survivorship: management of long-term treatment sequelae
Monitoring Parameters
- ◆Tumour markers: PSA (prostate), CA-125 (ovarian), CEA (colorectal), AFP (liver) — at defined intervals
- ◆Imaging: CT/MRI/PET per tumour-specific response criteria (RECIST)
- ◆FBC: myelosuppression monitoring during chemotherapy — weekly during active treatment
- ◆Cardiotoxicity: LVEF monitoring with anthracyclines and trastuzumab (echo before, during, after)
- ◆Renal and hepatic function: before each chemotherapy cycle; drug dose adjustments
- ◆Peripheral neuropathy grading: platinum and taxane-based regimens
Escalation Criteria
- →Febrile neutropenia: broad-spectrum IV antibiotics within 1 hour of presentation; emergency
- →Progressive disease on first-line treatment → second-line regimen; clinical trial consideration
- →Oncological emergencies: spinal cord compression, SVC syndrome, tumour lysis syndrome → urgent oncology review
- →Deteriorating performance status → reassess treatment goals; palliative focus
Special Populations
Elderly: comprehensive geriatric assessment (CGA) before initiation; adjust for organ function and polypharmacy
Children: paediatric oncology specialist; growth/developmental monitoring; school integration
Pregnancy: individualised risk-benefit; most chemotherapy avoided in 1st trimester; tumour board involvement
Genetic cancer syndromes: BRCA/Lynch testing; cascade testing and family surveillance
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