Guidelines for Complications of Cancer Treatment Vol VIII Part B

levels, to define anemia and this makes comparison of manystudies complex or neigh impossible. Assessment of the entirescope of potential symptoms is challenging because there isno instrument designed to examine the complete range offindings. Yellen et al developed and validated two instrumentsto measure the impact of anemia-related symptoms,particularly fatigue, in patients with cancer: the FunctionalAssessment of Cancer Therapy-Fatigue (FACT-F) scale andthe Functional Assessment of Cancer Therapy-Anemia (FACT-An). The latter encompasses the FACT-F and additional12, 13]questions related to anemia. [Impact of anemia in cancer treatment outcomesSevere anemia cause numerous physiologic complicationsincluding dyspnea, headache, fatigue, dizziness decreasedcognitive, sleep, and sexual function and significantdebilitation. Anemia may delay surgical interventions,chemotherapy cycles and may require dose reductions ordelays of myelosuppressive agents, thereby a decrease in theoverall intensity of the treatment. Tumor hypoxia also maylimit the effectiveness of oxygen-dependent chemotherapy.Data particularly those involving radiation therapy, suggestthat anemia has an effect on survival. Patients with head andneck, cervical, ovarian, or vulvar cancer have been shown tobe particularly affected. [14, 15] A secondary analysis of RTOG85-27, a study on patients with head and neck malignancytreated with radiation therapy, estimated that 5-year survivalrate among patients with normal hemoglobin was 35.7%, ascompared with 21.7% among patients with anemia. [15]A randomized, placebo-controlled study of 375 patients withdiagnoses of solid tumors or hematologic malignanciesundergoing non-platinum-based chemotherapy was conducted.The study arm received recombinant human erythropoietin482