Managing chemotherapy induced anemia with darbepoetin alfa and other erythropoiesis stimulating agents: a nurse's perspective

Abstract

Loraine Derbyshire, Colin W Thain School of Health, University of Central Lancashire, Preston, United Kingdom Abstract: Chemotherapy induced anemia (CIA) is a frequent complication of anticancer treatment, but often remains untreated. The main presenting symptom of CIA is fatigue, and this can have profound implications upon chemotherapy treatment compliance and patients' quality of life (QoL). Nevertheless, a tendency has been seen in both patients and physicians to underestimate the consequences of fatigue. As nurses are taking on greater responsibilities for identifying, monitoring, and in some cases even treating CIA, it is important that they have a clear understanding of the treatment options at their disposal. Erythropoiesis stimulating agents (ESAs) have been available as a tool for the treatment of CIA for many years. However, the vast majority of literature on this topic has been targeted towards physicians. Hence, the purpose of this review is to summarize the key ESA studies, with an emphasis on material that is of interest to the nursing community. Herein we present a brief chronological review of the development of ESAs to illustrate how the currently available treatment options for anemia arose. For conciseness, darbepoetin alfa (DA) has been used as a model to represent all ESAs; however, important findings from studies of other ESAs have also been included for completeness. We also discuss the management of CIA, based on the available literature and our experience of routine clinical practice in the UK. In conclusion, CIA is important in the context of maintaining QoL in patients undergoing chemotherapy and its effective management needs to be considered as part of their holistic care. Available studies show that ESA treatment can decrease fatigue levels and reduce the need for transfusions. ESAs, such as DA, may therefore be an important treatment option for patients with CIA. DA is well tolerated when used according to current recommendations, can be synchronized with chemotherapy cycles, and can also be self-administered. Keywords: chemotherapy-induced anemia, darbepoetin alfa, erythropoiesis stimulating agent, fatigue, quality of life, transfusion