The September CACONS educational meeting was presented by Susan Mott-Coles, RN, MSN, AOCN. We all know that chemotherapy works by killing cancer cells; unfortunately it can’t tell the differenced between a cancer cell and a healthy cell. Among the healthy cells chemotherapy can destroy are red blood cells. Red blood cells carry oxygen throughout the entire body, which helps maintain energy. Chemotherapy patients may find themselves with chemotherapy induced anemia. Symptoms of anemia include fatigue; trouble breathing or rapid heartbeat; chest pain; dizziness/lightheadedness; inability to concentrate; headache; difficulty staying warm; loss of sex drive; and pale skin. The chronic tiredness caused by anemia may affect quality of life and also have serious implications to overall health. Anemia can make certain cancer therapies less effective; can strain your heart as it overworks to deliver oxygen where it is needed; can make it difficult to think clearly; can express one’s sex drive; and if left untreated can result in the need for red blood cell transfusions. The National Cancer Institute considers normal hemoglobin levels as 12 to 16 g/dL for women and 14 to 18 g/dL for men.

Treatment for anemia associated with serious disease tends to focus first on addressing the underlying disease.

There is a new drug on the market, Aranesp. Aranesp is an erythropoiesis stimulating protein that is produced in Chinese hamster ovary cells by recombinant DNA technology. It is formulated for IV or SQ administration. Aranesp is indicated for the treatment of anemia associated with chronic renal failure, including patients on dialysis and patients not on dialysis, and for the treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy. It is contraindicated in patients with uncontrolled hypertension.

The most common side effects seen in clinical trials with Aranesp were fatigue, edema, nausea, vomiting, diarrhea, fever and shortness of breath.

The recommended starting dose for the correction of anemia in cancer patients receiving chemotherapy is 2.25mcg/kg administered as a weekly subcutaneous injection. The dose should be adjusted for each patient to achieve and maintain a target hemoglobin. If there is less than a 1.0 g/dL increase in hemoglobin after six weeks of therapy, the dose should be increased up to 4.5mcg/kg. If hemoglobin increases by more then 1.0 g/dL in a 2 week period or if it exceeds 12g/dL, the dose should be reduced by 25%. If the hemoglobin exceeds 13g/dL, dosed should be temporarily withheld until the hemoglobin falls to 12g/dL, then therapy should be reinitiated at a dose 25% below the previous dose.