Introduction Anaemia is associated with multiple symptoms including fatigue which in turn can contribute to impaired quality of life. It is a common finding in colorectal cancer as a result of chronic insidious haemorrhage and impaired iron haemostasis. Consequently, colorectal cancer patients are at risk of the symptomatology of anaemia.
Method Preoperative colorectal cancer patients (n=116) who were found to be anaemic (>1g/dL below the World Health Organisation definition) were randomised to receive either intravenous (IV) or oral iron. Quality of life (QOL) questionnaires were performed at; [i] recruitment, [ii] at least 14 days after iron therapy and [iii] post-operatively in the first outpatient follow-up. QOL assessments undertaken included the following; [a] Functional Assessment of Cancer Therapy-Anaemia (FACT-AN) [b] EuroQol EQ-5D-5L (EQ5D) and [c] modified Short-Form 36 (SF36) v1 questionnaires.
Results Both groups were comparable in patient demographics, starting haemoglobin, operative details, tumour histology and time from recruitment to postoperative review (oral 101 days [IQR 62-193]; IV 91 days [IQR 61-135, P=0.98]. Despite homogeneity in all initial QOL scores at recruitment significant differences were evident between groups at outpatient review in the all bar two of the SF36 components including: General Health (Oral 64.79u [58.8-70.8]; IV 73.63u [68.4-78.8]; P<0.01), Vitality (Oral 60.49u [53.7-67.3]; IV 74.83u [69.2-80.5]; P<0.001). EQ5D scores for the visual analogue scale were also significantly higher in the IV group at outpatient review (OI 70.9u [65.1-76.8]; IV 82.53u [77.8-87.2]; P<0.001), with parity in the remaining 4 components. Furthermore, significant differences were evident in FACT-AN Total scores (Oral 148.3u [139-158];IV 166.1u [160-172.3]; P<0.01), FACT-AN Anaemia subscale scores (Oral 59.6u [54.4-64.8]; IV 69.1u [65.7-72.5]; P<0.01), Functional Well Being (Oral 20.2u [17.9-22.5]; IV 24.1u [22.2-26];P<0.01) and Emotional Well Being (Oral 19.9u [18.5-21.2]; IV 21.5u [20-23]; P<0.05) at outpatient review. None of the QOL measures had higher scores in the oral group.
Conclusion Intravenous iron is more efficacious than oral iron at improving the post-operative quality of life of anaemic colorectal cancer patients. The usage of intravenous iron should be considered in patients who are found to have colorectal cancer during evaluation of anaemia by Gastroenterologists to optimise these outcomes.
Disclosure of Interest: M. Brookes Conflict with: Vifor International, Conflict with: Vifor International, B Keeler: None Declared, O Ng: None Declared, H Padmanabhan: None Declared, A Simpson: None Declared, A Acheson Conflict with: Vifor International
- COLORECTAL CANCER
- IRON Deficiency