Impact of hemoglobin levels before and during chemotherapy on survival of patients with ovarian cancer

Anemia is a common complication of cancer that has been associated with poor response to treatment and decreased survival in many malignancies. A retrospective chart review was undertaken to determine the effects of hemoglobin (Hb) levels, measured prior to initiation of chemotherapy and before each chemotherapy cycle, and clinical prognostic factors (e.g., age, tumor stage, residual tumor size, hematologic parameters, and type of health insurance) in 250 ovarian cancer patients treated between 1985 and 1998. All patients were scheduled to receive at least 6 courses of systemic chemotherapy. None of the patients received recombinant human erythropoietin. The difference between observed overall survival and its predicted value was computed by multiple regression analysis for each patient with respect to prognostic factors. Hemoglobin levels prior to and during chemotherapy were identified as a prognostic factor for overall survival. Hemoglobin levels ≥12 g/dl were significantly associated with prolonged overall survival (P<0.001). In addition, Hb level correlated with scheduled completion of chemotherapy, overall therapeutic success, tumor stage, age at diagnosis, and residual tumor size (all, P<0.005). Hemoglobin level represents an important prognostic factor for patients with ovarian cancer. This finding supports the use of measures to maintain adequate Hb levels, such as treatment with recombinant human erythropoietin, to improve patient survival.