Cancer-Related Anemia and Frailty in Older Persons

Anemia, defined by the World Health Organization as a hemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women, is particularly prevalent at advanced age. Nevertheless, it is not a condition simply explained by the normal aging process. Anemia represents a potentially reversible condition associated with numerous adverse health-related events, including hospitalization, disability, and mortality in older persons. Low haemoglobin concentrations are particularly common among patients with cancer due to direct (e.g., micro- and macroscopic blood losses) and indirect causes (e.g., increased production of pro-inflammatory cytokines with consequent reduction of erythropoietin release and erythropoiesis). The impaired oxygen-carrying capacity caused by the presence of anemia may play a major role in multiple clinical manifestations of cancer, such as dyspnea, fatigue, exhaustion, dizziness and/or headache. In the present review, we discuss the importance of low hemoglobin concentrations and anemia as important determinants of the frailty syndrome, a condition commonly present among cancer patients. Treatment of cancer-related anemia may improve quality of life and health-related outcomes (including disability and mortality) in older patients with oncological conditions.