The Necessity of Weekly Hemoglobin Level Monitoring in Cervical Cancer Patients Receiving Radiotherapy

Abstract

Background: Several studies have demonstrated that anemia is one of the poor prognostic factors for cervical cancer patients treated with radiotherapy. We questioned the necessity of weekly hemoglobin level monitoring in these patients.  This study was conducted to evaluate the value of weekly hemoglobin level measurement in cervical cancer patients receiving radiotherapy.

Objective: To evaluate the value of weekly hemoglobin (Hb) level measurement in cervical cancer patients receiving radiotherapy.

Materials and Methods: The medical records of cervical cancer patients admitted in gynecologic oncology ward between May 2000 and May 2002 were reviewed to evaluate the clinical characteristics and weekly Hb level. Measurement outcomes include grade 2-4 hematologic toxicity, Hb nadir, week of Hb nadir and the number of blood transfusion.

Design: Descriptive study.

Setting: Chiang Mai University Hospital.

Results: There were 113 cervical cancer patients receiving radiotherapy in the study period. Fifty-four patients (47.8%) had Hb level at presentation < 10 g/dL. Among these patients, grade 2-4 anemia was found in 21-30 patients per week with a mean of 23.5 (43.5%) in week 1-4. Between week 5-8, grade 2-4 anemia was found in 5-22 patients per week with a mean of 15.3 (28.3%). Among 59 patients with Hb level at presentation > 10 g/dL, grade 2-4 anemia was found in 7-9 patients per week with a mean of 7.5 (12.7%) in the first 4 week. After week 4, grade 2-4 anemia was found in 3-8 patients per week with a mean of 5.8 (9.8%). Patients with Hb level at presentation > 11 g/dL, grade 2-4 anemia was found in only 0.8% and 4.9% in week 1-4 and week 5-8, respectively. Fourty-seven patients (41.6%) received a blood transfusion. Among these patients, 42 patients (89.4%) had a Hb level at presentation < 10 g/dL, the remaining 5 patients (10.6%) had a Hb level at presentation > 10 g/dL(P < 0.001). Only one patient with Hb level at presentation > 11 g/dL received a blood transfusion. No blood transfusion was administered in patients with Hb at presentation > 12 g/dL.

Conclusions: For cervical cancer patients with Hb level at presentation < 10 g/dL, weekly Hb level should be checked during radiotherapy. Among those with Hb level at presentation > 11 g/dL, Hb level may be checked less frequently.

Key words: Hemoglobin level, cervical cancer, radiotherapy