Background Anaemia is common in patients with advanced cancer. Anaemia of chronic disease (ACD)/functional iron deficiency (FID) is the commonest cause, then iron deficiency (IDA), and the two combined (Neoh, Stanworth, Pasricha, et al. Support Care Cancer. 2017;25(4):1209–1214). Distinguishing between types of anaemia guides treatment but criteria vary, so this is challenging (Fletcher, Forbes, Svenson, et al. Br J Haematol. 2022;196(3):523–529). The role of IV iron in this setting remains unclear (National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: (2024) Hematopoietic Growth Factors. vers. 3., 2024; Aapro, et al. Ann Oncol. 2018;29(Suppl 4):iv96-iv110).

Method We developed a flow chart on management of anaemia and use of IV iron. Treatment with IV ferric derisomaltose is recommended for those intolerant of low-dose oral iron; half-dose is recommended for those with IDA+FID or FID alone. We conducted a retrospective audit of all patients prescribed IV ferric derisomaltose over 3 years.

Results 17 patients received IV ferric derisomaltose; all had cancer. Haemoglobin (Hb) range 37–90g/L. 7 had FID, 9 IDA, 1 both. 12 received packed red cell (PRC) transfusion (range 1–3 units). 10 received a dose of ferric derisomaltose at variance from the protocol. No serious undesirable effects reported. Post-infusion/transfusion Hb checked in 9/17. Hb increased in 8/9 patients by 12–33g/L. Of the 2 patients who did not receive concurrent PRC and who had post-infusion Hb, Hb increased by 16g/L in 1 and dropped by 5g/L in other. 4/17 patients had documented benefit.

Conclusion Administration of IV iron is possible in hospices. It was well tolerated. It was mostly given alongside PRC transfusion. When given alone to two patients with FID, it produced an increase in Hb of 16g/L in one. Improved documentation of post-transfusion/infusion Hb and symptom benefit are required. Impact of IV ferric derisomaltose on patients with IDA+FID or FID remains uncertain. The results of this audit support further expansion of the role of IV ferric derisomaltose to patients in the hospice setting e.g. daycare who do not require concurrent PRC transfusion.