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Iron deficiency in patients with cancer: a prospective cross-sectional study
  1. Elisabeth Luporsi1,
  2. Anthony Turpin2,3,
  3. Vincent Massard4,
  4. Sophie Morin5,
  5. Bruno Chauffert6,
  6. Aurélien Carnot7 and
  7. Patrice Cacoub8,9
  8. Behalf of the CARENFER Study Group
    1. 1Oncology Unit, Hôpital de Mercy, Ars-Laquenexy, France
    2. 2Medical Oncology Department, CHU Lille, Lille, France
    3. 3UMR9020 - UMR-S 1277 Canther, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
    4. 4Oncology Unit, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
    5. 5Oncology Unit, Institut Bergonié, Bordeaux, France
    6. 6Oncology Unit, CHU Amiens-Picardie, Amiens, France
    7. 7Medical Oncology Department, Oscar Lambret Cancer Centre, Lille, France
    8. 8Department of Internal Medicine and Clinical Immunology, Hopital Universitaire AP HP Pitie Salpetriere, Paris, France
    9. 9UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), Sorbonne Université, Paris, France
    1. Correspondence to Professor Patrice Cacoub, Department of Internal Medicine and Clinical Immunology, Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France; patrice.cacoub{at}aphp.fr

    Abstract

    Background Despite the deleterious consequences of iron deficiency (ID) in patients with cancer, underdiagnosis is frequent. The CARENFER study aimed to assess the prevalence of ID using both serum ferritin concentration and transferrin coefficient saturation (iron-saturation of transferrin, TSAT) index, as well as ID anaemia in patients with cancer.

    Methods This prospective cross-sectional study was conducted in 15 oncology units in France in 2019. All patients present in the medical unit during the 2-week study period, regardless of the type of tumour (solid or haematological) and treatment, were eligible. Serum ferritin concentration, TSAT index and haemoglobin level were determined. ID and ID-associated anaemia were defined according to European Society of Medical Oncology 2018 Guidelines: ID was defined either as ferritin <100 µg/L (absolute ID) or as ferritin ≥100 µg/L and TSAT <20% (functional ID).

    Results A total of 1221 patients with different types of solid malignant tumours were analysed: median age 64 years; 89.4% under treatment for their cancer, mainly by chemotherapy (75.4%). Overall, ID was found in 57.9% (55.1–60.6) of patients. Among them, functional ID accounted for 64% of cases. ID anaemia was reported in 21.8% (19.6–24.2) of all patients with cancer. ID was highly prevalent in untreated (75/130, 57.4%) and non-anaemic (419/775, 54.1%) patients.

    Conclusion This study highlights the high prevalence of ID in patients with cancer, whether or not associated with anaemia or treatment. These results emphasise the need to a better detection and management of ID in cancer, thereby optimising overall patient care.

    Trial registration number ClinicalTrials.gov Identifier: NCT03924271.

    • cancer
    • metabolic disorders

    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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    Footnotes

    • Twitter @AnthoTurpin

    • Collaborators Valérie Andrieu (Hôpital Bichat Claude Bernard, Paris, France); Gilles Berrut (Hôpital Bellier, CHU Nantes, Nantes, France); Patrice Cacoub (Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France); Aurélien Carnot (Centre Oscar Lambret, Lille, France); Bruno Chauffert (CHU Amiens – Site Sud, Amiens, France); Gabriel Choukroun (CHU Amiens – Site Sud, Amiens, France); Alain Cohen-Solal (Hôpital Lariboisière, Paris, France); Nadim Fares (CHU Rangueil, Toulouse, France); Elisabeth Luporsi (CHR-Metz-Thionville - Hôpital De Mercy, Metz, France); Anthony Lopez (CHU Nancy Brabois, Nancy, France); Vincent Massard (Institut De Cancérologie De Lorraine, Vandoeuvre-Lès-Nancy, France); Sophie Morin (Institut Bergonié, Bordeaux, France); Gaël Nicolas (Université Paris Diderot, Paris, France); Katell Peoc’h (Hôpital Beaujon, Clichy, France); Alain Pesce (Centre Hospitalier Princesse Grace, France); Laurent Peyrin-Biroulet (CHRU Nancy, Nancy, France); Anne-Marie Ruppert (Hôpital Tenon, Paris, France); Nacera Sakek (Centre hospitalier de Mulhouse, Hôpital Muller, Mulhouse, France); Hélène Simon (CHRU Morvan, Institut de Cancérologie et d’hématologie, Brest, France); Achille Tchalla (CHU de Limoges, Limoges, France); Anthony Turpin (Hôpital Claude Huriez - CHRU Lille, Lille, France); Jean-Marc Tourani (CHU de Poitiers, Poitiers, France); Jean-Noël Trochu (CHU de Nantes, Nantes, France).

    • Contributors Conceptualisation and Funding acquisition: EL, PC; Investigation: AC, VM, SM, BC, ATu; Supervision: EL, AC, VM, SM, BC, ATu, PC, VA, GB, GC, ACS, NF, AL, GN, KP, AP, LPB, AMR, NS, HS, ATc, JMT, JNT; Validation: EL, AC, VM, SM, BC, ATu, PC, VA, GB, GC, ACS, NF, AL, GN, KP, AP, LPB, AMR, NS, HS, ATc, JMT, JNT; roles/writing-original draft: EL, PC; Writing-review and editing: EL, AC, VM, SM, BC, ATu, PC, VA, GB, GC, ACS, NF, AL, GN, KP, AP, LPB, AMR, NS, HS, ATc, JMT and JNT.

    • Funding This work was supported by Vifor Pharma Group ((no grant number)), which contributed to the statistical analysis with the support of IQVIA Operations France.

    • Competing interests PC, EL, V. Andrieu, G. Choukroun, A. Cohen-Solal, G. Nicolas, K. Peoc’h, L. Peyrin-Biroulet, J-N. Trochu and A. Lopez received consultancies and honoraria from Vifor Pharma.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note See CARENFER Study Group members in online supplemental file 1.

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