Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Current trends in the management of anaemia in solid tumours and haematological malignancies Ronwyn van Eeden and Bernardo L. Rapoport Purpose of review Anaemia is a common problem in patients with solid tumors and haematological malignancies. Certain cancer therapies also contribute to anaemia. This article reviews the pathophysiology of cancer-related anaemia, investigation of a cancer patient with anaemia as well as how anaemia impacts patients in terms of quality of life, disease-related outcomes and treatment choices. Recent findings Different treatments for anaemia include transfusions, erythropoiesis-stimulating agents (ESA) and iron therapy. Within this context, we review the advantages and disadvantages concerning anaemia management in cancer patients as well as the risk–benefit ratio of different treatment choices, particularly the increased risk of thromboembolic events of ESAs and concern around mortality and effect on tumor growth. Summary This review is aimed at guiding treating physicians to make the best evidence-based treatment choices according to the product label and according to current guidelines for patients with cancer-related anaemia. Keywords anaemia, cancer, cancer-related fatigue, erythropoiesis stimulating agents, iron therapy INTRODUCTION Symptoms of anaemia are often the index presen- tation in patients with cancer. Of these patients, symptoms occur in about 60–70% with haemato- logical malignancies and in about 40% of patients with solid tumours. Furthermore, 30% will have mild anaemia, 9% will have moderate anaemia, and 1% will have severe anaemia. According to the National Cancer Institute, mild anaemia is defined as a haemoglobin level between 9.5–10.9 g/dl, moderate anaemia between 8.0 and 9.4 g/dl and severe anaemia between 6.5–7.9 g/dl. Life- threatening anaemia is found at levels less than 6.5 g/dl (Table 2). There is controversy around what prognostic implications cancer-related anaemia (CRA) has on patients. Anaemia has been associated with a shorter survival and an increased relative risk of death in patients, in several different malignancies. Treating and correcting the underlying anaemia in patients with cancer is said to improve outcome [1]. The treatment administrated for the underlying cancer, further complicates or worsens CRA. The overall incidence of chemotherapy and radiation- induced anaemia is 54% [2]. The nephrotoxic effects of chemotherapy agents such as cisplatin can be associated with the persistence of anaemia through reduced renal production of erythropoietin. The cause of CRA is multifactorial and can be categorized into different groups, including blood loss, increased destruction, and decreased production of red blood cells (Table 1). Often the various mech- anisms responsible for causing CRA are connected. The severity of CRA is graded according to the National Cancer Institute (Table 2) [2–4]. TEXT OF REVIEW Epidemiology and aetiology of anaemia in cancer The European Cancer Anaemia Survey assessed the epidemiology of anaemia in patients with cancer. The European Cancer Anaemia Survey trial was a The Medical Oncology Centre, Rosebank, Johannesburg, South Africa Correspondence to Bernardo L. Rapoport, MD, M Med, The Medical Oncology Centre, Rosebank, Parklands 2121, PO Box 2040, Johannes- burg, South Africa. E-mail: brapoport@rosebankoncology.co.za Curr Opin Support Palliat Care 2016, 10:189–194 DOI:10.1097/SPC.0000000000000209 1751-4258 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.supportiveandpalliativecare.com REVIEW