Sex Differences in Patients Who Have Cancer with Mild Anemia: Symptom Burden and Quality of Life

The same criterion for mild anemia (10 < hemoglobin [Hgb]<12 g/dL) has been used for male and female patients. Mild anemia is associated with greater symptom burden and reduced quality of life (QOL). We compared male and female patients who have mild anemia with each other and with their respective normal groups. Patients (N = 3553) from a community oncology database were sorted by sex and Hgb level into 3 anemic and 2 normal groups: men with 10 ≤ Hgb <12 g/dL, men with 12 ≤ Hgb <14 g/dL, women with 10 ≤ Hgb <12 g/dL, men with Hgb ≥ 14 g/dL, and women with Hgb ≥ 12 g/dL. Patients receiving chemotherapy (< 30 days) and/or growth factor (< 60 days) were excluded. Each case provided same-day scores on the Cancer Care Monitor, a validated measure of symptom burden, functioning, and health-related QOL comprising 7 scales. Compared with respective normal groups, male and female patients with mild anemia showed greater symptom burden, lower functioning, and worse QOL (P <0.05). Compared with normal men and women, patients with mild anemia showed clinically significant differences in terms of effect size (Cohen's d, 0.11-0.91). Men with 10 ≤ Hgb <12 g/dL were significantly more impaired and had worse QOL than men with 12 ≤ Hgb <14 g/dL or women with 10 ≤ Hgb <12 g/dL. Impact of mild anemia on QOL is significant, and treating men and women by the same standards (Hgb level < 12 g/dL) is likely incorrect. Mild anemia may be undertreated, especially for men with 12 ≤ Hgb <14 g/dL.