Prevalence and factors associated with chemotherapy-induced anemia in early and locally advanced breast cancer: A prospective tertiary care center study from India.

Abstract

e12688 Background: Chemotherapy-induced anemia (CIA) affects up to 89% of non-anemic cancer patients undergoing chemotherapy. CIA significantly impacts treatment outcomes and quality of life. This prospective study investigated the prevalence, associated factors, and quality-of-life implications of CIA in early and locally advanced breast cancer patients undergoing neoadjuvant or adjuvant chemotherapy. Methods: A prospective study enrolled 200 eligible patients with Stage I–III breast cancer receiving chemotherapy at a tertiary cancer center in Kerala (September 2023–June 2025). A baseline hemoglobin level of ≥12 g/dL was required. Patients were monitored pre-chemotherapy for the development of anemia and classified according to WHO criteria. Quality of life was assessed using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) tool. Results: All 200 patients (100% female, median age 56 years) developed CIA. Anemia severity distribution: mild 36.5% (n=73), moderate 48.5% (n=97), severe 15% (n=30). Statistically significant factors associated with severe anemia included younger age ≤ 50 years (p=0.004), premenopausal status (p=0.005), dose-dense chemotherapy (p<0.001, OR=6.60), and neoadjuvant treatment sequence (p=0.001, OR=4.13). Quality-of-life scores decreased significantly with increasing anemia severity across all FACT-An domains (p<0.001). Post-treatment quality of life improved substantially in severe CIA patients. Conclusions: This study establishes CIA as a universal hematologic toxicity warranting proactive surveillance and early intervention protocols in breast cancer populations, particularly in younger patients receiving intensive chemotherapy. Integration of CIA assessment into routine supportive care monitoring represents an actionable quality improvement opportunity to optimize treatment tolerance, preserve functional capacity, and enhance patient-reported outcomes throughout the cancer trajectory. Prevalence and risk factors associated with severe chemotherapy-induced anemia. Anemia Severity Number (n) Percentage (%) Risk Factors Odds Ratio 95% CI P Value Mild (Grade 1) 73 36.5 Age >50 years 0.31 0.14–0.68 0.004 Moderate (Grade 2) 97 48.5 Postmenopausal status 0.32 0.14–0.70 0.005 Severe (Grade 3) 30 15.0 Dose-dense regimen 6.60 2.75–15.82 <0.001 Neoadjuvant chemotherapy 4.13 1.74–9.80 0.001