Objective

2

To analyze the clinical features of advanced lung cancer patients complicated with anemia who received third-line or higher anti-cancer therapy.

Methods

2

Patients with advanced lung cancer complicated with anemia receiving third-line or higher anti-cancer therapy who visited the following hospitals from June 1， 2018， to September 30， 2023， were included in the study： Cancer Hospital of the Chinese Academy of Medical Sciences， Dongzhimen Hospital of Beijing University of Chinese Medicine， Beijing Hospital of Traditional Chinese Medicine of Capital Medical University， Beijing University of Chinese Medicine Third Affiliated Hospital， Guang'anmen Hospital of the China Academy of Chinese Medical Sciences， Xiyuan Hospital of the China Academy of Chinese Medical Sciences， Beijing Hospital of Integrated Traditional Chinese and Western Medicine， Peking University Cancer Hospital， and Beijing Luhe Hospital of Capital Medical University. General data of the patients were collected and analyzed.

Results

2

A total of 365 patients with stage Ⅳ lung cancer were included. The median hemoglobin （Hb） level was 102 g/L， with a range of 50–119 g/L. There were 205 patients （56.16%） with mild anemia， 129 patients （35.34%） with moderate anemia， 23 patients （6.30%） with severe anemia， and 8 patients （2.19%） with very severe anemia. The types of anemia were as follows： 8 cases （2.19%） of macrocytic anemia， 12 cases （3.29%） of microcytic anemia， and 345 cases （94.52%） of normocytic anemia. Leukocyte count （WBC） was reduced in 83 cases （22.74%）， neutrophils （NEUT） were reduced in 47 cases （12.88%）， and platelet count （PLT） was reduced in 50 cases （13.70%）. A total of 263 patients （72.05%） were receiving third-line or higher anti-cancer therapy. Anti-anemia therapy was administered to 194 patients （53.15%）， including 24 cases （6.58%） receiving blood transfusions， 20 cases （5.48%） treated with erythropoietin （EPO）， 34 cases （9.32%） receiving iron supplements， 32 cases （8.77%） treated with folic acid， 18 cases （4.93%） with vitamin B12 （including methylcobalamin）， 97 cases （26.58%） using Chinese patent medicines， and 56 cases （15.34%） treated with Chinese medicine decoctions. The detection rates for specific anemia-related tests were as follows： serum iron in 101 cases （27.67%）， ferritin in 61 cases （16.71%）， transferrin in 19 cases （5.21%）， unsaturated iron-binding capacity in 17 cases （4.66%）， total iron-binding capacity in 17 cases （4.66%）， transferrin saturation in 11 cases （3.01%）， and vitamin B12/folic acid in 11 cases （3.01%）. The main clinical symptoms were as follows： cough in 261 cases （71.51%）， pain in 216 cases （59.18%）， fatigue and/or weakness in 202 cases （55.34%）， loss of appetite in 160 cases （43.84%）， shortness of breath in 156 cases （42.74%）， constipation and/or dry stool in 149 cases （40.82%），

insomnia in 131 cases （35.89%）， pale complexion and/or sallow skin in 120 cases （32.88%）， and nausea and/or vomiting in 86 cases （23.56%）. In terms of traditional Chinese medicine （TCM） syndrome elements， there were 295 cases （80.82%） of qi deficiency， 191 cases （52.33%） of yin deficiency， 95 cases （26.03%） of phlegm-dampness， 137 cases （37.53%） of blood stasis， and 19 cases （5.21%） of heat toxin. Of these， 85 patients （23.29%） had only a single syndrome element. Patients with qi deficiency had significantly lower Hb and RBC levels than those without qi deficiency （

P

<

0.05）. Patients with phlegm-dampness had significantly lower Hb levels than those without phlegm-dampness （

P

<

0.05）. Patients with yin deficiency had significantly lower RBC levels than those without yin deficiency （

P

<

0.05）.

Conclusion

2

Advanced lung cancer patients complicated with anemia receiving third-line or higher anti-cancer therapy were primarily diagnosed with mild to moderate anemia. The rate of anti-anemia therapy was 53.15%， and TCM treatments accounted for 78.87% of the anti-anemia treatments. The detection rates for anemia-related tests ranged from 3.01% to 27.67%. TCM syndromes were predominantly deficiency-based， with composite syndromes being most common. These syndromes reflected the etiological and pathophysiological features of "qi and yin deficiency， phlegm and stasis mutual obstruction， toxin arising from deficiency， deficiency leading to toxin， and impaired new blood generation". TCM syndromes were found to have a certain correlation with Hb and RBC levels.