Four studies presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition spotlight how re-examining existing practices can illuminate new approaches, or the need for new approaches, to improving care and outcomes for patients living with blood disorders.
“These four studies all seek in different ways to improve care and outcomes for patients – by addressing care gaps, challenging long-held beliefs, and identifying equity gaps and unmet needs,” noted Adam Cuker, MD, MS, professor of medicine, chief of classical hematology, and director of the Penn Comprehensive Hemophilia and Thrombosis Program at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
“These findings speak to the ongoing importance of research that questions existing practices and zeroes in on how to achieve better outcomes for patients,” Cuker added.
Underdiagnosed and Undertreated
Two studies focus on iron deficiency and iron-deficiency anemia, related disorders that are underdiagnosed and undertreated in certain populations, including reproductive-age women. Iron deficiency occurs when the body’s iron stores are too low, and is the most common cause of anemia, when the body has too few red blood cells or those cells don’t work properly.
The body needs iron to, among other things, form hemoglobin, the component of red blood cells that carries oxygen to the organs and tissues and stores the majority of the body’s iron.
Findings from the first study indicate that iron deficiency is not only a common problem among pregnant patients, but can be readily addressed with a standardized approach to screening and treatment. Results from this multidisciplinary quality improvement initiative demonstrated significant increases within a year in screening rates, infusions of intravenous (IV) iron, and median hemoglobin levels among pregnant patients.[1]
Iron-deficiency anemia
The second study addressed iron-deficiency anemia in patients with a simultaneous acute bacterial infection. Its results challenge the long-time practice of not giving IV iron to these patients because of concern that doing so could worsen the infection.[2]
Analysis of data from more than 85,000 patients hospitalized with both iron-deficiency anemia and an acute bacterial infection found that, on the contrary, treatment with IV iron increased patients’ hemoglobin levels and significantly improved their survival.
Gaps in outcomes and unmet medical needs
The remaining two studies highlight gaps in outcomes and unmet needs for specific groups of patients with blood cancers. The first study – one of the largest to date to compare outcomes for Black and white patients with an aggressive form of leukemia who received treatment in clinical trials supported by the National Cancer Institute (NCI), a part of the U.S. National Institutes of Health (NIH), found that Black patients are diagnosed at younger ages and have significantly poorer survival than their white counterparts. Moreover, among patients with a common genetic mutation typically associated with more favorable treatment outcomes, survival for Black patients was less than half that for white patients.[3]
The final study sheds light on the financial impact of cancer treatment on the families of children undergoing chemotherapy for a fast-growing type of leukemia. This study found that nearly a third of families struggled to cover basic living expenses or lost 25% or more of their household income at some point during their child’s treatment.[4]
Reference
[1] Godby R, Wick M, Liu M, Grace R, Lamppa J, Gasner S, Torbenson V, Go R, Sridharan M, Bruns D, Burt J, Gonzalez J, Petsch J, Warner M. Implementation of a multidisciplinary quality improvement project standardizing an approach to screening and treating iron deficiency in pregnancy. 67th ASH® / American Society of Hematology Annual Meeting. [595] [Abstract]
[2] Sohail H, Wilson L, Collins J, Kamran A. Deciphering the dilemma: Intravenous (IV) iron use in iron deficiency anemia during acute infections. 67th ASH® / American Society of Hematology Annual Meeting. [5][Abstract]
[3] Saint Fleur-Lominy S, Chen L, Sun Z, Garrett-Bakelman F, Shukla M, Fernandez H, Foran J, Cripe L, Lazarus H, Wiernik P, Rowe J, Tallman M, Litzow M, Zhang Y, Luger S, Khan I. Inferior survival in black AML patients treated with intensive chemotherapy in ECOG-ACRIN clinical trials is independent of cytogenetic profiles. 67th ASH® / American Society of Hematology Annual Meeting. [290][Abstract]
[4] Zheng D, Robinson E, Flamand Y, Aziz-Bose R, Koch V, Cole P, Gennarini L, Getz K, Kahn J, Karvonen K, Kelly C, Kelly K, Michon B, Newman H, Paul M, Tran T, Umaretiya P, Welch J, Weller E, Silverman L, Bona K. Cumulative incidence of household material hardship and income loss as measures of financial toxicity during pediatric acute lymphoblastic leukemia (ALL) treatment: A report from the DFCI ALL 16-001 Trial. 67th ASH® / American Society of Hematology Annual Meeting.[710][Abstract]
Featured image The ASH Store at the American Society of Hematology 61th Annual Meeting at the Orange County Convention Center. Photo courtesy © 2019 – 2015. ASH/Scott Morgan. Used with permission.
DOI
 Annual Meeting and Exposition spotlight how re-examining existing practices can illuminate new approaches, or the need for new approaches, to improving care and outcomes for patients living with blood disorders.){kind=link}