Interaction of psychological factors and the effect of epoetin alfa treatment in cancer patients on hemoglobin and fatigue

Introduction and background Epoetin alfa is known to produce a hematological response in anemic cancer patients. A concomitant reduction in fatigue as well as an improvement of depression and anxiety and of quality of life has been reported. However, these effects are discussed controversially. Psychological variables may have a moderating effect on fatigue reduction. Materials and methods Fifty-four anemic cancer outpatients were treated with epoetin alfa over 26 weeks with an initial dose of 3×10,000 IU/week and further individually adapted dosage. Hemoglobin level, fatigue, depression, anxiety, and health-related quality of life were measured every 4 weeks. Results The hematological response rate was 50%, with 1/3 occurring after more than 8 weeks of treatment. Fatigue, depression, and quality of life improved significantly. Reduction in fatigue was associated with response, but the correlations between fatigue and hemoglobin were weak. Less depression and higher quality of life before treatment correlated with a better fatigue reduction when controlling for hemoglobin increase and initial fatigue level. Conclusion Psychological variables influence the reduction of fatigue during therapy with epoetin alfa in anemic cancer patients and should therefore be assessed at the beginning of treatment.