At the end of February 2025, a round table «Treatment of anemia in cancer patients» was held at the Rossiyskaya Gazeta media center. Medical experts and representatives of patient organizations discussed the issues of access to medical care for patients with this serious complication of cancer and its treatment. They also analysed the implementation of patient-centered approach in healthcare practice and the steps to be taken to improve the situation.
The participants included Oleg Levkovsky, Executive Director of the Association of Oncologists of Russia; Professor Anton Snegovoy, Head of the Department of Drug Treatment of Tumors at the N.A. Lopatkin Research Institute of Urology and Interventional Radiology; members of the Russian Society of Clinical Oncology, headed by Professor Lali Kogonia; co-chair of the All-Russian Union of Patients, Yuri Zhulev; Irina Borovova, president of Zdravstvyi, the Association of Cancer Patients; Nikolay Dronov, Chairman of the Coordinating Council of the Movement against Cancer Foundation, member of the Council of Public Organizations for the Protection of Patients’ Rights under the Ministry of Health of the Russian Federation; Polina Pchelnikova, President of the Russian Rheumatology Association Nadezhda, member of the Public Council under the Ministry of Health of the Russian Federation, and others.
What doctors say
Anemia in cancer patients is a symptom complex that includes both quantitative and qualitative blood parameters. Among other things, it is due to the suppression of erythropoiesis by cancer and chemotherapy. Hemoglobin concentration in cancer patients is considered an important prognostic factor that determines tolerability of radiation therapy and chemotherapy, as well as survival rates.
The introduction of a number of new drugs into clinical practice and the active use of intensive antitumor treatment regimens, including combined chemoradiotherapy, make cancer treatment more efficient. But this approach often causes complications and requires serious supportive therapy. One of its important components is the timely measures to manage anemia.
Oncologists are well aware that 30-90% of their patients develop anemia. Its frequency depends on the stage of the malignant tumor. In stage I/II colorectal cancer, anemia develops in 40% of cases, and in stage III/IV — in 80%. The type of tumor also matters: in solid tumors, anemia is observed in 40% of patients (30% have mild anemia, 9% have moderate anemia, and 1% have severe anemia).
As treatment progresses, with each subsequent course of chemotherapy, the myelosuppressive effect of cytostatic drugs increases. As a result, studies show that the number of patients with anemia increases to 70-75%, while the number of cases of moderate anemia grows to 19.3%, and severe anemia (with hemoglobin below 100 g/l) accounts for 2% of cases. Experts believe that timely diagnosis and treatment of anemia makes it possible to achieve better results in the treatment of the underlying disease. Chronic hypoxia in anemia significantly reduces the results of chemotherapy, which sometimes even has to be discontinued until a higher Hb level is achieved. This worsens the course of cancer, and the survival rates decrease.
Oleg Levkovsky: «Success in cancer treatment depends not only on the right antitumor therapy, but also on the general condition of the patient. And this is ensured, among other things, by adequate accompanying therapy. From a medical point of view, anemia impairs the quality of life and also has an impact on the course of the tumor process and on treatment effectiveness».
Doctors are sure that anemia needs to be treated. This has long been proven by clinical research and practical experience. There are clinical guidelines on the issue and a clear correction algorithm that provides for modern methods of treating anemia, including erythropoiesis stimulants (recombinant erythropoietins, intravenous iron, vitamins, and red blood cell transfusions). Modern drugs are also available: they are produced by Russian manufacturers. For example, epoetin alfa, which has been on the market for 20 years, is made by Sotex. Various dosages of epoetin alfa are produced in accordance with GMP standards, in compliance with the standards of the European Pharmacopoeia in terms of quality control methods. This guarantees the safety of the drug. It is available in prefilled safety syringes: the needle is automatically and irreversibly closed after the injection. This protects medical personnel from infection with dangerous diseases such as HIV, hepatitis B and C. Cancer centers have the necessary facilities to manage such patients. Anemia in cancer is a complication requiring concomitant therapy.
The main issue discussed at the round table was why patient routing is designed in such a way that a seriously ill patient is forced, wasting valuable time, to contact a different medical organization (a hematology clinic) to receive supportive therapy for anemia.
Anton Snegovoy: «According to modern principles of cancer treatment, supportive therapy is an integral component of cancer care. It is based on the choice of the most effective treatment regimen and enables positive results, that is, better recurrence-free survival and overall survival rates».
Regulatory and economic instruments and the patient-centered approach
The participants of the round table see the main problem of managing cancer patients with anemia in uncorrected regulatory and economic instruments and in the shortcomings of the organization of payment in the compulsory health insurance system. The core problem is that cancer is treated in oncological clinics, while anemia pertains to the sphere of hematological care. As a result, after a course of antitumor treatment, the patient has to be treated by a hematologist.
The discussion participants analyzed regulatory documents that define treatment under state guarantee programs. Since 2025, medical care in Russia has been provided strictly in accordance with clinical guidelines. Clinical recommendations have also been developed for anemia in cancer patients. The standards of medical care continue to play a role in the formation of territorial state guarantee programs.
Clinical recommendations establish indications for prescribing drug therapy for anemia to cancer patients (erythropoiesis-stimulating agents), i. e., treatment approaches are determined. But, according to Polina Pchelnikova, the president of the Russian Rheumatology Association Nadezhda and a member of the Public Council at the Ministry of Health of Russia, the document states that an oncologist also treats complications of cancer. The mandatory implementation of these measures during the hospitalization for cancer treatment has not been established, and it is not specified where the patients are to get treatment for anemia. However, section 6 of the Clinical Recommendations states: “due to the fact that anemia in cancer patients is a complication of cancer or results from the therapy, anemia treatment is provided as part of the treatment of the main disease,” that is, anemia is to be treated by an oncologist.
Doctors disagree with the existing model, where a complication can only be treated after the main disease, and not in parallel. Moreover, today’s drugs for supportive therapy include some that can be administered as infrequently as once in 3 weeks. If they are provided within the period of tumor therapy, the patient does not have to wait for admission to another hospital, and no time is lost.
There are also examples when the payment issue has been successfully solved through the use of treatment complexity coefficient. According to Anton Snegovoy, the Coefficient makes it possible «to rely on clear statistics and continue to plan the amount of care, financial resources, etc.», but, unfortunately, last year proposals to include anemia therapy in the list of treatment complexity coefficients were rejected.
What patients say
The speakers evaluated all the advantages and disadvantages of the existing mechanisms for paying for medical care based on clinical and statistical groups of diseases. But they showed a critical attitude when provision of care to patients was discussed.
Polina Pchelnikova: «When a person with a life-threatening condition, who feels bad, has to arrange their admission to another hospital, it is very inconvenient for them. What makes the situation more difficult is that timing is very important and even crucial in such cases».
Irina Borovova spoke about the patients’ calls to the hotline. Many complain that they are discharged from the hospital after a course of cancer treatment, despite a very serious condition caused by anemia. In surveys about the low quality of life, patients put fatigue second after a heart attack; 76% mention fatigue, lethargy, inability to react to events around you, 54% report nausea and 24% pain.
Fatigue, the main manifestation of anemia, significantly reduces motivation to continue treatment. Not only the patients, but also their near and dear ones feel despair. This is a predictor of unfavorable treatment outcomes for cancer. According to Irina Borovova, this category of patients has an increased risk of exacerbation of cardiovascular and other diseases, and a 65% higher risk of death. Their social activity becomes almost non-existent, they often develop severe depression, which also requires treatment.
Irina Borovova, President of the Zdravstvuy Association: «For more than 10 years we have been talking about providing cancer patients with the necessary supportive therapy, but little progress has been seen. Despite the fact that the state guarantee program and other documents assure the rights of cancer patients to receive a full range of treatment, not all patients actually get it».
Many aspects of the problem of managing cancer patients with anemia were discussed, and the participants of the round table agreed on such important issues as the quality of patient care and the expansion of treatment accessibility. They largely depend on organizational clarity: anemia is a complication of cancer or of cancer therapy, and anemia care should be provided as part of the treatment of the main disease.
As for the financial model, with mechanisms for paying for supportive therapy in the treatment of anemia for cancer patients, the speakers believed that it is necessary to prioritize the interests, well-being, survival, and quality of life of patients. Here, medical professionals and the patient community agree completely. Moreover, the experts’ suggestions do not require additional costs: they are about the redistribution of therapy opportunities within the framework of existing funding for the cancer program.
The proposals made during the discussion to improve the quality and accessibility of anemia treatment for cancer patients will be formulated in a resolution and submitted to the healthcare authorities.
