Intravenous iron and iron deficiency anemia in gastrointestinal cancer patients: a systematic review
Bibliographic record
Abstract
Abstract Background Iron deficiency anemia (IDA) is a prevalent hematological complication associated with gastrointestinal (GI) cancers due to an increased loss of iron and decreased iron absorption. We estimated the efficacy of parenteral iron on hemoglobin levels, blood transfusion needs and overall quality of life in patients with GI malignancies. Methods In this systematic review, we used PubMed, Cochrane, EMBASE, CINHAL and Scopus to conduct an electronic search from January 1, 2010 to March 24, 2022 with no language or study design restrictions. Studies were included if they discussed IDA, GI neoplasms, use of iron supplementation (with or without erythropoietin-stimulating agents [ESAs]), defined anemia and had a patient population of adults. Studies were excluded if were published before 2010. We assessed the efficacy of parenteral iron in comparison to other iron supplementation methods when treating IDA in GI cancer patients. The Cochrane Risk of Bias Tool 2 (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tools were used to assess the quality of the included studies. Moreover, the Cochrane Effective Practice and Organization data collection form was used to collect pertinent study information. Results Our search yielded 3,156 studies across all databases. With the exclusion of duplicates, ineligible study designs, as well as studies that did not pass abstract and full-text screening, 17 studies were included in our final analysis (4 randomized control trials; 13 non-randomized studies). Of the 13 studies evaluating hemoglobin (Hgb) response, seven studies found an increase in Hgb levels when patients were treated with IV iron. The 8 studies evaluating red blood cell (RBC) transfusion rates found no significant differences in RBC transfusion needs when treated with IV iron. Studies analyzing health related outcomes typically found an increase quality of life and decreased post-operative complications. Discussion This review reveals the improved outcomes of IDA in GI cancer patients treated with IV iron instead of other iron supplementation methods. Timely diagnosis and appropriate IDA management can greatly improve quality of life in this patient population, especially if myelosuppressive chemotherapy is required. Our systematic review presents some limitations due to heterogenous interventions in the randomized control trials, the varying time points of data collection in each study, and the use of small sample sizes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".