Evidence map›Paper›PMID 34527499›Full record

ReviewCureus2021

Efficacy and Cardiovascular Adverse Effects of Erythropoiesis Stimulating Agents in the Treatment of Cancer-Related Anemia: A Systematic Review of Randomized Controlled Trials.

Sanjay Rao Gergal Gopalkrishna Rao, Seif Bugazia, Tamil Poonkuil Mozhi Dhandapani, Anjli Tara, Ishan Garg, Jaimin N Patel, Jimin Yeon, Marrium S Memon, Abilash Muralidharan, Safeera Khan

Open access · diamondAbstract readReview
In one paragraph

Review in Cureus, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Observational
  4. Article
  5. Managing preoperative anemia: EPO is needed.Blood transfusion = Trasfusione del sangue · 2025
    Article
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 3 countries.

Sanjay Rao Gergal Gopalkrishna RaoInternal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Seif BugaziaInternal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Tamil Poonkuil Mozhi DhandapaniInternal Medicine/Family Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA.
Anjli TaraGeneral Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Ishan GargMedicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Jaimin N PatelMedicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Jimin YeonInternal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Marrium S MemonResearch, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Abilash MuralidharanMedicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Safeera KhanInternal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
California Institute of Behavioral Neurosciences and Psychology (United States) · USLiaquat University of Medical & Health Sciences · PKUniversity of Benghazi · LY

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Anemia is a common complication of cancer. Treatment of anemia in cancer is crucial as anemia adversely affects the quality of life, therapeutic outcomes, and overall survival. Erythropoiesis stimulating agents (ESAs) are valuable drugs for treating cancer-related anemia. Cardiovascular adverse effects are a significant concern with ESA therapy, and there is wide variability in therapeutic goals and characteristics of patients who undergo treatment with ESAs. As a result, a careful analysis of the currently available data on the efficacy and safety of these drugs is necessary. This data analysis will aid in the rational use of ESAs for the treatment of anemia in cancer. The objective of this systematic review is to elucidate the pathogenesis of anemia in cancer, assess the effectiveness of ESAs in treating anemia in cancer, and the overall risk of cardiovascular adverse effects associated with the use of ESAs and their impact on prognosis. We searched literature from online databases - PubMed, PubMed Central, MEDLINE, Cochrane Library, and clinical trials register (clinicaltrials.gov) to identify prospective phase II and phase III randomized controlled trials (RCTs). We chose RCTs that directly compared patients with cancer who were treated with ESAs to those who were not treated with ESAs. January 2008 was taken as the lower date limit and May 2021 as the upper date limit. Only English language literature and human studies were included. The quality appraisal was completed using the Cochrane risk bias assessment tool, and data from a total of 10,738 patients with cancer in 17 RCTs were identified and included for systematic review. Our review concludes that ESAs effectively reduce the necessity for blood transfusions and increase mean hemoglobin levels in anemic cancer patients. ESA therapy is associated with cardiovascular adverse effects, including venous thromboembolism, thrombophlebitis, hypertension, ischemic heart disease, cardiac failure, arrhythmia, arterial thromboembolism, and cardiac arrest. Aggressive ESA dosing to achieve higher hemoglobin levels and preexisting uncontrolled hypertension increases these cardiovascular side effects. Venous thromboembolism is the most significant adverse effect attributed to ESA therapy. However, there is no major change in overall survival with ESA therapy, and administration of ESAs can be carried out in anemic cancer patients with careful assessment of thromboembolism risk factors, risk-benefit ratio, and monitoring of hemoglobin levels.

Indexed as

anemiablood transfusioncancercardiovascular side effectsdarbepoetinepoetinerythropoiesis stimulating agentshemoglobinthromboembolism

Identifiers

PMID34527499
PMCPMC8432433
OpenAlexW3196609028

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.