Anemia-related chemotherapy Delays in breast cancer: A retrospective audit of real-world management practices

Objectives: Anemia is a common complication among patients receiving systemic chemotherapy for breast cancer and may adversely affect treatment delivery, particularly in resource-limited settings. In many government oncology centers, anemia evaluation is frequently constrained by the limited availability and affordability of diagnostic tests. This study aimed to describe anemia-related chemotherapy outcomes and real-world anemia management practices among breast cancer patients treated at a tertiary government hospital. Material and Methods: This retrospective audit reviewed medical records of breast cancer patients with documented anemia (hemoglobin <12.0 g/dL) who received systemic chemotherapy at the Tumor Clinic of East Avenue Medical Center from July to December 2021. Patient demographics, disease stage, chemotherapy regimens, anemia severity, supportive interventions, and chemotherapy outcomes (continued versus delayed) were collected. Anemia severity was classified using World Health Organization (WHO) hemoglobin thresholds for non-pregnant women: mild (11.0–11.9 g/dL), moderate (8.0–10.9 g/dL), and severe (<8.0 g/dL). Associations were explored using chi-square or Fisher’s exact tests. Results: A total of 85 patients were included, most of whom had stage III disease and received anthracycline-based chemotherapy. Anemia-related chemotherapy delay occurred in 5.9% of patients. No significant associations were observed between chemotherapy delay and age, cancer stage, chemotherapy regimen, or phase of chemotherapy. Analysis of 328 anemia episodes demonstrated that increasing anemia severity was associated with escalation of supportive interventions, including erythropoiesis-stimulating agents and blood transfusion, and with a higher likelihood of chemotherapy delay ( p <0.001). Mild anemia was generally managed conservatively without treatment interruption, while moderate and severe anemia prompted more intensive interventions. Iron studies, vitamin B12 levels, and reticulocyte counts were not routinely performed in the majority of patients, reflecting real-world resource limitations during the study period. Conclusion: Anemia-related chemotherapy delays were infrequent in this cohort. Management strategies largely reflected anemia severity rather than patient or treatment characteristics. This study highlights existing supportive care practices and diagnostic limitations in a government-funded oncology center and underscores the need for standardized anemia evaluation pathways in resource-constrained settings.