Autumnal revellers can put away the fireworks, vampire masks and fake teeth for another year, while the faces whitened by flour to celebrate the ancient Celtic festival of Hallowe’en can reassume their ruddy glow. Hallowe’en may have been replaced by All Saints’ Day on the Christian calendar, but many still subconsciously fear that ghostly apparitions can still make 21st-century hair stand on end.

Ghosts are not the only causes of pallor; when not caused by fear, this is seen as a sign of ill-health. Anaemia, and the sallow complexion that stems from it, is the result of too few red blood cells, or too little haemoglobin in these cells. Haemoglobin is the pigment that carries oxygen. If the oxygen supply to the cells is depleted, the organs may continue to function but they will be operating inefficiently. The simplest task will take more out of the person’s reserves than a more arduous one if they were fit.

An anaemic patient is prone to infections, is listless, easily fatigued, irritable and depressed. They are likely to tell their doctors that they have lost interest in activities they once found intriguing. Their zest for life has ebbed, so that consultations are likely to start with the patient volunteering comments such as: “I am so tired, doctor, I just want to sleep.”

Anaemia can be caused by a host of different conditions. It may follow bleeding (sometimes only a small, but constant, leak may induce severe anaemia), a shortage of protein, iron or some essential trace element or vitamin (these are the raw materials necessary for the production of haemoglobin); or there may be a premature breakdown of the red blood cells. In many diseases the bone marrow, the factory site of red cells, fails to produce enough red cells to keep the blood’s haemoglobin level up to par and, therefore, the body properly oxygenated.

Nearly all forms of cancer result in anaemia, whether they are solid tumours, such as cancer of the breast or prostate, cancers that obviously ooze blood, such as cancer of the stomach or colon, or the haematological malignancies, such as the leukaemias.

Anaemia is easily accounted for when it is a side-effect of essential drugs, when there is bleeding, or if the patient’s appetite is so depressed that their nutrition is inadequate. Likewise, patients understand that some drugs and X-ray treatment, or a secondary growth in the bone marrow, could result in anaemia if red cell production is interfered with. The mystery to well-nourished cancer patients is why, if the bone marrow hasn’t been infiltrated, there is no overt bleeding, and there has been no radiation of the bones or drugs that might affect the bone marrow, they still become anaemic, and in consequence depressed and tired. It seems that cytokines produced by cancer cells have an adverse effect on the bone marrow.

A survey presented in Paris last week at the European Congress of Clinical Oncology compared the awareness of anaemia in cancer patients across Europe. Whereas in Germany 64 per cent, in France 66 per cent, in Spain 72 per cent and in Italy 96 per cent of doctors routinelty discuss the symptoms and impact of anaemia such as tiredness with their patients, in the UK only 23 per cent of doctors do so.

We are the only developed country covered by the survey in which the majority of patients were not asked routinely about possible tiredness. When patients complained of it spontaneously, only about a third were given anaemia as a possible cause. If this question were only a conversational gambit it wouldn’t matter, but anaemia can be treated and the patient’s fatigue and lassitude alleviated.

Traditionally additional iron or blood transfusions were used. Now we have erythropoietin (EPO). This is a hormone secreted by the kidneys — as athletes who want to improve their performance have discovered — and is available as an injection. It stimulates the bone marrow to produce more red blood cells. Once the patient’s haemoglobin has increased, so are the almost universal symptoms of cancer alleviated for a time.

When doctors show any lack of enthusiasm in treating anaemia in their patients there is, as was clearly illustrated at the Paris congress, a subsequent cost in terms of shortened survival times and an earlier loss of the quality of life. Statistics show that British doctors are more reluctant than their European counterparts (or perhaps our Treasury is less prepared to pay) to prescribe erythropoietin.