eng Oriental Scientific Publishing Company Biosciences Biotechnology Research Asia 0973-1245 2026-10-10 23 3 59960 article Gayatri Kotwal 1 Kirti Barkale 1 Gauri Khaladkar 1 Gangadhar Magar 1 Pavan Udavant 1 Department of Pharm D., MET’s Institute of Pharmacy, Savitribai Phule Pune University, Nashik, India Chemotherapy is a cornerstone of cancer treatment but is frequently associated with complications such as anemia, pain, and malnutrition, which can adversely affect treatment tolerance, functional status, and quality of life. Although these complications are often evaluated individually, increasing evidence suggests that they are interconnected and may collectively contribute to clinical deterioration. This narrative review aimed to examine the pathophysiological relationships and cumulative clinical burden of chemotherapy-induced anemia, cancer-related pain, and malnutrition, with emphasis on their potential interactions and implications for supportive oncology care. A narrative review of the available literature was undertaken, focusing on evidence describing the underlying mechanisms, clinical manifestations, assessment parameters, and interrelationships among chemotherapy-induced anemia, pain, and nutritional impairment in patients with cancer. The review considered clinical and laboratory parameters related to inflammation, iron metabolism, nutritional status, functional status, treatment tolerance, and quality of life. Cancer-associated systemic inflammation, particularly increased inflammatory cytokine activity, contributes to impaired iron availability and hypercatabolic metabolic changes, thereby linking anemia and nutritional decline. Pain, including nociceptive and neuropathic pain, may further reduce oral intake and physical activity, while nutritional deficiencies may adversely affect tissue and nerve repair and potentially increase pain sensitivity. Anemia-related fatigue can additionally reduce appetite, mobility, and functional capacity, creating a reinforcing cycle of physical and nutritional decline. Together, these interrelated complications may contribute to treatment delays, dose reductions, hospitalization, impaired quality of life, and poorer clinical outcomes. Chemotherapy-induced anemia, pain, and malnutrition should therefore be recognized as interconnected components of a complex supportive-care burden rather than isolated complications. Early identification through clinical, laboratory, nutritional, and functional assessment, followed by coordinated multidisciplinary management, may improve treatment tolerance and overall patient outcomes. Further longitudinal and multicenter studies, particularly from low- and middle-income countries, are required to establish integrated, biomarker-guided supportive-care strategies. https://www.biotech-asia.org/vol23no3/chemotherapy-associated-anemia-pain-and-nutritional-deficiencies-in-cancer-patients-a-review-of-disease-parameter-interrelationships/ Cancer pain; Cancer cachexia; Chemotherapy-induced anemia; Malnutrition; Quality of life; Supportive oncology; Systemic inflammation