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Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms

The PS for adjustment of toxicities was composed using body surface area, age, histology, relapse after surgical resection, ECOG-PS, comorbidities, chemotherapy line, reduced dosage requirement status, and duration of premedication as independent variables, and the C-statistic of the ROC curve analysis was 0.808

Case example : A patient receives radiation treatment management, five treatments

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