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Background: Anemia is a common problem among patients with cancer, particularly among those undergoing chemotherapy. The purpose of this study was to determine the association between hemoglobin levels and severity of fatigue and quality of life in cancer patients undergoing chemotherapy.
Materials and methods: This is a descriptive– correlative study that utilized a purposeful sampling. One hundred twenty one outpatients with cancer participated in this study. Data collected by interview. The instruments used included the sample selection and demographic data form, Fatigue Severity Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Hemoglobin level was reviewed from medical records. Grading of anemia based on hemoglobin level according to the National Cancer Institute classification.
 Results: Prevalence of anemia in cancer patients undergoing chemotherapy was 63.6 percent 57 percent had mild anemia and 6.4 percent had moderate to severe anemia. There were significant differences between mean score of severity of fatigue (p<0.001) and quality of life (p=0.003) in relation to hemoglobin level. There found negative significant correlation between hemoglobin levels and quality of life or severity of fatigue (p<0.001).
Conclusion: Anemia is prevalent among cancer patients undergoing chemotherapy. During chemotherapy, decreased hemoglobin levels are associated with increased fatigue and reduced quality of life. Nurses can help by appropriate intervention and patient's education about self care intervention to reduce anemia and fatigue and also improve quality of life.