Transfusion in Palliative Cancer Patients: A Review of the Literature

Torres, Maria; Rodríguez, Juan Nicolás; Sánchez-Ramos, José Luis; Gómez, Francisco Alvarado

doi:10.1089/jpm.2013.0387

Cited by 43 publications

(43 citation statements)

References 49 publications

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“…35 However, the value of using predetermined Hb levels to determine need for transfusion in palliative care has not been studied. Similarly to a prior review, 36 we found that despite the lack of evidence-informed variables for transfusion in palliative care patients, Hb level remains the most common indication for transfusion in this population. The variation in practice observed in the current review suggests that the decision to transfuse was based largely on care providers' practice patterns rather than high-quality evidence.…”

Section: Discussionsupporting

confidence: 77%

Red blood cell transfusion in adult palliative care: a systematic review

et al. 2017

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BACKGROUND The risks and benefits of red blood cell (RBC) transfusion in palliative care patients remain poorly understood. We reviewed the literature to summarize available information on RBC transfusion in this population. STUDY DESIGN AND METHODS We searched electronic databases (MEDLINE, Embase, PsycINFO, CINAHL) from inception through September 2016 to identify studies reporting data on palliative patients receiving RBC transfusion. Original studies that assessed RBC transfusion as an intervention and reported at least one clinical outcome were included. Study characteristics, results on transfusion‐related outcomes, and authors' conclusions on the value of transfusion in palliative patients were abstracted and reported. RESULTS We identified 1839 studies, of which 137 were selected for data extraction and 13 were included (11 case series, one prospective cohort, and one retrospective cohort). Nine studies addressed symptom relief following transfusion using subjective symptom scales, of which eight (89%) indicated some degree of short‐term benefit and one study (11%) showed no benefit. Posttransfusion survival was reported in four studies—one demonstrated prolonged survival in patients receiving RBC transfusion; three had no comparison group. Other outcomes reported included hemoglobin values posttransfusion in four studies and adverse events following transfusion in three studies. CONCLUSIONS In palliative care, RBC transfusion may provide symptom relief and improve subjective well‐being, though the duration and magnitude of this effect, and transfusion‐associated risks specific to this population remain unclear. Currently, no high quality evidence exists to support or guide the use of RBC transfusion in this population. Moreover, the clinical heterogeneity within the palliative population limits the interpretation of most studies.

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Section: Discussionsupporting

confidence: 77%

Red blood cell transfusion in adult palliative care: a systematic review

et al. 2017

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“…According to our results, the GPs were more willing than the students to withhold blood transfusions, pleural drainage and chest X-rays in a patient scenario representing EOLcare. The benefit of blood transfusions in EOL-care is often brief and adverse effects may occur (15). Dyspnoea can sometimes be alleviated by pleural drainage, but the procedure is invasive (16).…”

Section: Discussionmentioning

confidence: 99%

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

Alminoja¹,

Piili²,

Hinkka³

et al. 2019

In Vivo

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Background/Aim: Appropriate decision-making in end-of-life (EOL) care is essential for both junior and senior physicians. The aim of this study was to compare the decisionmaking and attitudes of medical students with those of experienced general practitioners (GP) regarding EOL-care. Materials and Methods: A questionnaire presenting three cancer patient scenarios concerning decisions and ethical aspects of EOL-care was offered to 500 Finnish GPs and 639 graduating medical students in 2015-2016. Results: Responses were received from 222 (47%) GPs and 402 (63%) students. The GPs withdrew antibiotics (p<0.001) and nasogastric tubes (p=0.007) and withheld resuscitation (p<0.001), blood transfusions (p=0.002) and pleural drainage (p<0.001) more often than did the students. The students considered euthanasia and assisted suicide less reprehensible (p<0.001 in both) than did the GPs. Conclusion: Medical students were more unwilling to withhold and withdraw therapies in EOLcare than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care. There is a growing demand for palliative care in Europe due to the increase in noncommunicable diseases (1). Therefore, physicians should have basic skills needed to change the goal of the treatment from life-prolonging therapies to end-of-life (EOL)-care. Appropriate decisions needed for high-quality EOL-care involve, for example, statements regarding cardiopulmonary resuscitation (CPR), hydration, and diagnostic tests. Many physician-related factors (e.g., age, experience and personal attitudes) have been shown to influence these decisions (2-4). In addition, the changing public attitudes towards EOL-care and euthanasia influence the complexity of these issues (5). The physicians' decisions regarding life-sustaining treatments vary between different treatment modalities (6-8). In a survey of American internists, blood products and haemodialysis were among the most likely withdrawn therapies, while mechanical ventilation and intravenous fluids were more commonly continued (6). Withdrawing treatment is generally experienced as more difficult than withholding them (9). The education and experience of a physician have been shown to influence decision-making in EOL-care (8, 10). Although newly-graduated physicians often feel unprepared for providing EOL-care, they face the complexity of the decision-making process just as the senior physicians (11, 12). However, the difference between graduating medical students and physicians in making these decisions remains to be studied.

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“…32 Last, we must also study and explore models for providing end-of-life care for patients with hematologic malignancies that can overcome typical limitations of hospice care in the US, which fails to recognize the palliative benefits of supportive transfusions and palliative chemotherapies, as these are often not provided as part of hospice care because of reimbursement limitations. 31,46 …”

Section: Areas For Future Researchmentioning

confidence: 99%

When and why should patients with hematologic malignancies see a palliative care specialist?

2015

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Palliative care is a multidisciplinary approach to symptom management, psychosocial support, and assistance in treatment decision-making for patients with serious illness and their families. It emphasizes well-being at any point along the disease trajectory, regardless of prognosis. The term "palliative care" is often incorrectly used as a synonym for end-of-life care, or "hospice care". However, palliative care does not require a terminal diagnosis or proximity to death, a misconception that we will address in this article. Multiple randomized clinical trials demonstrate the many benefits of early integration of palliative care for patients with cancer, including reductions in symptom burden, improvements in quality-of-life, mood, and overall survival, as well as improved caregiver outcomes. Thus, early concurrent palliative care integrated with cancer-directed care has emerged as a standard-of-care practice for patients with cancer. However, patients with hematologic malignancies rarely utilize palliative care services, despite their many unmet palliative care needs, and are much less likely to use palliative care compared to patients with solid tumors. In this article, we will define "palliative care" and address some common misconceptions regarding its role as part of high-quality care for patients with cancer. We will then review the evidence supporting the integration of palliative care into comprehensive cancer care, discuss perceived barriers to palliative care in hematologic malignancies, and suggest opportunities and triggers for earlier and more frequent palliative care referral in this population. Learning Objectives• Describe the differences between "palliative care," "hospice care," and "end-of-life care" • List the major benefits of early palliative care as reported in the major randomized trials done to date • Recognize specific scenarios and indications that warrant specialist palliative care consultation for patients with hematologic malignanciesPalliative care is specialized medical care for people facing a serious illness, 1 like a hematologic malignancy. The term "palliative care" is sometimes incorrectly used as a synonym for end-of-life care, or "hospice care"; however, palliative care requires neither a terminal diagnosis nor proximity to death; a misconception that we will address in the first section of this article. Rather, a growing body of evidence highlights that patients with cancer derive many benefits from palliative care including reductions in symptom burden, 2 improvements in quality-of-life and mood, 3,4 improved survival, 4,5 as well as improved caregiver outcomes 6 ; this is true even for those receiving active cancer treatment. However, patients with hematologic malignancies are much less likely to access palliative care services than patients with solid tumors, 7,8 despite growing evidence of many unmet palliative care needs in this population. 9 This discrepancy suggests a need for more education about palliative care in the hematology community, and more efforts to adap...

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Transfusion in Palliative Cancer Patients: A Review of the Literature

Cited by 43 publications

References 49 publications

Red blood cell transfusion in adult palliative care: a systematic review

Red blood cell transfusion in adult palliative care: a systematic review

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

When and why should patients with hematologic malignancies see a palliative care specialist?

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