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. 2022 Dec 1;7(6):e195.
doi: 10.1097/j.pbj.0000000000000195. eCollection 2022 Nov-Dec.

Transfusion practices in patients with advanced cancer: a retrospective study in a palliative care service

Sara Marote  1 , Joana Marinho  2 , Maria Cândida Silva  3 , José Ferraz Gonçalves  3
Affiliations

Transfusion practices in patients with advanced cancer: a retrospective study in a palliative care service

Sara Marote et al. Porto Biomed J. .

Abstract

Background: Anemia is highly prevalent in patients with advanced cancer and adversely affects the quality of life. There are limited data on the frequency, clinical utility, and effectiveness of red blood cell (RBC) transfusions, and no randomized controlled clinical trials or clinical practice guidelines are available. The aim of this study was to evaluate clinician practices on RBC transfusion in an oncologic palliative care service and its impact on patients' symptoms, adverse events, and overall survival.

Methods: This is a retrospective analysis of all patients with advanced cancer who received RBC transfusions admitted for 3 years. Preblood counts, the reason for transfusion, subjective benefit, and objective outcomes were listed.

Results: We identified 179 patients who underwent RBC transfusions. The mean age was 67 years, and 60% were male. We found a total of 435 RBC units in 301 transfusion episodes. Asthenia/fatigue was the most frequent symptom (68%). The mean pretransfusion hemoglobin (Hb) was 6.85 g/dL, and 48% of patients had a Hb above 7 g/dL. The symptomatic benefit was achieved in 36% of patients. Adverse events were reported in 4%, with a 30-day survival rate of 57%. A statistically significant association was found between Eastern Cooperative Oncology Group performance status (ECOG-PS) and the symptomatic benefit (P = .005). Hb level pretransfusion, ECOG-PS, and symptomatic benefits with transfusions were significantly associated with survival.

Conclusion: This study suggests that patients with advanced cancer with a higher functioning level may benefit more from RBC transfusion. Post-transfusion symptomatic benefits and pretransfusion ECOG-PS and Hb levels are independent predictors of survival. Further studies are needed to develop validated measures of objective functional changes to evaluate transfusions' clinical impact and identify patients most likely to benefit from it.

Keywords: anemia; blood transfusion; palliative care; patients with advanced cancer.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Izaks GJ, Westendorp RCJ, Knook DL. The definition of anemia in older persons. J Am Med Assoc. 1999;281:1714-1717. - PubMed
    1. Dunn A, Carter J, Carter H. Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care. J Pain Symptom Manage. 2003;26:1132-1139. - PubMed
    1. To THM LeBlanc TW Eastman P, et al. . The prospective evaluation of the net effect of red blood cell transfusions in routine provision of palliative care. J Palliat Med. 2017;20:1152-1157. - PubMed
    1. Goksu SS Gunduz S Unal D, et al. . Use of blood transfusion at the end of life: does it have any effects on survival of cancer patients? Asian Pac J Cancer Prev. 2014;15:4251-4254. - PubMed
    1. Aapro M Beguin Y Bokemeyer C, et al. . Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29:iv96-iv110. - PubMed