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 39 publications

(42 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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“…[18][19][20][21] In addition, treatments such as blood transfusion have been questioned, as their benefit remains unclear in the context of palliative care. 22,23 Increasing evidence suggests that decreased treatment intensity near the end of life leads to better quality of life and even to improved survival. [24][25][26][27] The early identification of palliative care needs in patients with advanced cancer is critical to prevent and relieve distressing symptoms (e.g.…”

Section: What Does This Study Add?mentioning

confidence: 99%