Benefits of blood transfusions in palliative care patients with advanced cancer.

Abstract

e24090 Background: Anemia is highly prevalent in patients with advanced cancer and adversely affects quality of life. There is limited data on the frequency, clinical utility and effectiveness of red blood cell transfusions (RBC), and no randomized controlled trials or clinical practice guidelines on this subject are available. The aim of this study was to evaluate clinician practices on RBC transfusion in an oncologic palliative care unit (PCU), its impact on patients’ symptoms, overall survival and to identify predictive factors for survival. Methods: Retrospective cohort study of all advanced cancer patients who had received RBC transfusions over a 3-year period, after admission to the PCU for symptomatic control, as inpatients or outpatients. All had histologically confirmed malignant tumors and were not under anti-cancer treatments. Patients’demographics, clinical and laboratory features, symptoms and mortality were reviewed. Survival analysis was estimated using the Kaplan-Meier method and Cox's regression was used for multivariate analysis. Results: We identified 179 patients with a median age of 68 years [30-93], 60% were male, with a mean Charlson comorbidity index of 8.9 (SD ±2.3). The majority had gastrointestinal (42%) and genitourinary (35%) malignancies. A total of 435 RBC units, during 301 transfusion episodes were recorded. The majority (58%) were performed as inpatients. A combination of symptoms with low haemoglobin (Hb) levels was the main reason for transfusion (80%). Asthenia/fatigue was the most frequent symptom (68%). Prior to transfusion, the majority (73%) had an ECOG-performance status (ECOG-PS) greater than 2. The mean pretransfusion Hb was 6.9 g/dL and 48% patients had an Hb above 7 g/dL. Symptomatic benefit post-transfusion was achieved in 36% of patients. A statistically significant association between ECOG-PS and symptomatic benefit was found (p = 0.005). Median overall survival post-transfusion was 41 days (IC95% 30.6-51.4). On multivariate analysis, Hb level pre-transfusion, ECOG-PS and symptomatic benefit with transfusions were significantly associated with survival. Conclusions: Transfusion practices are more liberal in palliative care, increasing iatrogenic risk, while consuming a valuable and limited resource. However, transfusion does provide symptom relief, and should be offered to advanced cancer patients with a higher level of functioning. Post-transfusion symptomatic benefit, and pre-transfusion ECOG-PS and hemoglobin levels seem to be independent predictors of survival. Further high-quality trials are needed to develop validated measures of objective functional changes to evaluate the clinical impact of transfusions and to identify patients most likely to be positively impacted by transfusion.