Pancreas and Liver Resection in Jehovah's Witness Patients: Feasible and Safe

Konstantinidis, Ioannis T.; Allen, Peter J.; D’Angelica, Michael I.; DeMatteo, Ronald P.; Fischer, Mary; Grant, Florence; Fong, Yuman; Kingham, T. Peter; Jarnagin, William R.

doi:10.1016/j.jamcollsurg.2013.05.020

Cited by 19 publications

(21 citation statements)

References 34 publications

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“…On the contrary, several studies have shown feasibility of cancer treatment without blood and blood product support by implementing proper clinical strategies and comprehensive protocols designed to use transfusion alternatives and minimize blood loss . Brown et al demonstrated feasibility of transfusion‐free protocol for high dose chemotherapy and autologous peripheral blood stem cell transplantation even in JWs with acceptable morbidity and mortality …”

Section: Discussionmentioning

confidence: 76%

“…There is little published data on the patterns of cancer care of JW patients. Few studies have shown feasibility of cancer treatment without blood product support by interdisciplinary multimodality approach along with alternate blood‐conservation strategies …”

Section: Introductionmentioning

confidence: 77%

“…Few JW patients had their treatment discontinued at Hb level of 70 to 80 g/L to avoid adverse consequences. On the contrary, some studies in JW patients have demonstrated that acute morbidity and mortality were associated only with Hb level less than 70 g/L …”

Section: Discussionmentioning

confidence: 93%

“…Similarly according to Nagarsheth et al, pregnant JW patients who were younger, were more willing to accept major blood products (RBCs/WBCs/platelets) than older gynaecologic oncology patients. In Konstantinidis et al review of JWs who underwent liver and pancreatic resection, four out of 27 accepted blood transfusions in the event of life‐threatening bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

et al. 2018

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Background Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions. Aim The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management. Methods and results A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti‐cancer treatment. Forty‐three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non‐standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty‐seven percent (n = 17) received hematopoietic growth factors (erythropoiesis‐stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort. Conclusion Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

et al. 2018

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“…Previous studies that have reported outcomes in patients who decline ABT (bloodless patients) have focused primarily on patients undergoing cardiac surgery, [3][4][5][6][7][8][9][10][11][12][13] and only a few studies have reported on noncardiac surgical patients or nonsurgical (medical) patients. [14][15][16][17][18][19] When outcomes are reported in patients requesting bloodless care, the focus is often on easily measured outcomes, such as mortality and length of stay, 3,8,12,14,17 rather than on relatively common morbid outcomes such as infection or respiratory, cardiac, renal, and thrombotic events. Moreover, most prior studies are limited by lack of a control group 6,7,[9][10][11][12]20 to which the bloodless patients can be compared.…”

mentioning

confidence: 99%

Risk‐adjusted clinical outcomes in patients enrolled in a bloodless program

et al. 2014

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BACKGROUND Although clinical outcomes have been reported for patients who do not accept allogeneic blood transfusion (ABT), many previous studies lack a control group, fail to use risk adjustment, and focus exclusively on cardiac surgery. STUDY DESIGN AND METHODS We report a risk-adjusted, propensity score–matched, retrospective case-control study of clinical outcomes for inpatients who did not accept ABT (bloodless, n = 294) and those who did accept ABT (control, n = 1157). Multidisciplinary specialized care was rendered to the bloodless patients to conserve blood and optimize clinical outcomes. Differences in hemoglobin (Hb), mortality, five morbid outcomes, and hospital charges and costs were compared. Subgroups of medical and surgical patients were analyzed, and independent predictors of outcome were determined by multivariate analysis. RESULTS Overall, mortality was lower in the bloodless group (0.7%) than in the control group (2.7%; p = 0.046), primarily attributed to the surgical subgroup. After risk adjustment, bloodless care was not an independent predictor of the composite adverse outcome (death or any morbid event; p = 0.91; odds ratio, 1.02; 95% confidence interval, 0.68–1.53). Discharge Hb concentrations were similar in the bloodless (10.8 ± 2.7 g/dL) and control (10.9 ± 2.3 g/dL) groups (p = 0.42). Total and direct hospital costs were 12% (p = 0.02) and 18% (p = 0.02) less, respectively, in the bloodless patients, a difference attributed to the surgical subgroup. CONCLUSIONS Using appropriate blood conservation measures for patients who do not accept ABT results in similar or better outcomes and is associated with equivalent or lower costs. This specialized care may be beneficial even for those patients who accept ABT.

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Ethics of Surgical Intervention in Jehovah’s Witness Patients

Cho

Jeyarajah

2019

Surgical Ethics

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Pancreas and Liver Resection in Jehovah's Witness Patients: Feasible and Safe

Cited by 19 publications

References 34 publications

Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

Risk‐adjusted clinical outcomes in patients enrolled in a bloodless program

Ethics of Surgical Intervention in Jehovah’s Witness Patients

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