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

Abstract

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.

Managing suspected myasthenia gravis and myositis induced by pembrolizumab in a Jehovah's Witness sarcoma patient

“…Limited evidence suggests the use of colloidal starches are a safe and effective replacement for PLEX. 7 Adverse reactions to colloidal starch are infrequent, with rates estimated at 0.007% and are typically transient, mild, and clinically insignificant. 7 Typical preparations include a 6% hetastarch solution diluted to 3% allows for a total of 3 liters to be infused.…”

“…7 Adverse reactions to colloidal starch are infrequent, with rates estimated at 0.007% and are typically transient, mild, and clinically insignificant. 7 Typical preparations include a 6% hetastarch solution diluted to 3% allows for a total of 3 liters to be infused. 7,10 The NCCN guidelines also provide recommendations on the use of rituximab 375 mg/m 2 weekly for four treatments for MG treatment, representing another alternative to blood product treatment.…”

“…7 Typical preparations include a 6% hetastarch solution diluted to 3% allows for a total of 3 liters to be infused. 7,10 The NCCN guidelines also provide recommendations on the use of rituximab 375 mg/m 2 weekly for four treatments for MG treatment, representing another alternative to blood product treatment. 5 In a meta-analysis review 46% of AChR antibody positive and 86% of MuSK positive cases of MG responded to rituximab treatment.…”

Desafíos en el manejo del sarcoma de Ewing en una paciente testigo de Jehová

“…Todos los pacientes rechazaron las transfusiones cuando les fueron ofrecidas, incluso aquellos con anemia sintomática o amenazante para la vida, llegando a presentarse hasta un 24 % de discontinuación a la quimioterapia. Sin embargo, no se encontró que la mortalidad fuera directamente atribuible a la anemia o al rechazo de los hemoderivados, sino probablemente, a la discontinuación de la quimioterapia y la administración de agentes estimulantes de eritropoyesis 5 . La transfusión de hemoderivados en la paciente se llevó a cabo antes de la cirugía, por anemia grave, y después de la intervención quirúrgica y de la quimioterapia.…”

“…Los testigos de Jehová son una comunidad religiosa de más de ocho millones de miembros, que manifiestan su rechazo a las transfusiones y quienes, al presentar una enfermedad oncológica, representan un desafío para el equipo tratante. La anemia se presenta hasta en el 34 % de los pacientes oncológicos que son testigos de Jehová 5 , lo cual implica un riesgo de abandono o subdosificación de la quimioterapia, con compromiso de los resultados clínicos y la supervivencia.…”