Practice review: Evidence-based and effective management of anaemia in palliative care patients

Abstract

Background: Anaemia is a common sequela of advanced disease and is associated with significant symptom burden. No specific guidance exists for the investigation and management of anaemia in palliative care patients. Aim: We aim to offer a pragmatic overview of the approaches to investigate and manage anaemia in advanced disease, based on guidelines and evidence in disease specific patient groups, including cancer, heart failure and chronic kidney disease. Design: Scoping review methodology was used to determine the strength of evidence supporting the investigation and management of anaemia in patients with advanced disease. Data sources: A search for guidelines was performed in 2020. National or international guidelines were examined if they described the investigation or management of anaemia in adult patients with health conditions seen by palliative care services written within the last 5 years in the English language. Searches of MEDLINE, the Cochrane library and WHO guidance were made in 2019 to identify key publications that provided additional primary data. Results: Evidence supports patient-centred investigation of anaemia, results of which should guide targeted intervention. Blanket use of blood transfusion should be avoided, with evidence supporting a more restrictive approach to transfusion. Routine use of oral iron and erythropoetin stimulating agents (ESAs) are not recommended. Insufficient evidence exists to determine the effectiveness of IV iron in this patient group. Conclusion: We advocate early consideration and investigation of anaemia, guided by symptom burden and patient preferences. Correction of reversible causes should be the mainstay of treatment, with a restrictive approach to blood transfusion. Research is required to evaluate the efficacy of IV iron in these patients.

Anemia of chronic diseases: current state of the problem and perspectives

“…К настоящему времени разработан ряд клинических рекомендаций по лечению анемий, в генезе которых системное воспаление играет существенную роль: у онкологических пациентов [42], в том числе отечественные [43], у пациентов, получающих паллиативную помощь [44], c воспалительными заболеваниями кишечника [45], ХБП [46]. В качестве основных лечебных подходов при АХЗ рассматриваются гемотрансфузии, использование препаратов эритропоэтина (а при ХБП -и ингибиторов пролилгидроксилазы) и коррекция функционального или абсолютного дефицита железа в основном при помощи препаратов для парентерального применения.…”

The management of absolute iron deficiency anaemia in the palliative care population: A reply to Neoh et al.

“…This was based on the reasoning that oral iron is not well absorbed if systemic inflammation is present due to a higher level of hepcidin. 1 There are, however, no studies in the palliative care population comparing low dose oral iron versus parenteral iron for treatment of absolute iron deficiency anaemia. Indeed, the review referenced evidence from a randomised controlled trial comparing oral iron versus placebo in patients with cardiac failure.…”

“…This was based on the reasoning that oral iron is not well absorbed if systemic inflammation is present due to a higher level of hepcidin. 1…”

End-of-Life transfusion support at hospice and pediatric oncology unit: Bridging the gap between benefits and therapeutic alliance

“…Patients are sometimes admitted to a pediatric oncology ward for palliative treatments, or to reassess their worsening clinical conditions, or at the request of relatives unwilling to leave a place where their child has been treated for years. 7…”

“…Patients are sometimes admitted to a pediatric oncology ward for palliative treatments, or to reassess their worsening clinical conditions, or at the request of relatives unwilling to leave a place where their child has been treated for years. 7 The pediatric oncology unit at the Fondazione IRCCS Istituto Nazionale dei Tumori (INT) in Milan cares for approximately 250 new patients every year, and about 40 of them enter the terminal phase or die each year. Since 2015 the INT's pediatric oncology unit has been collaborating with a foundation called VIDAS, which offers palliative care at home in and around Milan.…”