Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

Abstract

Background: Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. Objective: We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. Design: Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. Results: Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). Conclusions: Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.

End-of-life palliative chemotherapy: Where do we stand?

“…In Italy, within 30 days of death, 23% of patients with incurable cancer received PCT [6]. This was within the range of previous published results, 18-33% [9][10][11].…”

“…But this time frame of has been used in other published studies [6,7,9,11,12,23,[25][26][27][28]. Retrospective studies most always are criticized as the completeness of data often is suboptimal and depends totally on medical documentation without matched controls beside the limited information about patients that died outside the hospital.…”

Red blood cell transfusion in adult palliative care: a systematic review

“…During data extraction, an additional six articles were excluded as they did not assess a transfusion‐related outcome. One additional study was included after screening the references of a review article, resulting in a total of 13 studies that were included in the final analysis of data …”

“…Three of these studies did not include a comparison group that was not transfused, but reported median or mean survival of 42 days to 3 months after RBC transfusion . In one retrospective cohort of palliative oncology patients who died in hospital, those receiving RBC transfusion had a longer duration of their terminal hospitalization compared to those not transfused (median, 15 days vs. 8 days) . Four studies reported increased Hb values posttransfusion as at least one endpoint.…”

The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care

“…[1][2][3][4][5] Causes include chronic inflammation, erythropoietin deficiency, bone marrow infiltration, bleeding, haematinic depletion and treatment effects.…”