1
|
Cheng HWB, Chan KP, Chung WKV, Hsu Y, Chan KY. Management of Anemia in Renal Palliative Care Clinic: A Patient-Centered Approach. J Pain Symptom Manage 2024; 67:e355-e360. [PMID: 38215894 DOI: 10.1016/j.jpainsymman.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Despite the growing needs in nondialytic alternatives for conservative kidney management, few studies have examined the management of anemia in palliative care (PC) outpatient clinics, which represent the key point of entry for timely access to PC. OBJECTIVE A retrospective study to review for a patient-centered approach in anemia management and symptom control. RESULTS Over the study period from July 2020 to March 2023, a total of 158 patients were seen at our renal PC clinic, 47 were included in data analysis. Patients had a mean age and glomerular filtration rate of 81.3 (9.5) years and 8.6 (5.3) mL/min/1.73 m2, and 68.1% and 44.7% were receiving erythropoiesis-stimulating agents (ESAs) and iron supplements respectively, with only 4.3% of patients required transfusion over past six months. Mean hemoglobin was maintained at 9.8 (1.4) g/dL, with a mean POS-S renal score of 4.7 (3.2). Majority of patients (93.6%) had satisfactory rating on "weakness and lack of energy" item. CONCLUSION A patient-centered approach in anemia management at renal PC outpatient clinics may alleviate symptom burden and minimize transfusion requirement.
Collapse
Affiliation(s)
- Hon Wai Benjamin Cheng
- Department of Medicine and Geriatrics (H.W.B.C., K.P.C., W.K.V.C., Y.H.S.U.), Tuen Mun Hospital, New Territories, Hong Kong.
| | - Ka Po Chan
- Department of Medicine and Geriatrics (H.W.B.C., K.P.C., W.K.V.C., Y.H.S.U.), Tuen Mun Hospital, New Territories, Hong Kong
| | - Wai Ki Vicky Chung
- Department of Medicine and Geriatrics (H.W.B.C., K.P.C., W.K.V.C., Y.H.S.U.), Tuen Mun Hospital, New Territories, Hong Kong
| | - Yong Hsu
- Department of Medicine and Geriatrics (H.W.B.C., K.P.C., W.K.V.C., Y.H.S.U.), Tuen Mun Hospital, New Territories, Hong Kong
| | - Kwok Ying Chan
- Palliative Medicine Unit (K.Y.C.), Grantham Hospital, Aberdeen, Hong Kong
| |
Collapse
|
2
|
Smith CM. CE: Recognizing Transfusion-Associated Circulatory Overload. Am J Nurs 2023; 123:34-41. [PMID: 37882401 DOI: 10.1097/01.naj.0000995356.33506.f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion-related deaths in the United States, accounting for more than 30% of fatalities reported to the Food and Drug Administration between 2016 and 2020. However, TACO is widely considered to be an underdiagnosed and underreported complication of blood transfusions, and its exact incidence is unknown. One of the reasons for this is a lack of recognition of TACO and its signs and symptoms, especially as the definition of TACO has been updated twice since 2018 without full dissemination to nurses, who are responsible for bedside care of patients during and following blood transfusions. This article seeks to bridge this gap by discussing the updated definitions and signs and symptoms of TACO, as well as the management of this treatable blood transfusion reaction.
Collapse
Affiliation(s)
- Christy M Smith
- Christy M. Smith is chief nursing executive at Versafusion Medical, a mobile infusion service, in Johnson City, TN. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
3
|
Duffy E, O'Mahony F, Burke C, Conneely A, O'Connell H, Twomey F. Red cell transfusion benefits in oncology, haematology and palliative medicine populations: a narrative review. BMJ Support Palliat Care 2023; 13:291-297. [PMID: 34475134 DOI: 10.1136/bmjspcare-2021-003052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 11/04/2022]
Abstract
Due to the heterogenous nature of the palliative medicine patient population, assessment of benefit, and thus choice of appropriate patient for consideration of transfusion, can be challenging. This can be confounded by the use of both liberal and restrictive transfusion thresholds. The multifactorial nature of many symptoms of anaemia, particularly in patients with advanced malignancy, can further complicate. As such, there is a paucity of data supporting the subjective, objective and clinical benefit of red cell transfusion in the palliative medicine setting. This narrative review summarises the research and evidence surrounding the benefits of red cell transfusion, with a particular emphasis on the oncological, haematological and palliative medicine population. There is a lack of a validated, reproducible patient-reported outcome measures (PROM) to assess response to red cell transfusions in the palliative medicine population with outcome measures varying from objective improvement in haemoglobin level post-transfusion, to subjective response in primary symptom(s). Further investigation is required regarding the development of effective PROMs assessing response to red cell transfusion in the palliative medicine population, to ensure judicious use of this scarce and valuable resource.
Collapse
Affiliation(s)
- Ed Duffy
- Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland
| | - Frances O'Mahony
- Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Caroline Burke
- Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland
| | - Aoibheann Conneely
- Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Helen O'Connell
- Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland
| | - Feargal Twomey
- Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland
| |
Collapse
|
4
|
Dickson EA, Ng O, Keeler BD, Wilcock A, Brookes MJ, Acheson AG. The ICaRAS randomised controlled trial: Intravenous iron to treat anaemia in people with advanced cancer - feasibility of recruitment, intervention and delivery. Palliat Med 2023; 37:372-383. [PMID: 36609173 PMCID: PMC10021128 DOI: 10.1177/02692163221145604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Anaemia is highly prevalent in people with advanced, palliative cancer yet sufficiently effective and safe treatments are lacking. Oral iron is poorly tolerated, and blood transfusion offers only transient benefits. Intravenous iron has shown promise as an effective treatment for anaemia but its use for people with advanced, palliative cancer lacks evidence. AIMS To assess feasibility of the trial design according to screening, recruitment, and attrition rates. To evaluate the efficacy of intravenous iron to treat anaemia in people with solid tumours, receiving palliative care. DESIGN A multicentre, randomised, double blind, placebo-controlled trial of intravenous iron (ferric derisomaltose, Monofer®). Outcomes included trial feasibility, change in blood indices, and change in quality of life via three validated questionnaires (EQ5D5L, QLQC30, and the FACIT-F) over 8 weeks. (ISRCTN; 13370767). SETTING/PARTICIPANTS People with anaemia and advanced solid tumours who were fatigued with a performance status ⩽2 receiving support from a specialist palliative care service. RESULTS 34 participants were randomised over 16 months (17 iron, 17 placebo). Among those eligible 47% of people agreed to participate and total study attrition was 26%. Blinding was successful in all participants. There were no serious adverse reactions. Results indicated that intravenous iron may be efficacious at improving participant haemoglobin, iron stores and select fatigue specific quality of life measures compared to placebo. CONCLUSION The trial was feasible according to recruitment and attrition rates. Intravenous iron increased haemoglobin and may improve fatigue specific quality of life measures compared to placebo. A definitive trial is required for confirmation.
Collapse
Affiliation(s)
- Edward A Dickson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Oliver Ng
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Barrie D Keeler
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK.,The University of Buckingham, Buckingham, MK18 1EG, UK
| | - Andrew Wilcock
- Department of Palliative Care, University of Nottingham, Nottingham, UK
| | - Matthew J Brookes
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.,Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Austin G Acheson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| |
Collapse
|
5
|
Transfusion practices in patients with advanced cancer: a retrospective study in a palliative care service. Porto Biomed J 2022; 7:e195. [PMID: 37152079 PMCID: PMC10158856 DOI: 10.1097/j.pbj.0000000000000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background Anemia is highly prevalent in patients with advanced cancer and adversely affects the quality of life. There are limited data on the frequency, clinical utility, and effectiveness of red blood cell (RBC) transfusions, and no randomized controlled clinical trials or clinical practice guidelines are available. The aim of this study was to evaluate clinician practices on RBC transfusion in an oncologic palliative care service and its impact on patients' symptoms, adverse events, and overall survival. Methods This is a retrospective analysis of all patients with advanced cancer who received RBC transfusions admitted for 3 years. Preblood counts, the reason for transfusion, subjective benefit, and objective outcomes were listed. Results We identified 179 patients who underwent RBC transfusions. The mean age was 67 years, and 60% were male. We found a total of 435 RBC units in 301 transfusion episodes. Asthenia/fatigue was the most frequent symptom (68%). The mean pretransfusion hemoglobin (Hb) was 6.85 g/dL, and 48% of patients had a Hb above 7 g/dL. The symptomatic benefit was achieved in 36% of patients. Adverse events were reported in 4%, with a 30-day survival rate of 57%. A statistically significant association was found between Eastern Cooperative Oncology Group performance status (ECOG-PS) and the symptomatic benefit (P = .005). Hb level pretransfusion, ECOG-PS, and symptomatic benefits with transfusions were significantly associated with survival. Conclusion This study suggests that patients with advanced cancer with a higher functioning level may benefit more from RBC transfusion. Post-transfusion symptomatic benefits and pretransfusion ECOG-PS and Hb levels are independent predictors of survival. Further studies are needed to develop validated measures of objective functional changes to evaluate transfusions' clinical impact and identify patients most likely to benefit from it.
Collapse
|
6
|
Neoh K, Page A, Chin-Yee N, Doree C, Bennett MI. Practice review: Evidence-based and effective management of anaemia in palliative care patients. Palliat Med 2022; 36:783-794. [PMID: 35331051 PMCID: PMC9087312 DOI: 10.1177/02692163221081967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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.
Collapse
Affiliation(s)
- Karen Neoh
- St Gemma’s Hospice, Leeds, UK
- Karen Neoh, St Gemma’s Hospice, 329
Harrogate Road, Leeds, LS17 6QD, UK.
| | - Andrew Page
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, Leeds, UK
| | - Nicolas Chin-Yee
- Department of Medicine, Division of
Palliative Care, St. Michael’s Hospital, Toronto, Canada
| | - Carolyn Doree
- NHS Blood and Transplant Systematic
Review Initiative, Oxford, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds
Institute of Health Sciences, Leeds, UK
| |
Collapse
|
7
|
Garraud O. Transfusion at the border of the "intention-to-treat", in the very aged person and in palliative care: A debate. Transfus Clin Biol 2021; 28:367-369. [PMID: 34464710 DOI: 10.1016/j.tracli.2021.08.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022]
Abstract
In both palliative care and in the very aged person i.e. at the end of life, transfusion aims at bringing supportive care; it has indeed no intention to treat. It can occasionally be compassionate as to bring oxygen to a patient or a resident in nursing home wishing to enjoy some exercise or entertainment. Transfusion in this condition is not consensual, for reasons that are medical and/or societal. The present essay aims at discussing the main options to provide transfusion in such extreme, though non-exceptional, conditions.
Collapse
Affiliation(s)
- O Garraud
- INSERM_U1059, Faculty of medicine of Saint-Etienne, University of Lyon, Saint-Étienne, France.
| |
Collapse
|
8
|
Chin-Yee N, Scott M, Perelman I, Pugliese M, Tuna M, Fitzgibbon E, Downar J, Tinmouth A, Fergusson D, Tanuseputro P, Saidenberg E. Red blood cell transfusion and associated outcomes in patients referred for palliative care: A retrospective cohort study. Transfusion 2021; 61:2317-2326. [PMID: 34145904 DOI: 10.1111/trf.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aim to describe the occurrence of red blood cell transfusion and associated predictive factors and outcomes among patients referred for palliative care. STUDY DESIGN AND METHODS This retrospective cohort study used linked health administrative data of adults referred for palliative care at an academic hospital from 2014 to 2018. Multivariable regression models were employed to evaluate patient characteristics associated with transfusion and the relationship between transfusion status and location of death. Survival analyses were performed using log-rank tests and Cox proportional hazards modeling. RESULTS Of 6980 evaluated patients, 885 (12.7%) were transfused following palliative care consultation. Covariate factors associated with transfusion included younger age, higher performance status, lower baseline hemoglobin, and a diagnosis of hematologic malignancy (OR = 2.97, 95% CI 2.20-4.01) or solid organ tumor (OR = 1.37, 95% CI 1.10-1.71) vs. noncancer diagnosis. Median survival from palliative care consultation was 19 (IQR 5-75) days; 83 (32-305) days in those transfused and 15 (4-57) days in the nontransfused group (p < .0001). Median survival following transfusion was 56 (19-200) days. Solid organ tumor diagnosis was independently associated with poor survival (HR = 1.7, 95% CI 1.39-2.09 vs. non-cancer diagnosis). Among individuals who survived ≥30 days, transfusion was associated with a higher likelihood of death in hospital (OR = 2.15, 95% CI 1.71-2.70 vs. home/subacute setting). DISCUSSION Transfusions commonly occurred in patients receiving palliative care, associated with cancer diagnoses and favorable baseline prognostic factors. Poor survival following transfusion, particularly in solid organ tumor patients, and the twofold likelihood of death in hospital associated with this intervention have important implications in prescribing transfusion for this population.
Collapse
Affiliation(s)
- Nicolas Chin-Yee
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mary Scott
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Iris Perelman
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | - Meltem Tuna
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | | | - James Downar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean Fergusson
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | | |
Collapse
|
9
|
Cripe LD, Cottingham AH, Martin CE, Hoffmann ML, Sargent K, Baker LB. Bereaved Informal Caregivers Rarely Recall a Relationship Between Transfusions and Hospice in Acute Myeloid Leukemia. Am J Hosp Palliat Care 2021; 39:68-71. [PMID: 33926274 DOI: 10.1177/10499091211013290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS The inability to prescribe blood transfusions is a potential barrier to timely hospice enrollment for patients with blood cancers. The benefits and harms of transfusions near the end of life (EOL), however, are poorly characterized and patients' preferences are unknown. We sought to characterize the recollections of bereaved caregivers about the relationships between transfusions and hospice enrollment decisions. METHODS We recruited 18 bereaved caregivers of 15 decedents who died within 6-18 months of the interview. Interviews focused on caregivers' recollections of transfusion and hospice enrollment decisions. Transcripts were analyzed for themes. RESULTS We identified 2 themes. First, caregivers described that transfusions were necessary and the decisions to receive transfusions or not were deferred to the clinicians. Second, only 1 caregiver recalled transfusions as relevant to hospice decisions. In that instance there was a delay. Caregivers identified difficulties recognizing death was imminent, hope for miracles, and the necessity of accepting life was ending as more relevant barriers. CONCLUSIONS The results indicate clinicians' beliefs in transfusion at EOL may be a more relevant barrier to hospice enrollment than patients' preferences. Strategies to evaluate accurately and discuss the actual benefits and harms of transfusions at the EOL are necessary to advise patients and integrate their preferences into decisions.
Collapse
Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Caroline E Martin
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mary Lynn Hoffmann
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Sargent
- Indiana University Simon Cancer Center, 14686Indiana University School of Medicine, Indianapolis, IN, USA
| | - Layla B Baker
- 50826The Regenstrief Institute, Indianapolis, IN, USA
| |
Collapse
|
10
|
Steele T, Bonwick H, Nwosu AC, Chapman L. Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data. AMRC OPEN RESEARCH 2021; 3:6. [PMID: 38708071 PMCID: PMC11064982 DOI: 10.12688/amrcopenres.12963.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 05/07/2024]
Abstract
Background Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice. Methods This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded. Results Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 46/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a statistically significant increase in overall mean haemoglobin were observed. Conclusions This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.
Collapse
Affiliation(s)
- Thomas Steele
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
| | - Helen Bonwick
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
| | - Amara Callistus Nwosu
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
- International Observatory on End of Life Care, Lancaster University, Lancaster, Lancashire, LA1 4YG, UK
- Liverpool University Hospitals NHS Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Laura Chapman
- Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK
| |
Collapse
|
11
|
Specific challenges in end-of-life care for patients with hematological malignancies. Curr Opin Support Palliat Care 2019; 13:369-379. [DOI: 10.1097/spc.0000000000000470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
12
|
Abstract
PURPOSE OF REVIEW The palliative care population is a complex and heterogeneous one. While transfusion therapy is a readily available intervention for many patients, inadequate knowledge for accurately identifying which patient subsets at end-of-life will benefit from a transfusion, along with an unclear understanding of the magnitude of attendant risks of transfusion in those receiving palliative care, complicates the risk-benefit assessment of this therapy. In this brief review, the current literature surrounding transfusion of red cells and platelets in the palliative care patient population will be reviewed and recommendations provided. RECENT FINDINGS Benefits of transfusion therapy include subjective relief of fatigue and dyspnea, and improved sense of wellness, amongst other findings. However, these responses are not durable and there are currently no validated, objective metrics that correlate with symptomatic improvements. It is clear that transfusion-associated adverse reactions are underestimated in those receiving palliative care, with reaction rates similar to the general patient population. Additionally, based on the high mortality rates reported soon after transfusion, the impact of these blood components must be considered as an exacerbating or causative factor of mortality when evaluating declining condition or death. Hematinics are rarely assessed in anemic palliative care patients or, when measured, are often not corrected. The decision to transfuse palliative care patients is multifactorial, and benefits, risks, patient wishes, blood component inventories, and alternatives to transfusion should all be considered. There are many unknowns regarding transfusion in palliative care. Critical next steps for optimizing blood component therapy in this population include high-quality trials that help to identify validated measures of objective functional changes that parallel patient-reported outcomes and subsets of patients receiving end-of-life care that will most likely be positively impacted by transfusion therapy.
Collapse
Affiliation(s)
- Jay S Raval
- Department of Pathology, MSC08 4640, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| |
Collapse
|