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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.
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Kaiser U, Vehling-Kaiser U, Hoffmann A, Kaiser F. Inpatient Hospices in Germany: Medical Care Situation and Use of Supportive Oncological Therapies for Symptom Control in Tumor Patients. Palliat Med Rep 2022; 3:169-180. [PMID: 36059908 PMCID: PMC9438444 DOI: 10.1089/pmr.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background: More than 80% of the residents in German hospices suffer from tumor disease. But the administration of supportive-oncological therapies in hospices for symptom control is controversially discussed. Objectives: This study aims to investigate the care situation of tumor patients in German hospices with regard to medical care and the use of supportive-oncological therapies. Methods: In February 2019, all hospices in Germany were offered the opportunity to participate in an anonymous online survey on medical and drug care for their tumor patients. The survey was conducted using the online platform SoSci Survey and ended in April 2019. The analysis was descriptive. Results: Of 202 hospices, 112 responded to the questionnaire. The hospices were distributed nationwide. Most have 8 to 10 places. More than 80% of hospice residents are tumor patients, and the length of stay is usually three to four weeks. Medical care is primarily provided by primary care physicians. While specialized outpatient palliative care is increasingly involved in care, hematologists/oncologists are rarely represented. Supportive-oncological therapies are rarely prescribed, whereas medication for other chronic conditions is often continued. The percentage of supportive-oncological therapies prescribed is higher in hospices with oncology co-care. Conclusions: Although most hospice residents suffer from malignant disease, co-care by a hematologist/oncologist is rare. Supportive-oncology therapies, particularly for symptom relief, may therefore be rarely used. However, since a small select group of hospice residents may benefit from these therapies, further investigation in this direction should be undertaken.
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Affiliation(s)
- Ulrich Kaiser
- Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Florian Kaiser
- Oncology/Palliative Care Network Landshut, Landshut, Germany
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
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3
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Moya-Salazar J, Cáceres E, Blejer J, Gonzalez C, Contreras-Pulache H. Frequency of allogenic blood transfusion in patients with gastrointestinal cancer: a cross-sectional study in Peru. Ecancermedicalscience 2021; 15:1289. [PMID: 34824612 PMCID: PMC8580600 DOI: 10.3332/ecancer.2021.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Gastrointestinal cancer demands a high frequency of transfusions, and the high availability of blood products. We aimed to determine the frequency of blood transfusions and the most used blood products according to the type of gastrointestinal cancer. Methods A cross-sectional study was conducted in a Peruvian Type I Hemotherapy and Blood Bank Service of a Private Oncological Clinic during 2016–2018. We included patients with gastrointestinal cancer using the International Code of Diseases. The donations were made in compliance with the requirements of the Programa Nacional de Hemoterapía y Banco de Sangre and in accordance with the Standardised Operational Procedure of the clinic. Results We analysed 3,022 patients, of which 163 (5.4%) had gastrointestinal cancer (67.1 ± 12 years). The 80 (49.1%) men did not show significant differences with the 83 (50.9%) women (p = 0.178). The most frequent neoplasia was the colon (41.7%) and pancreas (37.4%). Three hundred and four blood products were transfused (average 1.8 ± 2.5 units (range: 1–30 units/patient)), of which 81.3% (247 units) were red blood cells concentrated, 8.6% (26 units) were fresh-frozen-plasma (FFP) and 6.6% (20 units) were cryoprecipitate. The type of cancer that most blood products demanded was colon neoplasia (41.8%), followed by pancreatic cancer (26.3%) and liver cancer (10.9%). We determined that ~55% of patients were O Rh(D)+ and in five patients we were poly-transfused. Conclusion Our findings suggested that patients with gastrointestinal cancer require large numbers of transfusions of blood cell concentrate and FFP. Also, we showed that cancer of the colon, pancreas and liver demanded more than 75% of blood products.
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Affiliation(s)
- Jeel Moya-Salazar
- Pathology Department, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima 15001, Peru.,School of Medicine, Faculties of Health Science, Universidad Norbert Wiener, Lima 15001, Peru
| | - Eulogio Cáceres
- Service of Blood Bank, Department of Clinical Pathology, Oncosalud, Lima 15001, Peru
| | - Jorgelina Blejer
- Transfusion Transmissible Infections Section, Fundación Hemocentro Buenos Aires, Buenos Aires 1407, Argentina
| | - Carlos Gonzalez
- Hemotherapy Department, Hospital de Infecciosas F.J. Muñiz, Buenos Aires 1407, Argentina
| | - Hans Contreras-Pulache
- School of Medicine, Faculties of Health Science, Universidad Norbert Wiener, Lima 15001, Peru
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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.
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Affiliation(s)
- O Garraud
- INSERM_U1059, Faculty of medicine of Saint-Etienne, University of Lyon, Saint-Étienne, France.
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5
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Yang SY, Park SK, Kang HR, Kim HL, Lee EK, Kwon SH. Haematological cancer versus solid tumour end-of-life care: a longitudinal data analysis. BMJ Support Palliat Care 2020:bmjspcare-2020-002453. [PMID: 33376113 DOI: 10.1136/bmjspcare-2020-002453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore differences in end-of-life healthcare utilisation and medication costs between patients with haematological malignancies and patients with solid tumours. METHODS Data on deceased patients with cancer were selected from the sample cohort data of health insurance claims from 2008 to 2015 in South Korea. They were categorised into two groups: patients with haematological malignancies and patients with solid tumours. Longitudinal data comprised the patient-month unit and aggregated healthcare utilisation and medication cost for 1 year before death. Healthcare utilisation included emergency room visits, hospitalisation and blood transfusions. Medication costs were subdivided into anticancer drugs, antibiotics, opioids, sedatives and blood preparation. Generalised linear mixed models were used to evaluate differences between the two groups and time trends. RESULTS Of the 8719 deceased patients with cancer, 349 died from haematological malignancies. Compared with solid tumours, patients with haematological malignancies were more likely to visit the emergency room (OR=1.36, 95% CI 1.10 to 1.69) and receive blood transfusions (OR=5.44, 95% CI 4.29 to 6.90). The length of hospitalisation of patients was significantly different (difference=2.49 days, 95% CI 1.75 to 3.22). Medication costs, except for anticancer treatment, increased as death approached. The costs of antibiotics and blood preparations were higher in patients with haematological malignancies than in those with solid tumours: 3.24 (95% CI 2.14 to 4.90) and 4.10 (95% CI 2.77 to 6.09) times higher, respectively. CONCLUSIONS Patients with haematological malignancies are at a higher risk for aggressive care and economic burden at the end of life compared with those with solid tumours. Detailed attention is required when developing care plans for end-of-life care of haematological patients.
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Affiliation(s)
- So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Sun-Kyeong Park
- College of Pharmacy, Catholic University of Korea, Bucheon, Korea (the Republic of)
| | - Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Nowon-gu, Seoul, Korea (the Republic of)
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
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Gergi M, Soriano-Pisaturo MA. Palliative Care Issues for Transfusion-Dependent Patients #359. J Palliat Med 2020; 21:1359-1360. [PMID: 30207884 DOI: 10.1089/jpm.2018.0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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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]
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Buiar PG, Goldim JR. Barriers to the composition and implementation of advance directives in oncology: a literature review. Ecancermedicalscience 2019; 13:974. [PMID: 31921345 PMCID: PMC6946425 DOI: 10.3332/ecancer.2019.974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 12/21/2022] Open
Abstract
The advance directive (AD) is an important resource in oncology and all areas of medicine directly involved in the care of palliative patients. It provides people with the right to have their living wills honoured when they cannot respond by themselves. Despite their importance, ADs are still underused in most countries due to multiple factors. The objective of this review is to better categorise the barriers and difficulties that could impair the composition and implementation of ADs, allowing direct efforts against these obstacles. After the literature review, we believe that there would be five steps in the trajectory of an AD (discussion, composition, registration, access and implementation) and that all those steps can be affected by factors involving the health systems and professionals, the patient themselves and relatives or caregivers.
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Affiliation(s)
- Pedro Grachinski Buiar
- Medical Oncology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-007, Brazil
- http://orcid.org/0000-0001-5144-1197
| | - José Roberto Goldim
- Bioethics Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-007, Brazil
- http://orcid.org/0000-0003-2127-6594
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Ddungu H, Krantz EM, Phipps W, Naluzze S, Orem J, Kiwanuka N, Wald A, Kajja I. Survey to Assess Knowledge and Reported Practices Regarding Blood Transfusion Among Cancer Physicians in Uganda. J Glob Oncol 2019; 4:1-12. [PMID: 30307805 PMCID: PMC6818296 DOI: 10.1200/jgo.18.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Optimal decision making regarding blood transfusion for patients with cancer
requires appropriate knowledge of transfusion medicine among physicians. We
assessed blood transfusion knowledge, attitudes, and reported practices
among physicians working at Uganda Cancer Institute (UCI). Materials and Methods A cross-sectional self-administered survey of UCI physicians on their
knowledge, attitudes, and practices regarding blood transfusion was
conducted from June to September 2014. In consultation with transfusion
medicine experts, 30 questions were developed, including 10 questions for
each of the following three domains: knowledge, attitudes, and practices.
For the knowledge domain, we created a knowledge score equal to the number
of questions correctly answered out of 10. Results Of 31 physicians approached, 90% participated. The mean knowledge score was
5.3 (median, 5.5), and 32% correctly answered at least seven of 10
questions. Almost all (96%) understood the importance of proper patient
identification before transfusion and indicated identification error as the
most common cause of fatal transfusion reactions. More than 60% of
physicians acknowledged they lacked knowledge and needed training in
transfusion medicine. Most physicians reported sometimes changing their mind
about whether to provide a patient with a transfusion on the basis of
opinion of colleagues and sometimes administering unnecessary transfusions
because of influence from others. Conclusion Although UCI physicians have some basic knowledge in transfusion, most
reported gaps in their knowledge, and all expressed a need for additional
education in the basics of blood transfusion. Transfusion training and
evidence-based guidelines are needed to reduce inappropriate transfusions
and improve patient care. Greater understanding of peer influence in
transfusion decision making is required.
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Affiliation(s)
- Henry Ddungu
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Elizabeth M Krantz
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Warren Phipps
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Sandra Naluzze
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Jackson Orem
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Noah Kiwanuka
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Anna Wald
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Isaac Kajja
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
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10
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Mohammed AA, Al-Zahrani O, Salem RA, Elsayed FM. Aggressive Care at the End of Life; Where Are We? Indian J Palliat Care 2019; 25:539-543. [PMID: 31673209 PMCID: PMC6812417 DOI: 10.4103/ijpc.ijpc_59_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although, efforts to encourage palliative care only for terminal patients, aggressive end-of-life care (EOL) care still common for those probably to die shortly. AIM Multicenter experiences to investigate where did we stand in this era? PATIENTS AND METHODS A retrospective study included patients with advanced solid tumors. The presence of one or more of the following indicators in the last month of life (LM) referred to aggressive EOL care: emergency department (ED) visits ≥ twice, admission to the hospital through ED, death in critical care units (CCUs), and palliative chemotherapy (PC) at the past 2 weeks before death. RESULTS A total of 435 patients, 51.5% were men with a median age of 62 years (range: 17-108), were included in the study. Most of the patients (89.2%) belonged to Group II; they had attended ED at least twice (60%), approximately 53% admitted to the hospital through ED, 31% received PC-LM with 41% of them had at the past 2 weeks before death, 13% died in the CCUs, and more than half of them (53%) survived <2 weeks. Kaplan-Meier estimator revealed that median survival was 30 days in Group I versus 13 days in Group II (odds ratio: 1.63; 95% confidence interval: 1.20-2.21; P = 0.002). The median survival was statistically significantly associated with PC-LM ≥14 days and the admission mode. There was no statistically significant association with age, sex, and primary cancer sites. CONCLUSION The majority of our patients continue with anticancer treatments they possibly do not need and associated with poor survival.
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Affiliation(s)
- Amrallah A Mohammed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Egypt
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Omar Al-Zahrani
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Reham A Salem
- Department of Clinical Oncology, Zagazig University, Egypt
- Department of Clinical Oncology, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Fifi Mostafa Elsayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Egypt
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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.
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Affiliation(s)
- Jay S Raval
- Department of Pathology, MSC08 4640, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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12
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Timilsina S, Karki S, Timalsina S, Gautam A, Sharma S. Does packed red cell transfusion provide symptomatic benefits to cancer palliative patients?: a longitudinal study from a single private oncology center in Nepal. BMC Palliat Care 2019; 18:67. [PMID: 31387568 PMCID: PMC6685247 DOI: 10.1186/s12904-019-0454-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/31/2019] [Indexed: 11/20/2022] Open
Abstract
Background Palliative patients generally present with symptoms of dyspnea, easy fatigability, lethargy and feeling of being unwell which can broadly be attributed to one root cause: cancer-related anemia. So, packed red cell transfusion is often carried out aiming to improve patients’ functional status. Different cut off hemoglobin values have been suggested, with Hb < 9 g/dL the most commonly accepted. The present study aims at evaluating and comparing the benefits in subjective symptoms of fatigue and breathlessness among transfused and non-transfused palliative patients on Day 0 and Day 7. Methods Hemoglobin values, anemia related subjective symptoms of fatigue and breathlessness were recorded from 122 patients. The patients were re-evaluated on day-7 post-transfusion. The pre and post-transfusion symptomatic benefit was compared in both transfused and non-transfused palliative care patients. Results The currently practiced hemoglobin trigger for packed red cell transfusion is 10 g/dL. The units of packed red cell to be transfused was decided according to the hemoglobin values targeting the rise to > 10 g/dL. A mean 1.36 units were transfused. Statistically significant improvement was observed in patient reported symptoms of fatigue and breathlessness among both transfused and non-transfused palliative patients. Conclusion Anemic cancer palliative patients were found to benefit following packed red cell transfusion, suggesting a favorable association between the transfusion and patient-reported fatigue and dyspnea.
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Affiliation(s)
- Sameer Timilsina
- Department of Physiology, Tribhuvan University, Chitwan Medical College, Post Box No.: 42, Bharatpur-5, Chitwan, Nepal.
| | - Sirisa Karki
- Department of Pharmacology, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Santosh Timalsina
- Department of Biochemistry, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Aajeevan Gautam
- Department of Anatomy, Tribhuvan University, Chitwan Medical College, Bharatpur-5, Chitwan, Nepal
| | - Sabitri Sharma
- Palliative Care Unit, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
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13
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Sirianni G, Perri G, Callum J, Gardner S, Berall A, Selby D. A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting. Am J Hosp Palliat Care 2018; 36:185-190. [DOI: 10.1177/1049909118806456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre- and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.
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Affiliation(s)
- Giovanna Sirianni
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Giulia Perri
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Baycrest Hospital, Toronto, ON, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Sandra Gardner
- Baycrest Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | | | - Debbie Selby
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Chin-Yee N, Taylor J, Rourke K, Faig D, Davis A, Fergusson D, Saidenberg E. Red blood cell transfusion in adult palliative care: a systematic review. Transfusion 2017; 58:233-241. [DOI: 10.1111/trf.14413] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolas Chin-Yee
- Department of Medicine; University of Ottawa/The Ottawa Hospital
| | - Joshua Taylor
- The Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Kaitlyn Rourke
- The Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Danika Faig
- The Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Alexandra Davis
- Department of Medicine; University of Ottawa/The Ottawa Hospital
| | - Dean Fergusson
- The Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Elianna Saidenberg
- Department of Medicine; University of Ottawa/The Ottawa Hospital
- The Ottawa Hospital Research Institute; Ottawa Ontario Canada
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15
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To TH, LeBlanc TW, Eastman P, Neoh K, Agar MR, To LB, Rowett D, Vandersman Z, Currow DC. The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care. J Palliat Med 2017; 20:1152-1157. [DOI: 10.1089/jpm.2017.0072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Timothy H.M. To
- Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Southern Adelaide Palliative Services, Repatriation General Hospital, Adelaide, Australia
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Adelaide, Australia
| | | | | | - Karen Neoh
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Luen Bik To
- Directorate of Haematology, SA Pathology, Adelaide, Australia
| | - Debra Rowett
- Drug and Therapeutics Information Service, Repatriation General Hospital, Adelaide, Australia
| | - Zac Vandersman
- Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - David C. Currow
- Palliative and Supportive Services, Flinders University, Adelaide, Australia
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16
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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17
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Mohammed AA, Al-Zahrani AS, Ghanem HM, Farooq MU, El Saify AM, EL-Khatib HM. End-of-life palliative chemotherapy: Where do we stand? J Egypt Natl Canc Inst 2015; 27:35-9. [DOI: 10.1016/j.jnci.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 02/01/2015] [Accepted: 02/03/2015] [Indexed: 11/26/2022] Open
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