Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

  • Goksu, Sema Sezgin (Department of Medical Oncology, Kayseri State Hospital of Research and Education) ;
  • Gunduz, Seyda (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Unal, Dilek (Department of Radiation Oncology, Kayseri State Hospital of Research and Education) ;
  • Uysal, Mukremin (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Arslan, Deniz (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Tatli, Ali Murat (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Bozcuk, Hakan (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Ozdogan, Mustafa (Department of Medical Oncology, Akdeniz University, Faculty of Medicine) ;
  • Coskun, Hasan Senol (Department of Medical Oncology, Akdeniz University, Faculty of Medicine)
  • Published : 2014.05.30
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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.

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References

  1. American College of Physicians (1992). Practice strategies for elective red blood cell transfusion. Ann Intern Med, 116, 403-6. https://doi.org/10.7326/0003-4819-116-5-403
  2. Barrett-Lee PJ, Bailey NP, O'Brien ME, Wager E (2000). Large-scale UK audit of blood transfusion requirements and anaemia in patients receiving cytotoxicchemotherapy. Br J Cancer, 82, 93-7. https://doi.org/10.1054/bjoc.1999.0883
  3. Beutler E, Waalen J (2006). The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood, 107, 1747-50. https://doi.org/10.1182/blood-2005-07-3046
  4. Bokemeyer C, Aapro MS, Courdi A, et al (2007). European Organisation for Research and Treatment of Cancer (EORTC) taskforce for the elderly. EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer: 2006 update. Eur J Cancer, 43, 258-70. https://doi.org/10.1016/j.ejca.2006.10.014
  5. Brown E, Bennett M (2007). Survey of blood transfusion practice for palliative care patients in Yorkshire: implications for clinical care. J Palliative Med, 10, 919-22. https://doi.org/10.1089/jpm.2006.0199
  6. Calabrich A, Katz A (2011). Management of anemia in cancer patients. Future Oncol, 7, 507-17. https://doi.org/10.2217/fon.11.24
  7. Campos MP, Hassan BJ, Riechelmann R, Del Giglio A (2011). Cancer-related fatigue: a review. Rev Assoc Med Bras, 57, 211-9. https://doi.org/10.1590/S0104-42302011000200021
  8. Cella D (1997). The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol, 34, 13-9.
  9. Diedrich B, Remberger M, Shanwell A, Svahn BM, Ringden O (2005). A prospective randomized trial of a prophylactic platelet transfusion trigger of 105109 per L versus 305109 per L in allogeneic hematopoietic progenitor cell transplant recipients. Transfusion, 45, 1064-72. https://doi.org/10.1111/j.1537-2995.2005.04157.x
  10. Dunn A, Carter J, Carter H (2003). Anemia at the end of life: prevalence,significance, and causes in patients receiving palliative care. J Pain Symptom Manage, 26, 1132-9. https://doi.org/10.1016/j.jpainsymman.2003.04.001
  11. Eagleton HJ, Littlewood TJ (2003). Update on the clinical use and misuse of erythropoietin. Curr Hematol Rep, 2, 109-15.
  12. Gaydos LA, Freireich EJ, Mantel N (1962). The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med, 266, 905-9. https://doi.org/10.1056/NEJM196205032661802
  13. Greer DS, Mor V, Morris JN, et al (1986). An alternative in terminal care: results of the National Hospice Study. J Chronic Dis, 39, 9-26. https://doi.org/10.1016/0021-9681(86)90103-7
  14. Heckman KD, Weiner GJ, Davis CS, et al (1997). Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/mL versus 20,000/mL. J Clin Oncol, 15, 1143-9.
  15. Leibovitz A, Baumoehl Y, Walach N, et al (2004). Medical staff attitudes: views and positions regarding blood transfusion to terminally ill cancer patients. Am J Clin Oncol, 27, 542-6. https://doi.org/10.1097/01.coc.0000136021.27983.29
  16. Lozano M, Cid J (2007). Consensus and controversies in platelet transfusion: trigger for indication, and platelet dose. Transfus Clin Biol, 14, 504-8. https://doi.org/10.1016/j.tracli.2008.03.002
  17. Ludwig H, Strasser K (2001). Symptomatology of anemia. Semin Oncol, 28, 7-14 https://doi.org/10.1053/sonc.2001.25391
  18. Ludwig H, Van Belle S, Barrett-Lee P, et al (2004). The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer, 40, 2293-306. https://doi.org/10.1016/j.ejca.2004.06.019
  19. Meng J, Lu XB, Tang YX, et al (2013). Effects of allogeneic blood transfusion in patients with stage II colon cancer. Asian PacJ Cancer Prev, 14, 347-50. https://doi.org/10.7314/APJCP.2013.14.1.347
  20. Mercadante S, Ferrara P, Villari P, et al (2009). Effects of red blood cell transfusion on anemiarelated symptoms in patients with cancer. J Palliative Med, 12, 60-3. https://doi.org/10.1089/jpm.2008.0139
  21. Monti M, Castellani L, Berlusconi A, Cunietti E (1996). Use of red blood cell transfusions in terminally ill cancer patients admitted to a palliative care unit. J Pain Symptom Manage, 12, 18-22. https://doi.org/10.1016/0885-3924(96)00044-9
  22. Mozes B, Epstein M, Ben-Bassat I, et al (1989). Evaluation of the appropriateness of blood product transfusion using preset criteria. Transfusion, 29, 473-6. https://doi.org/10.1046/j.1537-2995.1989.29689318442.x
  23. National Comprehensive Cancer Network. NCCN Guideline on Cancer- and Chemotherapy - Induced Anemia, Version 2.2011. http://www.nccn.org/professionals/physician_ gls/pdf/anemia.pdf. April 25, 2011.
  24. Preston NJ, Hurlow A, Brine J, Bennett MI (2012). Blood transfusions for anaemia in patients with advanced cancer. Cochrane Database Syst Rev, 2, CD009007.
  25. Rebulla P, Finazzi G, Marangoni F, et al (1997). The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med, 337, 1870-5. https://doi.org/10.1056/NEJM199712253372602
  26. Rizzo JD, Brouwers M, Hurley P, et al (2010). American society of clinical oncology; American society of hematology. american society of clinical oncology/American society of hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer. J Clin Oncol, 28, 4996-5010. https://doi.org/10.1200/JCO.2010.29.2201
  27. Schrijvers D (2011). Management of anemia in cancer patients: transfusions. Oncologist, 16, 12-8.
  28. Vamvakas EC, Blajchman MA (2001). Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood, 97, 1180-95. https://doi.org/10.1182/blood.V97.5.1180
  29. Wachtel TJ, Mor V (1985). The use of transfusion in terminal cancer patients. Hospice versus conventional care setting. Transfusion, 25, 278-9. https://doi.org/10.1046/j.1537-2995.1985.25385219915.x
  30. Zumberg MS, del Rosario ML, Nejame CF, et al (2002). A prospective randomized trial of prophylactic platelet transfusion and bleeding incidence in hematopoietic stem cell transplant recipients: 10,000/mL versus 20,000/mL trigger. Biol Blood Marrow Transplant, 8, 569-76. https://doi.org/10.1053/bbmt.2002.v8.pm12434952

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