Transfusion Practices In Advanced Cancer Patients
Abstract Purpose: Anemia is highly prevalent in patients with advanced cancer and adversely affects quality of life. There is limited data on the frequency, clinical utility and effectiveness of red blood cell transfusions (RBC), and no randomized controlled 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 (PCS) and its impact in patients’ symptoms, adverse events and overall survival.Methods: Retrospective analyses of all advanced cancer patients who received RBC transfusions admitted, during a 3-year period. Pre-blood counts, reason for transfusion, subjective benefit and objective outcomes were listed.Results: We identified 179 patients with a mean age of 67 years. A total of 435 RBC units, during 301 transfusion episodes were recorded. Asthenia/fatigue was the most frequent symptom (68%). The mean pretransfusion hemoglobin (Hb) was 6.85 g/dL and 48% patients had an Hb above 7 g/dL. 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 between ECOG performance status (ECOG-PS) and symptomatic benefit was found (p=0.005). Hemoglobin level pre-transfusion, ECOG-PS and symptomatic benefit with transfusions were significantly associated with survival.Conclusion: This study suggests that advanced cancer patients with a higher level of functioning may have a bigger benefit from RBC transfusion. Post-transfusion symptomatic benefit, and pre-transfusion ECOG-PS and hemoglobin levels seem to be independent predictors of survival. Further studies are needed to develop validated measures of objective functional changes to evaluate the clinical impact of transfusions and to identify patients most likely to benefit from it.