Blood Transfusions in Patients with Advanced Cancer at the End-of-Life: Are They Really Beneficial?

Abstract

Objectives: Anaemia is prevalent in individuals with advanced cancer and may contribute to adversely affecting their quality of life. In palliative care (PC), red blood cell (RBC) transfusions are regularly administered to address bothersome symptoms such as fatigue and dyspnoea. However, they are not without risks and adverse effects in individuals who are often frail at the end of life. Within this context, RBC transfusion benefits and drawbacks have yet to be demonstrated. This study aimed to assess RBCs transfusion-targeted indications, practices and clinical outcomes at the end-of-life in hospitalised patients with advanced malignancy.

Materials and methods: A retrospective cohort design was used. All adults with a cancer diagnosis admitted to a PC Unit in a tertiary care centre in Saudi Arabia and who received at least one RBC transfusion between 1 January 2020 and 1 January 2024 were included in the study. Data were retrieved from their medical records (demographics, clinical and transfusion episode information) and included the Charlson Comorbidity Index.

Results: A total of 84 patients were included, comprising a total of 159 episodes of transfusion. Patients had a mean age of 47 years (19.4%). The most frequent location of cancer was the gastrointestinal system (34.6%). For most patients, a low haemoglobin level was the main indication for the transfusion, without precise symptoms being targeted. There was no improvement following several transfusion episodes (82.4%). A moderate negative correlation was observed between age and survival days post-transfusion.

Conclusion: There is a need for further studies to better understand the benefits of RBC transfusions at the end of life. In addition, more attention is warranted to establish targeted clinical outcomes pre-transfusion rather than relying on abnormal laboratory values. Validated self-reported tools should be used to ensure the benefits of an intervention that involves such a limited and valuable resource.