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Red blood cell transfusions in advanced cancer near the end-of-life: narrative review
Daniele Marelli1, Michela Romelli1,2, Cristina Cornali2
1Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italy.
Background:
Red blood cell (RBC) transfusions are commonly used to manage anemia-related symptoms, such as fatigue and dyspnea in patients with advanced cancer. Their use in palliative care (PC) remains controversial due to the lack of clear guidelines, potential risks, and ethical considerations.
Objective:
This narrative review aims to evaluate the role of RBC transfusions in patients with advanced cancer and those at the end of life.
Methods And Data Sources:
A comprehensive review of relevant existing literature was performed in various databases, using combinations of relevant keywords. Only studies published in English were considered.
Findings:
Anemia affects up to 77% of men and 68% of women with advanced cancer in palliative care. RBC transfusions may offer temporary symptomatic relief, but evidence supporting their routine use in palliative cancer patients is inconclusive. Studies report subjective response rates ranging from 31% to 70%. Benefits on fatigue and dyspnea often last <2 weeks and 23-35% of patients die within two weeks after the transfusion, raising concerns about futility. Variability in transfusion practices across different palliative care settings highlights the influence of clinician attitudes, resource availability, and institutional policies.
Conclusion:
RBC transfusions in advanced cancer and end-of-life care should be considered on a case-by-case basis, prioritizing patient-centered decision-making and ethical considerations. Though the benefit is often short, they may improve the quality of life for highly selected patients. Risks such as adverse reactions and resource allocation concerns must be considered. Further research is needed to establish evidence-based guidelines and standardized assessment tools to evaluate transfusion efficacy in this population.
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