Winnie S Wang1, Joseph D Ma2, Sandahl H Nelson3, Carolyn Revta4, Gary T Buckholz4, Carolyn Mulroney5, Eric J Roeland6. 1. Internal Medicine, University of California (UC), San Diego, San Diego, CA, USA. 2. Skaggs School of Pharmacy & Pharmaceutical Sciences, UC San Diego, La Jolla, CA, USA. 3. Department of Cancer Prevention and Control, UC San Diego Moores Cancer Center, La Jolla, CA, USA. 4. Division of Hematology/Oncology, Doris A. Howell Palliative Care Service, UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, MC 0987, La Jolla, CA, 92093, USA. 5. Blood and Marrow Transplant, UC San Diego Moores Cancer Center, La Jolla, CA, USA. 6. Division of Hematology/Oncology, Doris A. Howell Palliative Care Service, UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, MC 0987, La Jolla, CA, 92093, USA. eroeland@ucsd.edu.
Abstract
PURPOSE: Limited data exist regarding transfusion practices at end of life (EOL) for hematopoietic stem cell transplant (HSCT) patients. The purpose of this study was to examine red blood cell (RBC) and platelet transfusion practices in HSCT patients who enrolled or did not enroll in hospice. METHODS: This was a single-center, retrospective chart review in deceased HSCT patients. The primary objective was to determine the mean difference between the last transfusion and death in HSCT patients (n = 116) who enrolled or did not enroll in hospice. RESULTS: Sixteen (14%) and 100 (86%) patients were enrolled in hospice and not enrolled in hospice, respectively. Hospice patients observed a larger mean difference between death and last transfusion (45.9 ± 66.7 vs. 14.6 ± 48.1 days, p < 0.0001). A higher amount of platelet, but not RBC, transfusions occurred in patients not enrolled in hospice (p = 0.04). The last transfusion that occurred more than 96 h before death was observed in 12 (75%) and 22 (22%) in hospice and non-hospice patients, respectively. For HSCT patients not enrolled in hospice, 17 patients received a transfusion on the same day of death and 31 patients received the last transfusion 24 h before death. CONCLUSIONS: Blood transfusion practices differed in HSCT patients enrolled and not enrolled in hospice. For most patients not enrolled in hospice, the last transfusion occurred 24 h before death. Future efforts should explore if limited access to blood products is a barrier to hospice enrollment for HSCT patients.
PURPOSE: Limited data exist regarding transfusion practices at end of life (EOL) for hematopoietic stem cell transplant (HSCT) patients. The purpose of this study was to examine red blood cell (RBC) and platelet transfusion practices in HSCT patients who enrolled or did not enroll in hospice. METHODS: This was a single-center, retrospective chart review in deceased HSCT patients. The primary objective was to determine the mean difference between the last transfusion and death in HSCT patients (n = 116) who enrolled or did not enroll in hospice. RESULTS: Sixteen (14%) and 100 (86%) patients were enrolled in hospice and not enrolled in hospice, respectively. Hospice patients observed a larger mean difference between death and last transfusion (45.9 ± 66.7 vs. 14.6 ± 48.1 days, p < 0.0001). A higher amount of platelet, but not RBC, transfusions occurred in patients not enrolled in hospice (p = 0.04). The last transfusion that occurred more than 96 h before death was observed in 12 (75%) and 22 (22%) in hospice and non-hospice patients, respectively. For HSCT patients not enrolled in hospice, 17 patients received a transfusion on the same day of death and 31 patients received the last transfusion 24 h before death. CONCLUSIONS: Blood transfusion practices differed in HSCT patients enrolled and not enrolled in hospice. For most patients not enrolled in hospice, the last transfusion occurred 24 h before death. Future efforts should explore if limited access to blood products is a barrier to hospice enrollment for HSCT patients.
Entities:
Keywords:
Blood transfusion; End of life; Hematologic malignancies; Hospice; Stem cell transplantation
Authors: Richard W Toner; Laura Pizzi; Brian Leas; Samir K Ballas; Alyson Quigley; Neil I Goldfarb Journal: Appl Health Econ Health Policy Date: 2011 Impact factor: 2.561
Authors: Winnie S Wang; Joseph D Ma; Sandahl H Nelson; Carolyn Revta; Gary T Buckholz; Carolyn M Mulroney; Eric J Roeland Journal: J Oncol Pract Date: 2017-06-23 Impact factor: 3.840
Authors: María Elena Uceda Torres; Juan Nicolás Rodríguez Rodríguez; José Luis Sánchez Ramos; Francisco Alvarado Gómez Journal: J Palliat Med Date: 2013-12-10 Impact factor: 2.947
Authors: Melissa D Aldridge Carlson; Colleen L Barry; Emily J Cherlin; Ruth McCorkle; Elizabeth H Bradley Journal: Health Aff (Millwood) Date: 2012-12 Impact factor: 6.301