Blood transfusion is a widely used supportive treatment of
cancer patients, most of whom are anemic. In the particular subset of
cancer patients that undergoes
chemotherapy,
blood transfusion is viewed as an essential part of supportive care. However, the place of
blood transfusion in anemic terminally ill
cancer patients is far less established. There are no well-defined
blood transfusion guidelines ("transfusion trigger") for these patients. Hence, transfusion decisions are greatly influenced by the personal views of the medical team. Therefore, a mail survey of 500 physicians (from several specialties) and nurses was initiated to assess their personal opinions on this topic. The overall response rate was relatively high (70%). There was broad agreement that
blood transfusions, as a rule, should not be withheld from terminal
cancer patients. On the other hand, only nurses were of the opinion that these patients should be transfused "as usual." Significantly, there was but a slight majority (53% of participants) that was of the opinion that transfusions to these patients do not prolong suffering. There emerged a short list of agreed-on suggestions for
blood transfusion--namely, Hb level < or = 7 mg/dL, active
bleeding (acute and/or occult), functional deterioration of the patient, presence of
anemia resulting from
chemotherapy, anginal symptoms,
dyspnea, and worsening
congestive heart failure. The agreed-on suggestions for transfusions in terminally ill
cancer patients may serve as a reasonable physician standard for this complex clinical, medical-legal, and emotional issue.