Transfusion helpful in end stage cancer?

[IngeMu]

I started working in hospice care in March and although it has been very challenging for me, I do love working with my patients. I learned a lot already and I am always searching for Articles and resources to help me become a good hospice nurse.

My question is regarding a 45 year old patient with Stage 4 Ovarian Cancer. She has been declining fast over the last month or so and had 3 units of blood transfused 4 weeks ago for Anemia. That helped her feel stronger for a about 5 days. She now (4 weeks later) shows signs of Anemia again with increased nausea and increased Weakness (she now needs max. assist with all ADL`s)The family decided to keep her home and comfortable but they still wonder if she should be getting more blood transfusions. Does anyone have had a similar case and what would you tell her family? She has been through all treatments within the last 5 years including several chemotherapies and radiation treatments)

[tencat]

It depends where she is and where her family is in regard to her dying. Is she accepting death, are they accepting death? If not, I'd gently point out that giving the transfusions is just prolonging the inevitable. If they are ready to let go, I'd reassure them that they have done everything possible, and one or two blood transfusions are not going to cure her, and at this point they really wouldn't be much help anyway. Hope that helps.

[leslie :-D]

it's all going to depend on the particular hospice and their philosophy, where the pt is in the dying process, and if transfusing will truly be a palliative measure.

yes, we've done it w/some.

but it's certainly not a rubberstamp intervention.

many variables involved.

leslie

[marachne]

Agree w/Leslie.

Looking at how it was handled at the VA, when I worked there kind of illustrates how tricky it can be.

As a way of providing some extra energy, perhaps to get some important things done, it can be a palliative measure.

I think it is important to emphasize that it is a stop-gap measure that will provide some limited benefit. Doesn't fix anything, but you can't deny that it can, short term, for some folks improve their QoL

Sometimes I look at it in terms of "diminishing returns."