Transfusions and Hospice Care: A Path Forward?

For some patients with advanced blood cancers, enrolling in hospice care can mean forgoing access to palliative transfusions that can help alleviate fatigue, shortness of breath or bleeding related to low blood counts.

Thomas LeBlanc, MD, MA, a hematologic oncologist at Duke Cancer Center who treats patients with acute leukemias and various myeloid diseases and is board-certified in hospice and palliative medicine, described this scenario—deciding between palliative transfusions or home-based hospice care—as an “awful, impossible choice” for patients and their families. Patients may be told they can continue supportive care, including transfusions and antimicrobials, to help manage debilitating symptoms. But they may also be told they cannot elect hospice if they want to continue transfusions.

“In many areas, patients can’t do both,” he said. “I’ve seen several cases where patients were incredibly distraught about being forced to give up transfusions and felt it was unfair to choose between receiving help at home through hospice services and continuing transfusions that made them feel better. It becomes a deeply distressing situation. When we’re able to offer both, you can see the relief. It’s palpable.”