Study finds home transfusions safe in hospice care for blood cancer
No patients required hospital or ICU admission during hospice
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Among adults with blood cancers receiving end-of-life hospice care at home, a blood transfusion, based on symptoms, not blood tests, was feasible and safe, according to a pilot study. (Photo by iStock)
Among adults with blood cancers receiving end-of-life hospice care at home, a blood transfusion based on symptoms, not blood tests, was feasible and safe, with no reported transfusion-related reactions, according to a pilot study.
No patients were admitted to the hospital or intensive care unit during hospice care.
“We believe our study has shown that hospices can safely deliver transfusions, with an improvement in hospice care,” Jennifer Holter-Chakrabarty, MD, a blood cancer specialist at the University of Oklahoma Health Stephenson Cancer Center and study lead, said in a university news story. “As a physician, it was gratifying to see patients and their families spend quality time at home. We took something that was frustrating for families and turned it into something comforting.”
The pilot study, “Home-based transfusions in hospice patients with hematologic malignancies: a pilot study,” was published in eClinicalMedicine.
Concern about stopping blood transfusions a barrier to hospice
Blood cancers, including myeloma, lymphoma, and leukemia, are on the rise in the U.S., with over 190,000 new cases expected this year. Despite promising advances in treatments that extend survival and improve quality of life, about one-third of blood cancer patients die each year from their disease.
Compared with other types of cancer, people with blood cancers are less likely to use hospice services, which provide comfort-focused, compassionate care and support for individuals with life-limiting or terminal illnesses. These patients often enroll in hospice care late in their disease course.
One reason for this pattern is concern about stopping blood transfusions, which many blood cancer patients depend on. The cost of providing transfusions under the daily payment model used in hospice has also limited their use.
To address these barriers, the American Society of Hematology issued a statement in 2019 supporting palliative transfusions for patients in hospice. A Senate bill, the Improving Access to Transfusion Care for Hospice Patients Act of 2025 (S.1936), has also been introduced.
However, “research is needed to provide concrete, actionable data for a patient-centric, safe, and ideally [home-based transfusion] program for patients receiving hospice services to enhance quality care,” the authors wrote.
‘We wanted to flip the script and give the patient control’
To address this gap, Holter-Chakrabarty and colleagues launched a pilot study (NCT04454723) to describe the initial experience with a home-based transfusion program in hospices.
“Patients with blood cancers like leukemia or myeloma have a much higher likelihood of dying in the hospital or ICU instead of getting to die at home,” Holter-Chakrabarty said. “If patients want to transition to hospice, the need for transfusions doesn’t go away.”
The study included 20 adults (65% men), ages 31-83, with different types of blood cancers and a life expectancy of less than six months. They were enrolled in hospice care and transfusion-dependent.
Transfusions were based on symptoms, including fatigue, shortness of breath, bruising, or bleeding, not on blood tests. In hospitals and clinics, in contrast, transfusions are generally guided by lab test results. Of the 20 patients, 16 had such symptoms that made them eligible for transfusion and received at least one unit of blood cells.
“We wanted to flip the script and give the patient control,” Holter-Chakrabarty said. “Because the study was designed to deliver palliative, patient-centered care, we felt like the patients’ symptoms should trigger a transfusion, not a number.”
‘They had the peace of being around people they love’
Nurses gave transfusions during 44 home visits, for a total of 68 infused products. No transfusion reactions were noted. No patients died in the hospital, and none were admitted to the intensive care unit.
Before transfusion, the most common symptoms were fatigue (95%), bruising (79%), shortness of breath (56%), lightheadedness (53%), and headache (26%). Symptom scores changed little after transfusion. Platelet counts and the levels of hemoglobin, the oxygen-carrying protein in red blood cells, also remained stable before and after transfusion.
This trial demonstrates proof of concept for an economical, patient-centered [home-based transfusion] protocol in [blood cancer] patients receiving [hospice care].
The mean cost of transfusion products and preparation was $571 per patient per week of life. A single red blood cell product cost $709, and red blood cells with platelets together cost $1,411. Nursing time was not included. Time in hospice ranged from two to 163 days (about five months), with a median of 11 days.
The team noted that “the cost of improving utilization of hospice with the addition of transfusions was quite low, with an increase of $400/week of life while on hospice for the additional product(s).”
“[Home-based transfusion] in the setting of hospice represents a feasible and safe option for further study to avoid costly hospitalizations and ICU admissions, with limited cost,” the authors wrote. “This trial demonstrates proof of concept for an economical, patient-centered [home-based transfusion] protocol in [blood cancer] patients receiving [hospice care].”
Added Holter-Chakrabarty: “In this study, all of the patients we approached wanted to take part in the study, and all of our patients were able to die at home. They had the peace of being around people they love.”
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