Red blood cell transfusions in advanced cancer near the end-of-life - narrative review

Q: Why are RBC transfusions controversial in palliative care for advanced cancer near end of life?

RBC transfusions are used to relieve anemia-related symptoms, but controversy persists because clear guidelines are lacking, potential risks exist, and ethical considerations must be weighed.

Q: How common is anemia and anemia-related fatigue and dyspnea in advanced cancer patients receiving hospice or palliative care?

Anemia affects up to 77% of men and 68% of women in palliative settings. Fatigue and dyspnea are frequently associated with anemia, reported in roughly 80% and 70% of patients, respectively.

Q: What does the review report about symptom benefit and futility after RBC transfusion?

Subjective response rates are reported between 31% and 70%, and benefits on fatigue and dyspnea often last less than two weeks. About 23–35% of patients die within two weeks after transfusion, raising concerns about futility.

Sep 23, 2026

Uploaded by anakgang17

Red blood cell (RBC) transfusions are used to manage anemia-related symptoms such as fatigue and dyspnea in patients with advanced cancer, but their role in palliative care remains controversial. This narrative review evaluates the evidence for end-of-life patients, noting that anemia is highly prevalent. RBC transfusions may provide temporary symptomatic relief, yet routine use is supported by inconclusive data. Findings describe subjective responses from 31% to 70%, benefits often lasting under two weeks, and concerns about futility due to high early mortality. Practice variability reflects clinician attitudes and institutional policies. Case-by-case, patient-centered decisions with ethical considerations are emphasized, alongside the need for evidence-based guidelines and standardized assessment tools.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

ABSTRACT

Background

Objective

Methods and data sources

Findings

Conclusion

WHAT WAS ALREADY KNOWN?

WHAT ARE THE NEW FINDINGS?

WHAT IS THEIR SIGNIFICANCE?

INTRODUCTION

Clinical Vignette

Background

Review Red blood cell transfusions in advanced cancer near the end-oflife: narrative review Daniele Marelli , 1 Michela Romelli, 1,2 Cristina Cornali,2 Daniela Martinelli,2 Andrea Sbrana,3 Cosimo Chelazzi 1,2 1Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italy 2ASST Spedali Civili di Brescia, Brescia, Lombardy, Italy 3Azienda Ospedaliero Universitaria Pisana, Pisa, Italy Correspondence to Professor Cosimo Chelazzi; [cosimo.chelazzi@unibs.it](cosimo.chelazzi@unibs.it) Received 15 April 2025 Accepted 7 September 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. To cite: Marelli D, Romelli M, Cornali C, et al. BMJ Supportive & Palliative Care Epub ahead of print: [please include Day Month Year] . doi:10 . 1136/ spcare-2025-005579 ABSTRACT Background Red blood cell (RBC) transfusions are commonly used to manage anemia-related symptoms, such as fatigue and dyspnea inpatients with advanced cancer. Their use in palliative care (PC) remains controversial due to the lack of clear guidelines, potential risks, and ethical considerations. Objective This narrative review aims to evaluate the role of RBC transfusions in patients with advanced cancer and those at the end of life. Methods and data sources A comprehensive review of relevant existing literature was performed in various databases, using combinations of relevant keywords. Only studies published in English were considered. Findings Anemia affects up to 77% of men and 68% of women with advanced cancer in palliative care. RBC transfusions may offer temporary symptomatic relief, but evidence supporting their routine use in palliative cancer patients is inconclusive. Studies report subjective response rates ranging from 31% to 70% . Benefits on fatigue and dyspnea often last <2 weeks and 23–35% of patients die within two weeks after the transfusion, raising concerns about futility. Variability in transfusion practices across different palliative care settings highlights the influence of clinician attitudes, resource availability, and institutional policies. Conclusion RBC transfusions in advanced cancer and end-of-life care should be considered on a case-by-case basis, prioritizing patient-centered decision-making and ethical considerations. Though the benefit is often short, they may improve the quality of life for highly selected patients. Risks such as adverse reactions and resource allocation concerns must be considered. Further research is needed to establish evidence-based guidelines and standardized assessment tools to evaluate transfusion efficacy in this population. WHAT WAS ALREADY KNOWN? | ⇒ Anaemia-related fatigue and dyspnoea are frequent in advanced cancer.
⇒ Red blood cell transfusions may relieve symptoms and support autonomy.
WHAT ARE THE NEW FINDINGS? | | --- | | ⇒ Up to 70% of patients benefit, often temporarily.
⇒ Practices are widely variable.
WHAT IS THEIR SIGNIFICANCE? | a. Clinical: transfusions may improve quality of life; benefit to be balanced with prognosis and futility. b. Research: need for guidelines/tools to assess efficacy in palliative care. INTRODUCTION Clinical Vignette A previously healthy, young adult woman presented with a left humeral sarcoma and received initial chemotherapy, which led to severe myelosuppression. This was managed with granulocyte colonystimulating factor and blood transfusions, resulting in 1 year of clinical remission. After 1 year, she developed shortness of breath and pain. Diagnostic work-up revealed disease progressed involving distant bone sites, the liver, lungs and pleura. Red blood cell (RBC) transfusions alleviated her anaemia-related fatigue, allowing for second-line chemotherapy and radiotherapy, which achieved another year of disease control. Following an additional ye

FAQs

Why are RBC transfusions controversial in palliative care for advanced cancer near end of life?

RBC transfusions are used to relieve anemia-related symptoms, but controversy persists because clear guidelines are lacking, potential risks exist, and ethical considerations must be weighed.

How common is anemia and anemia-related fatigue and dyspnea in advanced cancer patients receiving hospice or palliative care?

Anemia affects up to 77% of men and 68% of women in palliative settings. Fatigue and dyspnea are frequently associated with anemia, reported in roughly 80% and 70% of patients, respectively.

What does the review report about symptom benefit and futility after RBC transfusion?

Subjective response rates are reported between 31% and 70%, and benefits on fatigue and dyspnea often last less than two weeks. About 23–35% of patients die within two weeks after transfusion, raising concerns about futility.

Sep 23, 2026

Uploaded by anakgang17