Challenges for hospitals today

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Treating cancer patients with blood:

Given that about one-fourth of donated blood is used to treat severe anemia in people with cancer, it’s important for cancer clinics to understand patient perceptions about the benefits and risks of blood transfusion and confidence in the blood supply. Last spring, with concerns in the media about the potential impact of West Nile Virus, the Anemia Institute for Research and Education conducted a survey among physicians, patients, and the public on their knowledge and attitudes about blood and alternatives. The sample of 107 physicians included anesthesiologists, hematologists, oncologists, nephrologists, and family physicians. There were 500 public respondents and 100 participants selected from patients with cancer, kidney disease, HIV/AIDS, hepatitis C, and arthritis.

The good news is that almost half of public and patients surveyed were very confident in the safety of blood transfusion today; however, one-fourth were “not at all” confident in receiving a transfusion.

While almost all said they would like to make the decision about receiving blood themselves or together with their physician, most were not well informed about the risks or alternatives. Key concerns remained viral diseases (HIV and hepatitis C) with only a small percentage concerned about West Nile Virus and almost no one concerned about vCJD (variant Creutzfeldt-Jakob or mad cow disease). Most were not aware of the risks of NOT receiving blood, if needed, with less than 20% recognizing the risks of not receiving treatment if their blood counts were low. Most were also unaware of any alternatives to transfusion, with only one-fourth mentioning pre-autologous donation (donating your own blood in advance of surgery) and less than 5% aware of growth factors (erythropoietin). Most were unaware of the risks of alternatives.

Physicians, for the most part, were aware of patient concerns around viral transmissions but tended to overestimate patient confidence in blood transfusions, with about 25% responding that patients were “too concerned” about the safety of the blood.

Clearly, education is needed to ensure that cancer patients are fully aware of the benefits and risks of blood and alternatives to blood. In a series of patient workshops conducted by the Anemia Institute following the survey, we found that only some cancer patients undergoing chemotherapy were aware of the importance of maintaining their blood levels. Some, whose treatments had been denied or delayed due to low blood levels, clearly could benefit from erythropoietin therapy to raise their red blood cell levels or GSF to increase white blood cell counts.

The Anemia Institute continues to offer workshops on anemia and fatigue management and on blood safety for patient groups, especially those undergoing treatment for cancer, hepatitis C, and HIV/AIDS and those preparing for surgery. This summer, we are repeating our physician and public survey on perceptions of blood safety, benefits, risk and alternatives.