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A Clinical and Economic Evaluation of Red Blood Cell Transfusions in Patients Receiving Cancer Chemotherapy

Published online by Cambridge University Press:  10 March 2009

Ana Ortega
Affiliation:
Princess Margaret Hospital
George Dranitsaris
Affiliation:
Princess Margaret Hospital
Anitasha Puodziunas
Affiliation:
Princess Margaret Hospital

Abstract

A clinical and economic evaluation of red blood cell (RBC) utilization in cancer patients during chemotherapy is described. Using a randomized sampling process, 100 patients who had received chemotherapy with or without cisplatin were selected (50 in each group). Multiple logistic regression was then used to identify risks factors for transfusion requirements. Twenty-five percent of patients in the cisplatin and 12% in the noncisplatin group received at least one blood transfusion during chemotherapy (p =.09). Depressed hemoglobin levels and cisplatin dosage were identified as risk factors for transfusion requirements. Combining all transfused patients revealed an overall cost of Can $599 (95% Cl: $513–$683) per transfusion. The results of the current study indicated that anemia is a common complication of cancer chemotherapy that can be costly to manage.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1998

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References

REFERENCES

1.Abels, R. I., Larholt, K. M., Krantz, K. D., & Bryant, E. C. Recombinant human erythropoietin (r-HuEPO) for the treatment of anemia of cancer. In Murphy, M. J. Jr., (ed.), Blood celt growth factors: Their present and future use in hematology and oncology. Proceedings of the Beijing Symposium. Cleveland, OH: Alpha Med Press, 1991, 121141.Google Scholar
2.Abels, R., Larholt, K., Nelson, R., & Young, D.Risk of transfusion in small cell lung cancer patients receiving chemotherapy. Blood, 1994, 84(suppl.), 664a.Google Scholar
3.Aledort, L., & Mohandas, K.Transfusion requirements in patients with malignancy. Seminars in Hematology, 1996, 33(suppl. 1), 69.Google ScholarPubMed
4.Cantor, S. B., Hudson, D. V., Lichtiger, B., & Rubenstein, E. B.The costs of blood transfusion: A process flow analysis. Proceedings of the American Society of Clinical Oncology, 1996, 15, 325.Google Scholar
5.Case, D. C., Bukowski, R. M., Carey, R. W., et al. Recombinant human erythropoietin therapy for anemic cancer patients on combination chemotherapy. Journal of the National Cancer Institute, 1993, 85, 801–06.CrossRefGoogle ScholarPubMed
6.Cazzola, M., Mercuriali, F., & Brugnara, C.Use of recombinant human erythropoietin outside the setting of uraemia. Blood, 1997, 89, 4248–67.Google Scholar
7.Denton, T. A., Diamond, G. A., Matloff, J. M., & Gray, R. J.Anemia therapy: Individual benefit and societal cost. Seminars in Oncology, 1994, 21(suppl. 3), 2935.Google Scholar
8.Dillman, R. O., Barth, N. M., Nayak, S. K., et al. High-dose chemotherapy with autologous stem cell rescue in breast cancer. Breast Cancer Research and Treatment, 1996, 37, 277–89.Google Scholar
9.Doyle, C., Stockier, M., Pintilie, M., et al. Resource implications of palliative chemotherapy for ovarian cancer. Journal of Clinical Oncology, 1997, 15, 1000–07.CrossRefGoogle ScholarPubMed
10.Expert Working Group. Guidelines for red blood cell and plasma transfusion for adults and children. Canadian Medical Association Journal, 1997, 156 (suppl. 11) S1–S24.Google Scholar
11.Feinstein, A. R.Multivariate analysis: An introduction. New Haven, CT: Yale University Press, 1996.Google Scholar
12.Galloway, G. Red cross blood shortage delays elective operations. The Globe and Mail, 03 27, 1997, A11.Google Scholar
13.Glaspy, J., Bukowski, R., Steinberg, D., et al. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Journal of Clinical Oncology, 1997, 15, 1218–34.Google Scholar
14.Hesketh, P. J., Cooley, T. P., Finkel, H. E., Wright, J., & Henketh, A. M.Treatment of advanced non-small cell lung cancer with cisplatin, 5-fluoracil, and mitomycin C. Cancer, 1988, 62, 1466.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
15.Koeller, J. M., & Van Den Berg, C. Anemias. In Young, L. Y. & Koda-Kimble, M. A. (eds.), Applied Therapeutics. The clinical use of drugs. Vancouver: Applied Therapeutics Inc., 1995, 88–1–88–3.Google Scholar
16.Lee, G. R.The anemia of chronic disease. Seminars in Hematology, 1983, 20, 6180.Google ScholarPubMed
17.Means, R. T., & Krantz, S. B.Progress in understanding the pathogenesis of the anemia of chronic disease. Blood, 1992, 80,1639–47.CrossRefGoogle ScholarPubMed
18.Miller, C. B., Jones, R. J., Piantadosi, S., Abeloff, M. D., & Spivak, J. L.Decreased erythropoietin response in patients with the anemia of cancer. New England Journal of Medicine, 1990, 322, 168992.CrossRefGoogle ScholarPubMed
19.Mohandas, K., & Aledort, L.Transfusion requirements, risks, and costs for patients with malignancy. Transfusion, 1995, 35, 427–30.Google Scholar
20.Moliterno, A. R., & Spivak, J. L.Anemia in cancer. Hematology/Oncology Clinics of North America, 1995, 10, 345–63.CrossRefGoogle Scholar
21.Niskanen, E.Autologous stem cell transplantation in the treatment of cancer. Annals of Medicine, 1996, 28, 5762.Google Scholar
22.Ontario Ministry of Health. Schedule of benefits: Physicians services under the Health Insurance Act. Toronto: Ontario Ministry of Health, 1992.Google Scholar
23.Pavel, J. N.Red blood cell transfusions for anemia. Seminars in Oncology Nursing, 1990, 6, 117–22.Google Scholar
24.Sheffield, R. E., Sullivan, S. D., Saltiel, E., & Nishimura, L.Cost comparison of recombinant human erythropoietin and blood transfusion in cancer chemotherapy-induced anemia. Annals of Pharmacotherapy, 1997, 31, 1522.CrossRefGoogle ScholarPubMed
25.Silberstein, L. E., Kruskall, M. S., Stehling, L. C., et al. Strategies for the review of transfusion practices. JAMA, 1989, 262, 1993–97.CrossRefGoogle ScholarPubMed
26.Skillings, J. R., Sridhar, F. G., Wong, C., & Paddock, L.The frequency of red cell transfusion for anemia in patients receiving chemotherapy. A retrospective cohort study. American Journal of Clinical Oncology, 1993, 16, 2225.CrossRefGoogle ScholarPubMed
27.Starnes, R. Hospitals face blood shortages as Red Cross loses donors. Calgary Herald, 03 13, 1997, A16.Google Scholar
28.Statistics Canada. Income distribution by size in Canada, 1992 Ottawa: Statistics Canada, 1993, 19. Catalog No. 13–207.Google Scholar
29.Tretiak, R., Laupacis, A., Riviere, M., et al. Cost of allogeneic and autologous blood transfusion in Canada. Canadian Medical Association Journal, 1996, 154, 1501–08.Google ScholarPubMed
30.Welch, H. G., Meehan, K. R., & Goodnough, L. T.Prudent strategies for elective red blood cell transfusion. Annals of Internal Medicine, 1992, 116, 393402.Google Scholar
31.Wuest, D. L.Transfusion and stem cell support in cancer treatment. Hematology/Oncology Clinics of North America, 1996, 10, 397.CrossRefGoogle ScholarPubMed
32.Zucker, S.Anemia in cancer. Cancer Investigation, 1985, 3, 249–60.CrossRefGoogle ScholarPubMed