Differences in perceptions of hematologists and palliative care physicians regarding transfusion therapy in patients with terminal hematological malignancies: a nationwide cross-sectional questionnaire survey in Japan

To examine differences in perceptions between hematologists (HOs) and palliative care physicians (PCs) regarding red blood cell transfusion at the end of life.

This cross-sectional questionnaire survey, conducted from August to September 2020, included responses from 1000 hematologists (HOs) and 759 palliative care physicians (PCs). The questionnaire assessed cutoff indications and opinions regarding red blood cell transfusion for anemia due to hematologic malignancy progression in patients with no indication for anticancer therapy. We defined a consensus Hb threshold as the highest level at which ≥ 70% of respondents would transfuse.

Of 659 responses, 596 were valid (269 HOs and 327 PCs). For symptomatic cases, > 70% of HOs and PCs considered Hb cutoffs of 8.0 and 7.0 g/dL, respectively. For asymptomatic cases, < 70% of PCs recommended transfusion even at Hb ≤ 6.0 g/dL; therefore, an Hb cutoff for PCs could not be determined. Most HOs and PCs agreed to reduce transfusion frequency, while PCs were more likely than HOs to agree to discontinue transfusion. In contrast, HOs were more likely than PCs to agree to continue transfusion upon patient and/or family request and to consider patients with performance status 4 eligible for transfusion.

Among adult patients with hematological malignancies who have no indication for anticancer therapy, hematologists tend to view transfusion more favorably and to transfuse more actively than palliative care physicians. Greater mutual understanding and consensus-building regarding transfusion indications at the end of life may facilitate appropriate palliative care referral for these patients.