Bloodless Cancer Treatment Results of Patients Who Do Not Want Blood Transfusion: Single Center Experience of 77 Cases

Background: Patients may be unwilling to accept blood products for religious reasons – Jehovah’s Witnesses (JW). Because of its minority, as well as JW patients, physicians have a lot of difficulty and anxiety to treatment. Furthermore, sometimes cancer patients are needed transfusion during operation or chemotherapy. So, we analyze the clinical outcomes of JW cancer patients who had treated for identifying the risk of treatment and transfusion need.

Methods: We analyzed 77 cases of histological confirmed cancer patients (JW) from Jan. 2001 to Apr. 2008.

Results: Male to female ratio was 1:1.48. Median age of patients was 59 years (range, 8 –83 years). The most common primary site was stomach (20.8%) followed by breast (14.3%), colorectal (11.7%), liver (7.8%), lung (6.5%), and hematologic malignancy (5.2%). At diagnosis, 53 patients (68.8%) were operable early cancer patients. Operation was done in 47 patients (89%). three patients refused operation itself. Change of CBC profile after operation was observed in hemoglobin (Mean ± SD; 12.7 ± 2.1 g/dL to 10.6 ± 2.3 g/dL, P<0.001). WBC and platelet were not affected by operation (P=0.818, P=0.179). Twenty-eight patients received adjuvant chemotherapy. Of them, 21 patients (78%) had completed their planed schedule. There is no treatment related transfusion need or death during adjuvant chemotherapy. Initially, 20 patients had been presented with advanced stage and 8 patients relapsed after curative treatment. 127 cycles of palliative intravenous chemotherapy was administrated in 19 patients. G-CSF and erythropoietin was used in 45 and 20 cycles of treatment, respectively. Grade I/II anemia (38.6%) and leucopenia (42.5%) were common hematologic toxicities. Grade ≥III thrombocytopenia and anemia were observed in 3.9% and 2.4%. Only 1 patient had stopped chemotherapy due to thrombocytopenia. Reduced dose chemotherapy was administrated at 23 cycles (18.1%). The median overall survival for all the patients has not yet been determined. 3 year and 5 year survival rate was 80% and 70%, respectively. Major cause of death was disease progression, not bleeding

Conclusion: Bloodless cancer treatment was not accompanied with serious complication. A few cases of palliative chemotherapy were needed transfusion, but adequate physician’s assist - dose modification and use of G-CSF and erythropoietin - could make keep the patient’s hope and quality of life.