Bloodless cancer treatment results of patients who do not want blood transfusion: single center experience of 77 cases.
OBJECTIVE
Certain patients may be unwilling to accept blood products for religious reasons. In this study, we have assessed the clinical cancer treatment outcomes of Jehovah's Witnesses (JW) cancer patients in order to identify the risks associated with their treatment, as well as their transfusion needs.


METHODS
We analyzed 77 cases of histologically confirmed cancer patients (JW) from January 2001 to April 2008.


RESULTS
The median age of the patients was 59 years (range, 8-83 years). The most common primary site was the stomach (20.8%), followed by the breast (14.3%), and colorectal region (11.7%). Operations were performed on 44 patients (89.8%). Changes in complete blood count profiles after operation were detected in the patients' hemoglobin (mean +/- SD; 12.7 +/- 2.1 g/dL to 10.6 +/- 2.3 g/dL, P < 0.001). Twenty-six patients received adjuvant chemotherapy. Among these, 21 (80.8%) completed their planned schedule. One hundred twenty-seven cycles of palliative intravenous chemotherapy were administered to 19 patients. Granulocyte-colony stimulating factor and erythropoietin were used in 45 and 20 cycles of treatment, respectively. Grade > or =III thrombocytopenia and anemia were noted in 3.9% and 2.4% of the patients. Three- and 5-year survival rates were 80% and 70%, respectively. The most frequent cause of death was disease progression rather than bleeding.


CONCLUSIONS
Bloodless cancer operation and chemotherapy were not accompanied by serious complications. A few cases of palliative chemotherapy also required transfusions. A prospective cohort study group will need to be used to determine precisely the safety of bloodless cancer treatment and the efficacy of transfusion alternatives.
Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
Sung Yong
SY
Oh
Sung-Hyun
SH
Kim
Hyuk-Chan
HC
Kwon
Suee
S
Lee
Kyeong Hee
KH
Kim
Kyung A
KA
Kwon
Jong-Hwan
JH
Lee
Kyu-Yeol
KY
Lee
Hyo-Jin
HJ
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001803:Blood Transfusion; D057668:Bloodless Medical and Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D016312:Treatment Refusal; D055815:Young Adult
D000970:Antineoplastic Agents; D006454:Hemoglobins