Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.
Flinders University, Bedford Park, SA, 5042, Australia.
Cancer Rep (Hoboken). 2019 Apr;2(2):e1148. doi: 10.1002/cnr2.1148. Epub 2018 Oct 26.
Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions.
The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management.
A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti-cancer treatment. Forty-three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non-standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty-seven percent (n = 17) received hematopoietic growth factors (erythropoiesis-stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort.
Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.
支持见证人的支持性护理（JW）被诊断患有癌症可能具有挑战性，因为他们不接受红细胞（RBC）输注。
本研究旨在确定诊断患有癌症及其对癌症管理影响的 JW 的治疗偏好和护理模式。
对 2005 年至 2015 年期间在我们机构中患有实体恶性肿瘤或淋巴瘤的 JW 进行了回顾性队列研究。使用 Kaplan-Meier 生存曲线和 Cox 比例风险回归模型估计生存统计数据。确定了 63 名 JW，中位年龄为 70 岁。在诊断时，34％（n=22）有贫血。所有 63 名 JW 均拒绝 RBC 输注，其中 19 名患者在抗癌治疗期间后来出现了输血阈值。43％（n=27）的 JW 患有晚期（IV 期）疾病，76％（n=48）的东部合作肿瘤学组（ECOG）为 0 至 1。JW 愿意接受手术和放疗，而不是化疗。由于早期治疗中止，给予非标准化疗方案或因贫血和拒绝输血而减少剂量，22％（n=14）的 JW 认为治疗不理想。27％（n=17）接受了造血生长因子（促红细胞生成素刺激剂和培非格司亭）。整个队列中没有因贫血或拒绝输血而直接导致的死亡。
即使在医学上需要，JW 在诊断和癌症治疗期间也拒绝 RBC 输注。需要为这群患者前瞻性定义管理途径。
