Anemia, Thrombosis, Transfusion Therapy, and Cancer Outcomes
Journal Title
In: Hagberg, C.A., Gottumukkala, V.N.R., Riedel, B.J., Nates, J.L., Buggy, D.J. (eds) Perioperative Care of the Cancer Patient
Publication Type
Book section
Abstract
As surgical and anesthetic techniques have evolved, perioperative mortality in complex cancer surgical interventions has decreased significantly. However, complications and associated morbidity remain a challenge not only for surgical recovery, but also for functional restoration, completion of care for the patient, and long-term cancer outcomes. As such, optimization and preparation for major cancer surgery (prehabilitation) should be a high priority safety initiative and a fundamental strategy in perioperative medicine. Appropriate preparative management or optimization of functional capacity prior to an anticipated stressor can mitigate adverse outcomes, which carry substantial clinical and economic implications. Pivotal strategies with substantial impact include hematological optimization (including the correction of iron deficiency and anemia), appropriate use of blood products, and prevention of thromboembolic complications. Blood loss is an inherent risk with more complicated cancer surgeries. Moreover, even prior to surgery, anemia and iron deficiency are common findings and remain important contributors to adverse postoperative outcomes and mortality. Equally, perioperative allogeneic red cell transfusions, which remain the most common strategy to correct anemia, are an independent predictor of postoperative complications and have been linked with an increased risk of cancer recurrence and reduced overall survival. Prevention of thromboembolism (TE) has been a high priority safety initiative for over a decade. TE is a common complication among patients with cancer, particularly in the postoperative period, and a leading cause of preventable morbidity and mortality. Yet systematic real-time approaches to TE prevention, particularly postsurgery, remain suboptimal. Here we review the burden of these important contributors to outcomes in patients with cancer in association with the perioperative period. In addition, we propose pragmatic, expert and evidence-based strategies that can be easily implemented and scaled in real-time to patient care.
Publisher
Elsevier
Keywords
Anemia; iron deficiency; outcomes; surgery; thrombosis; transfusion
Department(s)
Clinical Haematology
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