Management of bleeding in the advanced oncologic patient

Abstract

Hemorrhage in the advanced or terminal cancer patient represents a distressing and complex situation in the palliative care setting, potentially leading to death of the patient due to massive loss of circulating volume. Although it is a relatively rare event, it is an urgent and distressing clinical problem for the patient, family and health care providers(1). Its incidence in patients with advanced cancer varies from 6% to 14% in solid tumors, being higher in head and neck cancers and up to 30% in hematological neoplasms[2],[3]. Among the risk factors are those related to the tumor, treatments, systemic factors, among others, and it may present as an acute catastrophic event, severe episodic bleeding or continuous low volume exudation[4],[5]. Available recommendations for the management of terminal hemorrhage are based on: identification of high-risk patients, early establishment of general supportive measures, local and systemic measures and the use of emergency or crisis medications[6]. Treatment should be individualized, including interventions on the underlying causes and on the risk-benefit ratio of interventions for mitigation or control of bleeding, within the context of survival expectations. In the palliative patient at the end of life, decision making should be based on providing adequate symptomatic control, comfort measures and improving quality of life[3].