Palliative Care

Palliative care includes methods that relieve symptoms of blood cancer and side effects from other forms of treatment. Palliative care is also called supportive care.1

Palliative care is tailored to the specific type of blood cancer a person has and the side effects they may have from treatment.

Palliative care for lowered blood cell counts

Blood cancer cells can crowd out healthy cells in the blood. This leads to lowered amounts of red blood cells, white blood cells, and platelets. Many treatment strategies, including chemotherapy, immunotherapy, and targeted therapy, can also lower blood cell counts.

When there are not enough red blood cells, anemia develops. This can cause symptoms like:2

  • Fatigue
  • Shortness of breath
  • Dizziness or lightheadedness
  • Headaches
  • Cold hands or feet
  • Pale skin
  • Fast or irregular heartbeat

When there are not enough white blood cells, a person is at greater risk for infections. This includes bacterial, viral, and fungal infections. A person with low white blood cells may experience:3

  • Repeated infections
  • Infections that will no go away
  • Fevers
  • Chills
  • Mouth or skin sores
  • Fatigue
  • Sore throat

When there are not enough platelets, a person is at greater risk for bleeding and may experience:4

  • Frequent bruises
  • Frequent nosebleeds
  • Small red spots on the skin (petechiae)
  • Blood in urine or stool
  • Heavier menstrual flows than usual
  • Prolonged and easy bleeding from cuts
  • Fatigue
  • An enlarged spleen

Palliative care for lowered blood cell counts may include blood transfusions or:2,5

  • Red blood cell growth factors, such as erythropoietin-stimulating agents
  • White blood cell growth factors, known as granulocyte-colony stimulating factor (G-CSF) or granulocyte macrophage-colony stimulating factor (GM-CSF)
  • Platelet growth factors, such as thrombopoietin receptor agonists

In certain blood cancers, low platelet and red blood cell counts can be caused by abnormal antibodies. Management options may include corticosteroids, rituximab, or spleen removal (splenectomy).5

Management of infections

Blood cancer and many of the methods used to treat it can cause an increased risk of infections. Management of infections may include:5

  • Antibiotics
  • Anti-viral drugs
  • Vaccines, including those for the flu and pneumonia. However, vaccines with live viruses, like the shingles vaccine, should generally be avoided.
  • Intravenous immunoglobulin (IVIG) to help treat low levels of antibodies

Palliative care for damaged bones

Multiple myeloma is a blood cancer that can damage the interior of bones, causing pain. Palliative care to stabilize damaged bones may include:1

  • Surgery
  • Bisphosphonate drugs like pamidronate (Aredia®) or zoledronic acid (Zometa®)

Management of too many platelets

Essential thrombocythemia is a form of myeloproliferative neoplasm (MPN) that causes too many platelets (thrombocytes) in the blood. This can cause blood clots and damage to organs. It may also cause symptoms like:7,8

  • Headaches
  • Burning or tingling in the hands and feet
  • Redness or warmth in the hands or feet
  • Vision problems
  • Hearing problems

Management of essential thrombocythemia may include:7,8

  • Platelet apheresis, a procedure where a machine filters out excess platelets from the blood)
  • Aspirin
  • Other drugs

Some drugs or supplements may interfere with each other and cause side effects. Before beginning palliative care, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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Written by: Emily Downward and Heather Morse | Last reviewed: April 2021