Palliative care, also called supportive care, includes methods that relieve symptoms of blood cancer and those that relieve side effects from other forms of treatment.1 The types of palliative care will be tailored to the individual based on their type of blood cancer and the side effects they may be experiencing from treatment.
Palliative care for lowered blood cell counts
Blood cancer cells can crowd out healthy cells in the blood, leading 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 aren't enough red blood cells, anemia develops, potentially causing symptoms such as fatigue, shortness of breath, dizziness or lightheadedness, headaches, cold hands or feet, pale skin, and a fast or irregular heartbeat.2 When there aren't enough white blood cells, a person is at greater risk for infections, including bacterial, viral, and fungal infections. A person with low white blood cells may experience repeated infections, infections that won't go away, fevers, chills, mouth sores, fatigue, sore throat, or skin sores.3 When there aren't enough platelets, a person is at greater risk for bleeding and may experience frequent bruises, frequent nosebleeds, small red spots on the skin (called "petechiae"), blood in urine or stool, heavier menstrual flows than usual, prolonged and easy bleeding from cuts, fatigue, and an enlarged spleen.4
Palliative care for lowered blood cell counts may include blood transfusions or growth factors, such as:
- Red blood cell growth factors, such as erythropoietin-stimulating agents, to help boost red blood cells
- White blood cell growth factors, known as granulocyte-colony stimulating factor (G-CSF) or granulocyte macrophage-colony stimulating factor (GM-CSF), to help boost white blood cells
- Platelet growth factors, such as thrombopoietin receptor agonists, to help boost platelets2,5
In certain blood cancers, low platelet and red blood cell counts can be caused by abnormal antibodies. If abnormal antibodies are causing low blood cell counts, management options may include corticosteroids, rituximab, or spleen removal (splenectomy).5
Management of infections
Blood cancer and many of the methods used to treat blood cancer can cause an increased risk of infections. Management of infections may include:
- Anti-viral medicines
- Vaccines, including vaccines for the flu and pneumonia (although vaccines with live viruses, like the shingles vaccine, should generally be avoided)
- Intravenous immunoglobulin (IVIG), to help treat low levels of antibodies5
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 surgery or bisphosphonate medications like pamidronate (brand name: Aredia®) or zoledronic acid (brand name: Zometa®).1
Management of too many platelets
In essential thrombocythemia, a form of myeloproliferative neoplasm (MPN), there are too many platelets (thrombocytes) in the blood. This can cause the blood to form clots and can cause damage to organs, as well as causing symptoms like headaches, burning or tingling in the hands and feet, redness or warmth in the hands or feet, vision problems, and hearing problems. Management of essential thrombocythemia may include platelet apheresis (a procedure that involves a machine that filters out the excess platelets from the blood), aspirin, or other medications.7,8
Patients undergoing any form of palliative care should talk to their healthcare provider about all their health conditions, as well as any medications (prescription and over-the-counter), herbal supplements, and vitamins they are taking. Some medications or supplements may interfere with each other and may cause side effects. Patients should take their medication as prescribed by their healthcare provider. Patients should talk to their healthcare provider if they have any questions, or if they have questions regarding their palliative care regimen.