Perceptions of a Home Blood Transfusion Program Among Patients with Hematologic Malignancies Who Are Newly Diagnosed As Compared to Those with Relapsed/Refractory Disease

Background: In the United States, home-based blood transfusion programs are not standard of care for patients with transfusion dependent cytopenias, despite the significant burden for patients needing to regularly travel to receive transfusions. While prior research regarding potential benefits of home-based transfusions has focused on patients near the end of life, home-based transfusion services have the potential to reduce patient and caregiver burden for patients with transfusion-dependent hematologic malignancies (HM) across the spectrum of disease. It is imperative to understand the utility of home services in patients at any point in the treatment process. The aim of this study is to compare experiences with hospital-based blood transfusion programs and perceptions of a potential home blood transfusion program in patients with HMs on their first line of treatment versus those who have received 2 or more lines of therapy.

Methods: We performed semi-structured interviews with patients with transfusion-dependent HM at Thomas Jefferson University Hospital. Patients were split into two groups; those on first line treatment and those who have received 2 or more lines of treatment. Interviews were transcribed, coded, and analyzed using a content analysis approach. The entire team developed the codebook and coding was conducted by two team members. Coding was monitored with frequent assessments to ensure interrater reliability across codes.

Results: We interviewed 20 patients: 11 patients had acute leukemia (55%) and 9 had myelodysplastic syndrome (45%). The median age was 56 (Range: 23-85). 11 (55%) patients identified as female, 12 (60%) as Caucasian, and 5 (25%) as Black/African American. Twelve (60%) patients were on 1^st line treatment and 8 (40%) patients were on 2^nd or 3^rd line treatment at the time of the interview. Patients in both groups felt that familiarity of the care team would be essential for a home transfusion service. This stemmed from concerns of lack of comfort and inconsistency in care experienced with current home care services. Several patients on 2+ lines of therapy felt that individuals with relapsed/refractory disease or those who are physically incapable of going to in-person appointments would benefit the most from home transfusions. Otherwise, patients across both groups had similar concerns about home services, including scheduling issues, a sufficient home environment, and management of complications in the home. Despite such concerns, overall patients in both groups viewed a home blood transfusion program favorably. Most patients agreed that home services would ease inconveniences of transportation and travel time/costs of in-person appointments. Patients also perceived a benefit of increased comfort with home transfusions.

Conclusions: Regardless of their stage of treatment, HM patients who depend on transfusions demonstrated comparable levels of openness towards home transfusion services. They also perceived similar benefits and concerns associated with receiving transfusion services at home. The majority of patients perceived increased comfort, convenience, and quality of life with home services, supporting the potential benefit of home transfusion services for transfusion dependent patients across the treatment course and not just at end of life.