Many patients with advanced blood cancers delay hospice to keep access to blood transfusions

For many patients with advanced blood cancers, the decision to enter hospice can mostly depend on whether they can continue receiving blood transfusions. This requirement can become a major barrier and could help explain why hospice use remains low in this population, according to a study published in November 2025 in JAMA Network Open.

Hospice care is designed to improve comfort and quality of life for those with serious, terminal illnesses by focusing on symptom relief, emotional support and care delivered largely in the home. Research over numbers of decades has shown that hospice can help patients feel more comfortable near the end of life and can reduce stress for family members and caregivers.

Due to these benefits, national medical organizations encourage timely hospice enrollment and view it as a marker of high-quality, end-of-life care, according to the study conducted by researchers from Dana-Farber Cancer Institute, Yale Cancer Center and several academic medical centers.

However, with these recommendations, patients with advanced blood cancers use hospice much less than patients with solid tumors. These advanced cancers include leukemia, lymphoma and multiple myeloma, which affect the blood and bone marrow and commonly cause fatigue, anemia, infections and bleeding.

Even when treatment is no longer working to heal the patient, many depend on regular blood transfusions to manage symptoms, maintain strength and preserve daily functioning.

Unfortunately, many hospice programs in the U.S. don’t provide blood transfusions, the study noted. This limitation forces patients to make a difficult choice between enrolling in comfort-focused hospice care and continuing access, to transfusions that help control symptoms.

In fact, a 2024 national survey of hospice providers published in the Journal of Pain and Symptom Management found that fewer than 3% of hospices always offer blood transfusions, while more than half never offer them, and more than three-quarters said limited transfusion access is a major barrier to hospice enrollment for patients with blood cancers.

Researchers of this study looked at this issue because little was known about how strongly patients value transfusion access when making decisions about hospice. By directly surveying patients with advanced blood cancers, the study aimed to better understand what matters most to these patients near the end of life and why hospice enrollment remains low in this group.

To explore how patients with advanced blood cancers approach hospice decisions, researchers conducted a survey study focused on quality of life and preferences for supportive services. The study included adults with blood cancers who were estimated by their physicians to have six months or less to live and who were not enrolled in hospice at the time of participation.

Patients were recruited between October 2020 and November 2022 from two large academic cancer centers located in Boston and New Haven.

Eligible patients were contacted by phone, and those who agreed completed an online survey. The survey collected information on demographics, cancer diagnosis and recent transfusion history.

The survey also included questions measuring quality of life, physical function, emotional well-being and perceived social support. A central part of the survey asked patients to rank the importance of different services that could support comfort and daily living near the end of life.

These services included traditional hospice supports such as nursing visits and emotional counseling, as well as nontraditional options, including access to blood transfusions, telemedicine and transportation to medical appointments.

Researchers analyzed the responses to identify which services patients valued most and to determine whether preferences differed based on transfusion needs. They also examined patterns across groups of patients with similar priorities.

Out of 331 eligible participants, 200 patients with advanced blood cancers completed the survey. The median age of participants was 70 years, and most respondents were older adults. The majority were male White and non-Hispanic.

Leukemia and lymphoma were the most common diagnoses, and nearly one-third of patients reported receiving more than one blood transfusion in the month before completing the survey. Quality-of-life scores suggested moderate physical, emotional, functional and social well-being, and most patients reported having strong social support.

When patients were asked to rank hospice services, blood transfusions consistently came up as the most important factor influencing decision-making. This was followed by access to telemedicine and transportation support.

Traditional hospice services, including visits from nurses, social workers and chaplains, were ranked lower overall. While transfusion access was especially important for patients who were transfusion dependent, it remained a top priority even among patients who required transfusions less often.

The researchers also found two distinct groups of patients based on their service preferences. One group placed greater value on supportive services such as emotional counseling and in-home care, while the other prioritized transportation and logistical support. Regardless of these differences, both groups ranked access to blood transfusions as the most important service overall, highlighting its central role in hospice decision-making for this population.

Based on results and methods of the study, there are several strengths to note, including a strong response rate and direct input from patients with advanced blood cancers who are usually underrepresented in end-of-life research. By focusing on patient preferences rather than assumptions about care needs, the researchers were able to clarify what matters most to patients as they approach the end of life.

Authors also noted a number of limitations. For example, participants were recruited from two urban academic cancer centers and were mostly White and non-Hispanic, which may limit how well the findings apply to more diverse or rural populations. In addition, estimating life expectancy in blood cancers is particularly challenging, which may influence eligibility assessments for hospice and affect how patients view the timing of enrollment.

Based on these findings, the researchers suggest testing new hospice models that allow access to palliative blood transfusions alongside standard hospice services. They also point to the need for updated payment approaches that would make it more affordable for hospices to provide transfusions while maintaining a focus on comfort, symptom management and quality of life.