Supportive care for blood cancer focuses on helping you feel better. This is by managing your symptoms and side effects from cancer or treatment. The goal is to improve comfort, well-being, and overall quality of life.
Supportive care can include supporting:
- your physical needs such as pain, fatigue, or nausea
- your information needs like understanding your diagnosis, treatments and what might happen next
- your emotional and social needs, including anxiety, stress, or practical challenges
- your spiritual needs like helping you find meaning, peace, or connection during your care.
You can receive supportive care alongside your cancer treatment, or on its own to focus on symptom management and quality of life. It’s important to remember that supportive care does not treat cancer. It focuses on helping you manage the effects of cancer and its treatment so you can live as well as possible.
Visit our Online Support Service to connect to information, tools and people that can support you. The Online Support Service has information on:
- cancer related fatigue
- complementary therapy
- emotional resilience
- long term side effects
- managing school and study
- returning to work and more.
Use the External Providers Directory to find trusted community services such as:
- physiotherapists
- exercise programs
- wellbeing centres and more.
Accessing supportive care services
There are many supportive care services available at treatment centres. Access to these may require a referral from your doctor or nurse. Smaller or regional centres may have limited services.
Generally large centres have:
- social workers
- dietitians
- physiotherapists
- occupational therapists
- psychologists or counsellors
- music and art therapists
- pastoral care workers.
Outside the hospital, there are websites, hotlines, and organisations to support you.
You can contact the Leukaemia Foundation’s Healthcare Professionals for support. To talk to one of our team, call 1800 620 420, Monday to Friday 9am-4pm AEST. You can also apply for support via our website.
WeCan is an Australian website that provides easy access to trusted supportive care resources, services, and information for people affected by cancer. You can use their Supportive Care Needs Screening Tool to help identify the areas where you may need extra support, whether that’s physical, emotional, practical, or spiritual.
Our Mob and Cancer has links to support Aboriginal or Torres Strait Islander people.
Support medications, infusions and therapies
Supportive care that helps and protects your body is often given or prescribed at treatment centres. These medications and infusions may include:
- blood transfusions
- injections to support your white blood cell count (growth factors)
- preventative antibiotics, antivirals and antifungals
- vaccines
- infusions to support your bone health (bisphosphonates).
Blood transfusions
It is not uncommon to have lower-than-normal levels of red blood cells, white blood cells, or platelets. Supportive care includes managing changes to keep you feeling as well as possible. You may be advised to have a blood transfusion or platelet transfusion to reduce your symptoms. You might also be given an immunoglobulin infusion (IVIg) if your antibody levels are low. This helps support your immune system and reduce the risk of infections.
Click on the headings below to read more about each type of transfusion
blood cell transfusion may be recommended if you have symptoms of anaemia. Normal levels of red blood cells are:
- 130-180g/L for men
- 120-160g/L for women.
Symptoms of anaemia can include:
- breathlessness
- fatigue
- dizziness
- feeling faint
- chest pain
- weakness
- pale skin colour
- irregular heartbeat
- headaches.
The Australian Red Cross – Life Blood – provides guidance on when a red blood cell transfusion may be needed.
A platelet transfusion may be recommended if you have abnormal bleeding or bruising. Or you have a lower-than-normal platelet count.
Use of platelets | Australian Red Cross Lifeblood – provides guidance on when a platelet transfusion is needed.
Immunoglobulins are antibodies made by plasma cells. Plasma cells come from activated B-cells. A type of white blood cell that plays an important role in your immune system. Antibodies help protect your body by fighting bacteria and other harmful microorganisms.
Immunoglobulin infusions may be:
- given for a range of medical conditions
- used when your body doesn’t make enough antibodies but needs them to help fight infections
- recommended if your immune system is weakened because of an illness or treatment.
Immunoglobulins are found in the liquid part of blood, called plasma. Plasma is collected from many different donors and then pooled (mixed) together.
Where do immunoglobulin infusions come from?
- Blood is collected from donors. This could be from a whole blood collection, or a process called plasmapheresis.
- Plasma is separated from red blood cells, white blood cells, and platelets.
- The plasma is then chemically treated, and most of the liquid is removed.
- This results in a purified and concentrated immunoglobulin product.
Immunoglobulins are given as an infusion either intravenous (IV) or under the skin (subcutaneous).
Types of intravenous immunoglobulin (IVIg) products:
- Privigen AU – manufactured from Australian donors
- Privigen 10%, Gamunex, Flebogamma, Octagam, Kiovig – manufactured from USA and European donors
Some people self-administer subcutaneous immunoglobulins (SCIG). This reduces the need for them to go to the hospital to have treatment.
Subcutaneous immunoglobulin (SCIG) product:
- Hizentra AU – made from Australian donors
- Hizentra, Cuvitru, Xembify – manufactured from USA and European donors
Immunoglobulin Treatment and Wellbeing Management Plan
Intravenous immunoglobulin (IVIg) | National Blood Authority – provides guidance on when people need IVIg.
Receiving a blood transfusion
There are two important steps to go through before you can receive a blood transfusion. These are:
The doctor should explain the risk and benefits of receiving a blood transfusion. Including the risk of an allergic type of reaction. They may ask you to sign a consent form after they have discussed the risk with you.
You will need to have a blood test one to two days before have a blood transfusion. This is the check your blood type and match it to donated blood. This is called a group and hold, and a cross match. Your treatment team will tell you when and where to have the blood test. You can read more about this testing on the Australian Red Cross Lifeblood website.
Signs of a blood transfusion reaction
It is possible to have an allergic type reaction to a blood product. Some symptoms of a blood product reaction can include:
- feeling of impending doom
- chest pain
- breathlessness
- tingling feeling in the mouth or lips
- fever
- chills
- changes to your heart rate or blood pressure.
It is important to tell your nurse if you feel unwell or different during a blood transfusion.
Growth factors
Growth factors are natural chemicals found in your blood. They help your bone marrow make different types of blood cells. Some of these growth factors can also be made in a laboratory. They are used as medicines to increase blood counts.
- Neutrophils are a type of white blood cell that helps your body fight infections.
- G-CSF (granulocyte colony-stimulating factor) helps your bone marrow make more neutrophils.
- Low neutrophil levels can happen because of cancer treatment or blood cancer.
- G-CSF is given as a subcutaneous injection to increase your neutrophil count.
- Growth factors may have some side effects, including chills, headaches and bone pain.
Iron chelation therapy
Iron chelation therapy is a type of treatment used to manage iron overload. Iron overload is when you have too much iron in your body. It can happen when you receive a lot of red blood cell transfusions. When you have too much iron, it can deposit in important organs like the heart, liver, and pancreas. This can lead to heart failure, liver damage, and diabetes.
Medications are used to lower your levels, they bind to the iron. This allows your body to remove the excess iron through urine and faeces.
Iron chelating medications are:
- oral tablet Deferasirox
- subcutaneous or intravenous infusion of Desferrioxamine.
These medications are usually ongoing, or until your iron levels are normal. Your treatment team will tell you when to take your medication and for how long.
Side effects of iron chelation therapy might include:
- nausea
- vomiting
- dizziness
- diarrhoea
- rash
- muscle cramps
- red coloured urine
- vision and hearing changes.
Sometimes side effects can impact your quality of life. Your treatment team will discuss side effects and management options with you.
Iron chelation therapy is not suitable for all people. Talk to your treatment team about the possibility of iron overload.
Antibiotics, antivirals and antifungals
Antibiotics, antivirals, and antifungal medications are prescription medications. They are given to people with blood cancer to help prevent bacterial, viral, or fungal infections. This is called prophylaxis. These medications are normally an oral tablet. It is important to take them as instructed by your treatment team.
There is a risk you may still get a bacterial, viral, or fungal infection while you take these medications. So, it is important that you take measures to protect yourself from infection. This could include:
- frequent hand washing
- wearing a mask in crowded places
- avoiding sick family or friends
- wearing a mask, gloves, long sleeves and shoes whilst gardening.
Vaccines
Vaccines are important for people with blood cancer because you have a higher risk of infection. They help prevent infections. Inactivated vaccines are the safest. Talk to your treatment team before having them, including the best timing.
Bisphosphonates
Bisphosphonates are medications used to strengthen and protect bones. They also treat high levels of calcium in the blood (hypercalcaemia). If you have blood cancer, myeloma, you will likely have bisphosphonates.
People with myeloma:
- have more bone loss than growth
- are at higher risk of having bone fractures.
When the balance between bone growth and loss is uneven, it can lead to:
- osteoporosis
- lytic lesions (holes in bones)
- bone pain
- high levels of blood calcium
- bone fractures.
Bisphosphonates can reduce the risk of:
- bone pain
- high levels of calcium in the blood
- bone fractures.
Bisphosphonate treatments include:
- zoledronic acid – 15 minute infusion through a vein
- pamidronate – 90 minute infusion through a vein
- clodronate – tablets taken twice a day.
Bisphosphonates have some side effects including:
- flu like symptoms
- muscle and joint aches and pains
- low blood calcium, phosphate and magnesium levels
- osteonecrosis of the jaw (ONJ).
You’ll need to have a dental assessment and any dental treatment before you start bisphosphonates. You’ll also need regular dental reviews and blood tests while you have treatment. Tell your treatment team if you experience any side effects.
Read more about ONJ below.
ONJ is a serious but rare side effect of bisphosphonate therapy. Osteo means bone and necrosis means tissue death. ONJ occurs because the blood supply to the jawbone can be cut off, causing cell death. When this happens, the bone can become exposed through the gums.
Symptoms include:
- pain
- gums that don’t heal
- loose teeth
- bad breath/taste
- a small piece of bone showing through the jaw
- jaw numbness or heaviness.
Before you start bisphosphonates, you’ll need to have a dental assessment and provide your haematologist with a letter from the dentist. You’ll also need regular dental reviews and blood tests while you have treatment.
It is important to notify your treatment team and dentist immediately if you experience any of these symptoms. If you have ONJ, you may be referred to an oral surgeon with experience in osteonecrosis.
Tips on how to prevent ONJ
- Practice good oral hygiene – brush with a soft toothbrush and use regular mouthwash.
- If you have dentures, make sure they fit well.
- Have regular dental check-ups.
- Talk with your treatment team before you have any invasive dental work done.
