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CC BY 4.0 · TH Open 2021; 05(02): e188-e194
DOI: 10.1055/s-0041-1729754
Original Article

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Anette Arbjerg Højen 
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
,
Thure Filskov Overvad
2   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
3   Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
,
Mads Nybo
4   Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
,
Thomas Kümler
5   Department of Cardiology, Herlev- Gentofte Hospital, Copenhagen, Denmark
,
Morten Schnack Rasmussen
6   Department of Surgical Gastroenterology, Bispebjerg Hospital, University of Copenhagen, Denmark
,
Thomas Decker Christensen
7   Department of Cardiothoracic and Vascular Surgery and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
,
Torben Bjerregaard Larsen
1   Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
› Author Affiliations Funding T.D.C. reports personal fees from AstraZeneca, Boehringer-Ingelheim, Roche Diagnostics, Merck Sharp & Dohme (MSD), and Bristol Myers Squibb outside the submitted work. A.A.H. reports personal fees from Merck Sharp & Dohme, Bayer, and The Bristol-Myers Squibb-Pfizer Alliance outside the submitted work.
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Abstract

Background Treatment patterns for cancer-associated venous thrombosis (CAT) has been shown to be nonconsistent with contemporary guideline recommendations, resulting in poor patient outcomes.

Objectives The study aimed to describe contemporary CAT management in Danish oncology departments and identify knowledge gaps and inconsistencies between guidelines and clinical practice.

Patients and Methods A survey questionnaire in Danish was developed based on contemporary national guidelines. Using an open recruitment strategy, invitations to participate in the electronic survey were sent to physicians employed at oncology departments in Denmark in winter of 2018/2019. The questionnaire was based on current national guidelines and included 10 items with multiple choices and a free-text option to specify or comment. The questionnaire was pilot-tested by a junior and senior oncologist.

Results A total of 142 physicians completed the survey, representing all Danish geographical regions and various seniority. The majority reported that CAT was treated and followed up in oncology departments. However, 36.6% of the physicians were unaware of the existence of designated cancer thrombosis guidelines. Risk of venous thrombosis was generally assessed without diagnostic scores. Almost all (98.6%) reported low-molecular-weight heparin to be first-line treatment for CAT. Treatment duration seemed wrongly influenced by subtype of venous thrombosis, and 44.5% responded that thromboprophylaxis among hospitalized patients was substantially underused.

Conclusion The variability in the daily clinical management of CAT demonstrated through this survey indicates a potential to increase awareness of available guidelines, standardized use of inpatient thromboprophylaxis, and organized treatment and follow-up in a multidisciplinary setting, which would potentially improve management of CAT in Denmark.

Keywords

venous thromboembolism - cancer associated venous thrombosis - practice guideline - cancer - survey

Authors' Contributions

A.A.H. drafted the survey questionnaire, chaired the project, analyzed the survey results, and drafted the manuscript. T.F.O., M.N., T.K., M.S.R., T.D.C., and T.B.L. revised the survey questionnaire, revised the manuscript, and approved the final version to be published.


Supplementary Material



Publication History

Received: 01 December 2020

Accepted: 19 January 2021

Article published online:
16 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Stein PD, Beemath A, Meyers FA, Skaf E, Sanchez J, Olson RE. Incidence of venous thromboembolism in patients hospitalized with cancer. Am J Med 2006; 119 (01) 60-68
    CrossrefPubMedGoogle Scholar
  • 2 Cronin-Fenton DP, Søndergaard F, Pedersen LA. et al. Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997-2006. Br J Cancer 2010; 103 (07) 947-953
    CrossrefPubMedGoogle Scholar
  • 3 Prandoni P, Lensing AWA, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedGoogle Scholar
  • 4 Albertsen IE, Nielsen PB, Søgaard M. et al. Risk of recurrent venous thromboembolism: a Danish nationwide cohort study. Am J Med 2018; 131 (09) 1067-1074.e4
    CrossrefPubMedGoogle Scholar
  • 5 Farge D, Frere C, Connors JM. et al; International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2019; 20 (10) e566-e581
    CrossrefPubMedGoogle Scholar
  • 6 Angelini D, Ashrani A, Bockenstedt PL. et al. NCCN Guidelines Version 1.2019 Cancer-Associated Venous Thromboembolic Disease. Accessed 2019 at: https://media.mycme.com/documents/385/nccn_guidelines_96189.pdf
    PubMedGoogle Scholar
  • 7 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 2020; 38 (05) 496-520
    CrossrefPubMedGoogle Scholar
  • 8 Rasmussen MS, Dorff MH, Holt MI, Grove EL, Hvas AM. Cancer Og Venøs Tromboembolisme. Retningslinje Fra Dansk Selskab for Trombose Og Hæmostase Og Dansk Selskab for Klinisk Onkologi. Accessed 2020 at: https://dsth.dk/pdf/CAT_2020.pdf
    PubMedGoogle Scholar
  • 9 Mahé I, Puget H, Buzzi JC. et al. Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study. Support Care Cancer 2016; 24 (08) 3369-3377
    CrossrefPubMedGoogle Scholar
  • 10 Matzdorff A, Ledig B, Stuecker M, Riess H. Practice patterns for prophylaxis and treatment of venous thromboembolism in german cancer patients. Oncol Res Treat 2016; 39 (04) 194-201
    CrossrefPubMedGoogle Scholar
  • 11 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 12 Dansk Selskab for Trombose og Hæmostase. Cancer Og Venøs Tromboembolisme. Accessed 2017 at: https://dsth.dk/pdf/CAT_2020.pdf
    PubMedGoogle Scholar
  • 13 Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res 2004; 6 (03) e34
    CrossrefPubMedGoogle Scholar
  • 14 Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62 (01) 107-115
    CrossrefPubMedGoogle Scholar
  • 15 Sundhedsstyrelsen. Lægeprognose 2018–2040 Udbuddet Af Læger Og Speciallæger. Copenhagen. Accessed 2019 at: https://www.sst.dk/-/media/Udgivelser/2019/L%C3%A6geprognose-2018-2040.ashx?la=da&hash=B64A451ED51D2CFDD09976F3CD49DB045BCA0451
    PubMedGoogle Scholar
  • 16 Spyropoulos J, Padbury C. Uncovering clinical gaps in treatment of cancer-associated thrombosis: a clinical practice assessment. Res Pr Thromb Haemost 2020; 4 (01) 2150
    PubMedGoogle Scholar
  • 17 Mahtta D, Rodriguez F, Jneid H, Levine GN, Virani SS. Improving adherence to cardiovascular guidelines: realistic transition from paper to patient. Expert Rev Cardiovasc Ther 2020; 18 (01) 41-51
    CrossrefPubMedGoogle Scholar
  • 18 Sheard L, Prout H, Dowding D. et al. Barriers to the diagnosis and treatment of venous thromboembolism in advanced cancer patients: a qualitative study. Palliat Med 2013; 27 (04) 339-348
    CrossrefPubMedGoogle Scholar
  • 19 Khorana AA, McCrae KR, Milentijevic D. et al. Current practice patterns and patient persistence with anticoagulant treatments for cancer-associated thrombosis. Res Pract Thromb Haemost 2017; 1 (01) 14-22
    CrossrefPubMedGoogle Scholar
  • 20 Raskob GE, van Es N, Verhamme P. et al; Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018; 378 (07) 615-624
    CrossrefPubMedGoogle Scholar
  • 21 Young AM, Marshall A, Thirlwall J. et al. Comparison of an oral factor xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 2018; 36 (20) 2017-2023
    CrossrefPubMedGoogle Scholar
  • 22 Søgaard M, Nielsen PB, Skjøth F, Kjaeldgaard JN, Larsen TB. Risk of recurrence and bleeding in patients with cancer-associated venous thromboembolism treated with rivaroxaban: a nationwide cohort study. Cancer Med 2019; 8 (03) 1044-1053
    CrossrefPubMedGoogle Scholar
  • 23 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
    CrossrefPubMedGoogle Scholar
  • 24 Steffel J, Verhamme P, Potpara TS. et al; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39 (16) 1330-1393
    CrossrefPubMedGoogle Scholar
  • 25 Seaman S, Nelson A, Noble S. Cancer-associated thrombosis, low-molecular-weight heparin, and the patient experience: a qualitative study. Patient Prefer Adherence 2014; 8: 453-461
    PubMedGoogle Scholar
  • 26 Mockler A, O'Brien B, Emed J, Ciccotosto G. The experience of patients with cancer who develop venous thromboembolism: an exploratory study. Oncol Nurs Forum 2012; 39 (03) E233-E240
    CrossrefPubMedGoogle Scholar
  • 27 Noble S, Prout H, Nelson A. Patients' Experiences of LIving with CANcer-associated thrombosis: the PELICAN study. Patient Prefer Adherence 2015; 9: 337-345
    CrossrefPubMedGoogle Scholar
  • 28 Overvad TF, Larsen TB, Søgaard M. et al. Cancer-associated venous thromboembolism and the non-vitamin K antagonist oral anticoagulants: a review of clinical outcomes and patient perspectives. Expert Rev Cardiovasc Ther 2020; 18 (11) 791-800
    CrossrefPubMedGoogle Scholar
  • 29 Guo JD, Hlavacek P, Poretta T. et al. Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States. J Thromb Thrombolysis 2020; 50 (02) 386-394
    CrossrefPubMedGoogle Scholar
  • 30 Etxeandia-Ikobaltzeta I, Zhang Y, Brundisini F. et al. Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines. Blood Adv 2020; 4 (05) 953-968
    CrossrefPubMedGoogle Scholar
  • 31 Lee AYY. When can we stop anticoagulation in patients with cancer-associated thrombosis?. Hematology (Am Soc Hematol Educ Program) 2017; 2017 (01) 128-135
    CrossrefPubMedGoogle Scholar
  • 32 Noble S, Pease N, Sui J. et al. Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise. BMJ Open 2016; 6 (11) e013321
    CrossrefPubMedGoogle Scholar
  • 33 Ky B. JACC: CardioOncology: poised to serve a maturing, collaborative field. JACC Cardio Oncol 2019; 1 (01) 131-132
    CrossrefPubMedGoogle Scholar
  • 34 Mahé I, Chidiac J, Helfer H, Noble S. Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis. J Thromb Haemost 2016; 14 (11) 2107-2113
    CrossrefPubMedGoogle Scholar
  • 35 Tully KH, Krimphove MJ, Reese SW. et al. Trends in adherence to thromboprophylaxis guideline in patients undergoing radical cystectomy. Urology 2020; 135: 44-49
    CrossrefPubMedGoogle Scholar
  • 36 Martin KA, Molsberry R, Khan SS, Linder JA, Cameron KA, Benson III A. Preventing venous thromboembolism in oncology practice: use of risk assessment and anticoagulation prophylaxis. Res Pract Thromb Haemost 2020; 4 (07) 1211-121
    CrossrefPubMedGoogle Scholar