VTE risk assessment in cancer

2016 ◽  
Vol 07 (01) ◽  
pp. 20-25
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Clinical Importance ◽  
Cancer Surgery ◽  
Ambulatory Setting ◽  
Oncology Patients ◽  
Related Factors ◽  
Risk Assessment Models ◽  
Increased Risk

SummaryVenous thromboembolism (VTE) in patients with cancer is associated with an increased morbidity and mortality, and its prevention is of major clinical importance. However, the VTE rates in the cancer population vary between 0.5% - 20%, depending on cancer-, treatment- and patient-related factors. The most important contributors to VTE risk are the tumor entity, stage and certain anticancer treatments. Cancer surgery represents a strong risk factor for VTE, and medical oncology patients are at increased risk of developing VTE, especially when receiving chemotherapy or immunomodulatory drugs. Also biomarkers have been investigated for their usefulness to predict risk of VTE (e.g. elevated leukocyte and platelet counts, soluble P-selectin, D-dimer, etc.). In order to identify cancer patients at high risk of VTE and to improve risk stratification, risk assessment models have been developed, which contain both clinical parameters and biomarkers. While primary thromboprophylaxis with lowmolecular- weight-heparin (LMWH) is recommended postoperatively for a period of up to 4 weeks after major cancer surgery, the evidence is less clear for medical oncology patients. Thromboprophylaxis in hospitalized medical oncology patients is advocated, and is based on results of randomized controlled trials which evaluated the efficacy and safety of LMWH for prevention of VTE in hospitalized medically ill patients. In recent trials the benefit of primary thromboprophylaxis in cancer patients receiving chemotherapy in the ambulatory setting has been investigated. However, at the present stage primary thromboprophylaxis for prevention of VTE in these patients is still a matter of debate and cannot be recommended for all cancer outpatients.

VTE risk assessment in cancer

Phlebologie ◽  
2016 ◽  
Vol 45 (03) ◽  
pp. 140-145 ◽  
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Clinical Importance ◽  
Cancer Surgery ◽  
Ambulatory Setting ◽  
Oncology Patients ◽  
Related Factors ◽  
Risk Assessment Models ◽  
Increased Risk

SummaryVenous thromboembolism (VTE) in patients with cancer is associated with an increased morbidity and mortality, and its prevention is of major clinical importance. However, the VTE rates in the cancer population vary between 0.5–20 %, depending on cancer-, treatment- and patient-related factors. The most important contributors to VTE risk are the tumour entity, stage and certain anticancer treatments. Cancer surgery represents a strong risk factor for VTE, and medical oncology patients are at increased risk of developing VTE, especially when receiving chemotherapy or immunomodulatory drugs. Also biomarkers have been investigated for their usefulness to predict risk of VTE (e.g. elevated leucocyte and platelet counts, soluble P-selectin, D-dimer, etc.). In order to identify cancer patients at high risk of VTE and to improve risk stratification, risk assessment models have been developed, which contain both clinical parameters and biomarkers. While primary thromboprophylaxis with low-molecular- weight-heparin (LMWH) is recommended postoperatively for a period of up to 4 weeks after major cancer surgery, the evidence is less clear for medical oncology patients. Thromboprophylaxis in hospitalized medical oncology patients is advocated, and is based on results of randomized controlled trials which evaluated the efficacy and safety of LMWH for prevention of VTE in hospitalized medically ill patients. In recent trials the benefit of primary thromboprophylaxis in cancer patients receiving chemotherapy in the ambulatory setting has been investigated. However, at the present stage primary thromboprophylaxis for prevention of VTE in these patients is still a matter of debate and cannot be recommended for all cancer outpatients.

Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients

2021 ◽  
Author(s):  
Noori A.M. Guman ◽  
Matteo Candeloro ◽  
Noémie Kraaijpoel ◽  
Marcello Di Nisio
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Arterial Thrombosis ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Individual Risk ◽  
Risk Assessment Models ◽  
Increased Risk ◽  
Cancer Associated Thrombosis

AbstractCancer patients have a high risk of developing venous thromboembolism and arterial thrombosis, along with an increased risk of anticoagulant-related bleeding with primary and secondary prophylaxis of cancer-associated thrombosis. Decisions on initiation, dosing, and duration of anticoagulant therapy for prevention and treatment of cancer-associated thrombosis are challenging, as clinicians have to balance patients' individual risk of (recurrent) thrombosis against the risk of bleeding complications. For this purpose, several dedicated risk assessment models for venous thromboembolism in cancer patients have been suggested. However, most of these scores perform poorly and have received limited to no validation. For bleeding and arterial thrombosis, no risk scores have been developed specifically for cancer patients, and treatment decisions remain based on clinical gestalt and rough and unstructured estimation of the risks. The aims of this review are to summarize the characteristics and performance of risk assessment scores for (recurrent) venous thromboembolism and discuss available data on risk assessment for bleeding and arterial thrombosis in the cancer population. This summary can help clinicians in daily practice to make a balanced decision when considering the use of risk assessment models for cancer-associated venous thromboembolism. Future research attempts should aim at improving risk assessment for arterial thrombosis and anticoagulant-related bleeding in cancer patients.

Attention to diet, exercise, and weight in the oncology clinic: Results of a national patient survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Jennifer A. Ligibel ◽  
Lori J. Pierce ◽  
Catherine M. Bender ◽  
Tracy E Crane ◽  
Christina Marie Dieli-Conwright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Online Survey ◽  
Early Stage ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
Increased Risk ◽  
Diet And Exercise ◽  
To Receive

10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.

Ambulatory Patient Preference for VTE Prophylaxis

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4709-4709
Author(s):  
Tarek Sousou ◽  
Alok Khorana
Keyword(s):  
Cancer Patients ◽  
Stage Iv ◽  
Morbidity And Mortality ◽  
Ambulatory Setting ◽  
Cancer Center ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Willingness To Use ◽  
Cancer Associated Thrombosis ◽  
The University

Abstract Introduction: Cancer-associated thrombosis leads to morbidity and mortality in cancer patients. Thromboembolism can be prevented with the use of existing and emerging anticoagulants. We sought to ascertain awareness as well as receptiveness to anticoagulation amongst ambulatory cancer patients receiving active therapy. Methods: Two-hundred-fifty 12 question surveys were distributed to ambulatory cancer patients at the James P. Wilmot Cancer Center of the University of Rochester. Patients included in this study were those with active cancer, age ≥ 18 years and ambulatory. Hospitalized patients were excluded. Data was gathered regarding: age, gender, stage as well as type of malignancy, awareness of increased risk of venous thromboembolism and willingness to use various forms of anticoagulation. Results: One hundred ninety surveys (76%) were completed over a three week period. Study population consisted of 71 males (37%) and 119 females (63%) with mean age of 58. Malignancies surveyed include: lymphoma 26%, breast 20%, gastrointestinal 15%, leukemia 9% and lung cancer 7% among others. Nineteen percent of patients had stage IV malignancy. Of the patients surveyed, 53% reported being unaware of the increased risk of VTE with malignancy. Eighty-six percent of patients surveyed would be willing to use an oral anticoagulant 46% would be willing to perform daily anticoagulant injections. Conclusions: Prophylaxis for VTE in ambulatory cancer patients is an area of active investigation and could lead to improvements in morbidity and mortality. This study reveals a lack of knowledge of the increased risk of VTE amongst cancer patients. However, informed patients expressed willingness to use prophylaxis if shown effective to reduce VTE in the ambulatory setting.

Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia

Perfusion ◽  
2007 ◽  
Vol 22 (6) ◽  
pp. 381-383
Author(s):  
C Marshall
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cancer Patients ◽  
Protein C ◽  
Thromboembolic Event ◽  
Cancer Surgery ◽  
Protein C Deficiency ◽  
Post Surgery ◽  
Increased Risk ◽  
Cardiac Surgeon ◽  
Cardiac Operations

Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

Risk Assessment and Prophylaxis for VTE in Cancer Patients

2011 ◽  
Vol 9 (7) ◽  
pp. 789-797 ◽  
Author(s):  
Alok A. Khorana
Keyword(s):  
Risk Assessment ◽  
Risk Model ◽  
Ambulatory Setting ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Mortality And Morbidity ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Leukocyte Counts ◽  
D Dimer

The frequency of venous thromboembolism (VTE) is rising in patients with cancer. VTE contributes to mortality and morbidity, but the risk for VTE can vary widely between individual patients. Clinical risk factors for VTE in cancer include primary site of cancer, use of systemic therapy, surgery, and hospitalization. Biomarkers predictive of VTE include platelet and leukocyte counts, hemoglobin, D-dimer, and tissue factor. A recently validated risk model incorporates 5 easily available variables and can be used clinically to identify patients at increased risk of VTE. In high-risk settings, including surgery and hospitalization, thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparins has been shown to be safe and effective. Recent studies have also suggested a potential benefit for thromboprophylaxis in the ambulatory setting, although criteria for selecting patients for prophylaxis are not currently well defined. This article focuses on recent and ongoing studies of risk assessment and prophylaxis in patients with cancer.

scholarly journals Risk assessment of thromboembolic events in hospitalized cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Federico Nichetti ◽  
Francesca Ligorio ◽  
Giulia Montelatici ◽  
Luca Porcu ◽  
Emma Zattarin ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Predictive Value ◽  
Assessment Model ◽  
Primary Study ◽  
Low Grade ◽  
Thromboembolic Events ◽  
Study Objective ◽  
Increased Risk ◽  
The Impact

AbstractHospitalized cancer patients are at increased risk for Thromboembolic Events (TEs). As untailored thromboprophylaxis is associated with hemorrhagic complications, the definition of a risk-assessment model (RAM) in this population is needed. INDICATE was a prospective observational study enrolling hospitalized cancer patients, with the primary objective of assessing the Negative Predictive Value (NPV) for TEs during hospitalization and within 45 days from discharge of low-grade Khorana Score (KS = 0). Secondary objectives were to assess KS Positive Predictive Value (PPV), the impact of TEs on survival and the development of a new RAM. Assuming 7% of TEs in KS = 0 patients as unsatisfactory percentage and 3% of as satisfactory, 149 patients were needed to detect the favorable NPV with one-sided α = 0.10 and power = 0.80. Stepwise logistic regression was adopted to identify variables included in a new RAM. Among 535 enrolled patients, 153 (28.6%) had a KS = 0. The primary study objective was met: 29 (5.4%) TEs were diagnosed, with 7 (4.6%) cases in the KS = 0 group (NPV = 95.4%, 95% CI 90.8–98.1%; one-sided p = 0.084). However, the PPV was low (5.7%, 95% CI 1.9–12.8%); a new RAM based on albumin (OR 0.34, p = 0.003), log(LDH) (OR 1.89, p = 0.023) and presence of vascular compression (OR 5.32, p < 0.001) was developed and internally validated. Also, TEs were associated with poorer OS (median, 5.7 vs 24.8 months, p < 0.001). INDICATE showed that the KS has a good NPV but poor PPV for TEs in hospitalized cancer patients. A new RAM was developed, and deserves further assessment in external cohorts.

scholarly journals Predicting VTE in Cancer Patients: Candidate Biomarkers and Risk Assessment Models

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 95 ◽  
Author(s):  
Silvia Riondino ◽  
Patrizia Ferroni ◽  
Fabio Zanzotto ◽  
Mario Roselli ◽  
Fiorella Guadagni
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Prediction Models ◽  
Individual Risk ◽  
Treatment Delays ◽  
Advantages And Disadvantages ◽  
Risk Assessment Models ◽  
Current Guidelines ◽  
Impaired Quality

Risk prediction of chemotherapy-associated venous thromboembolism (VTE) is a compelling challenge in contemporary oncology, as VTE may result in treatment delays, impaired quality of life, and increased mortality. Current guidelines do not recommend thromboprophylaxis for primary prevention, but assessment of the patient’s individual risk of VTE prior to chemotherapy is generally advocated. In recent years, efforts have been devoted to building accurate predictive tools for VTE risk assessment in cancer patients. This review focuses on candidate biomarkers and prediction models currently under investigation, considering their advantages and disadvantages, and discussing their diagnostic performance and potential pitfalls.

Venous thromboembolism in cancer patients – Risk scores and recent randomised controlled trials

2012 ◽  
Vol 108 (12) ◽  
pp. 1042-1048 ◽  
Author(s):  
Cihan Ay ◽  
Ingrid Pabinger ◽  
Johannes Thaler
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Randomised Controlled Trials ◽  
Incidence Rates ◽  
Risk Scores ◽  
Controlled Trials ◽  
Increased Risk ◽  
Randomised Controlled

SummaryCancer patients are at increased risk of developing venous thromboembolism (VTE). Guidelines recommend routine thromboprophylaxis in hospitalised acutely ill cancer patients and in myeloma patients receiving combination treatments including thalidomide or lenalidomide. Currently, thromboprophylaxis is not recommended in cancer out-patients. It is the aim of this review to give an overview of studies that applied scores for the risk assessment of cancer-related VTE. We will also discuss randomised controlled trials (RCTs) that investigated primary thromboprophylaxis in cancer patients. Recently, Khorana et al. published a practical and reproducible risk assessment score that includes clinical and laboratory parameters for the stratification of cancer patients according to their propensity to develop VTE. Patients assigned to the high-risk group are likely to benefit most from primary thromboprophylaxis. This score was validated in prospective and retrospective observational studies. In the Vienna Cancer and Thrombosis Study (CATS) the score was expanded by adding two biomarkers, and the prediction of VTE was considerably improved. In recent RCTs including cancer patients with different malignancies it was shown that thromboprophylaxis is safe and effective. However, VTE incidence rates were low. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorised into high-risk groups on the basis of risk assessment with scores. From the available literature we conclude that risk assessment for VTE is feasible in cancer patients;however, interventional studies to investigate the safety and efficacy of thromboprophylaxis in a high risk cancer population have yet to be performed.

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