Embedded model palliative care (PC) at a community oncology practice in central Nebraska.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 64-64
Author(s):  
Cindy Kathman ◽  
Mehmet Sitki Copur ◽  
Penny Price ◽  
Carrie Edwards ◽  
Pornchai Jonglertham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Management ◽  
Hospice Care ◽  
Prognostic Index ◽  
Cancer Center ◽  
Care Utilization ◽  
Community Oncology ◽  
Oncology Practice ◽  
Active Cancer

64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.

Integration of oncology palliative care in a regional health care system.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 34-34
Author(s):  
Connie Edelen ◽  
Nicole Koesel
Keyword(s):  
Palliative Care ◽  
Healthcare System ◽  
Symptom Management ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Cancer Center ◽  
Care Utilization ◽  
Full Time ◽  
Treatment Pathways ◽  
Regional Health Care

34 Background: Early incorporation of palliative medicine in cancer care has been shown to be associated with improved symptom control, quality of life, and patient and family satisfaction however integration in the outpatient setting remains deficient nationwide. Regional healthcare systems carry the additional challenge of providing consistent quality care across a diverse geographic area. We performed a retrospective review of oncology palliative care utilization in a regional healthcare system following the implementation of a fully integrated model of palliative care. Methods: In 2012, Levine Cancer Institute (LCI) and Carolinas Palliative Care collaborated to establish palliative care access across its 12-site regional cancer center. This was a transition from a vendor service to a fully embedded clinic at multiple LCI locations. The new model offered full time outpatient multidisciplinary services in addition to an inpatient oncology palliative care consult service. Standardization of care and early integration were augmented by the creation of symptom management guidelines and tumor treatment pathways with built in recommendations for palliative/supportive care. Results: New oncology palliative care referrals increased from 150 annually to over 475 in the first 12 months. The top diagnoses were lung (16%), breast (11%), and head and neck cancer (7.2%) with pain and symptom management as the primary reason for consultation. Ten symptom management pathways have been published for regional utilization, enabling primary palliative care and serving as a trigger for palliative specialist consultation. A toolkit was created to identify operational needs, clinical tools, and staffing at each site. Conclusions: The growth of oncology palliative care utilization by 317% demonstrates the success of a fully embedded program. This multidisciplinary model is being standardized across regional sites to ensure access to primary and secondary palliative care. Additional clinic sites and the application of telemedicine for rural areas are in development. Future research is needed to document outcomes associated with palliative care integration across the cancer trajectory in a regional healthcare system.

Results from year 1 of an embedded supportive oncology practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 40-40
Author(s):  
Bethann Scarborough ◽  
Emily Chai ◽  
Randall F. Holcombe ◽  
Eric Lee ◽  
Nathan Goldstein
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Utilization ◽  
Symptom Management ◽  
Care Utilization ◽  
First Year ◽  
Goals Of Care ◽  
Supportive Oncology ◽  
Oncology Practice ◽  
Over Time

40 Background: We present the findings from our first year of a Supportive Oncology practice embedded in a quaternary care center’s outpatient cancer practice. Methods: One palliative medicine physician saw patients 4 days per week. Oncologists made referrals for symptom management, psychosocial support, advance care planning, or by predetermined triggers for palliative care. Results: 239 patients were referred for a total of 821 visits. Palliative care referrals increased over time; 0.6% of the cancer center’s patients were referred in the first quarter and 1.5% were referred in the third quarter. Referral reasons included symptom management/support (90%), goals of care (5%), or triggers (6%). Six to 9 symptoms were addressed at 41% of visits. Sixteen percent of patients initially referred for symptoms were later seen for conversations regarding goals of care. Of these patients, 76% discussed goals of care with their oncologist, 61% were referred to hospice and 47% enrolled in hospice. Supportive oncology visits were associated with decreased health care utilization, with a downward trend in Emergency Department visits (0.82 vs. 0.72 per patient) and inpatient admissions (0.91 vs. 0.84 per patient) after the initial palliative care visit compared to use before the visit. Approximately 17% of all Supportive Oncology patients enrolled in hospice. Conclusions: Our first year of an embedded palliative care practice focused on building collaborative relationships. The steady referral growth over time indicates that oncologists increasingly accepted the program. While only a small proportion of patients were referred, the high visit complexity reflects this population’s acuity. Decreased health care utilization may be due to better symptom control or care aligned with patients’ values. Early referrals for symptom management facilitate goals of care discussions later on, and the importance of delivering a unified message on treatment options is seen in the hospice referral rate of 61% for the subset of patients who discussed goals of care with palliative care and oncology. Embedding palliative care in oncology fosters expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care, and patients.

Understanding the challenges for oncologists in predicting the end-of-life phase of care in cancer patients with advanced solid tumor diagnoses.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 281-281
Author(s):  
Aaron J. Lyss ◽  
Cheryl A. Crouse ◽  
Natalie R. Dickson ◽  
Jeffrey Patton ◽  
Christopher A. Waynick ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Metastatic Cancer ◽  
Life Phase ◽  
Community Oncology ◽  
Medicare Patients ◽  
Oncology Practice

281 Background: Early advanced care planning and palliative care improves outcomes during the end-of-life phase of care (EOL) for metastatic cancer patients. Identifying patients who are likely to transition to EOL is a necessary step to prioritize limited palliative care resources and is integral to success in value-based payment models. We analyzed whether physician documentation of prognosis in a clinical pathways system (CPS) could reliably predict when patients are nearing EOL for a large community oncology practice of more than 70 medical oncologists. Methods: Tennessee Oncology (TO) requires physicians to use CPS for all Medicare patients. CPS prompts physicians to answer the “prognostic question” “would you be surprised if this patient died in the next year?” for all OCM patients with advanced solid tumors at the beginning of treatment or at the time of a change in treatment plan. Prognostic question responses were compared to actual dates of death documented in the practice management system. Results: A total of 5,266 distinct patients were expected to trigger an OCM episode during 2017. The CPS prompted a response to the prognostic question for 1,228 (23%) of these OCM patients. There were 665 (54%) positive prognoses (expect patient to live more than 1 year) and 563 (46%) negative prognoses (expect patient to die within 1 year). Physicians documented accurate prognoses in 712 (58%) of cases. For patients with positive prognosis 557 (84%) were accurate. For patients with negative prognosis 155 (21.8%) were accurate. Conclusions: We found that for patients with terminal cancer, it is difficult for physicians to accurately predict prognosis. These findings support the importance of ASCO guidelines pertaining to patient access to palliative care during the entirety of cancer treatment for all patients with metastatic cancer. [Table: see text]

Earlier access to palliative medicine: An experience of integration into a community oncology practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 92-92 ◽  
Author(s):  
Sandra Burcham ◽  
Jacqueline Matthews
Keyword(s):  
Palliative Care ◽  
Care Provider ◽  
Well Being ◽  
Quality Data ◽  
Medical Decision ◽  
Cancer Center ◽  
Full Time ◽  
Psychosocial Needs ◽  
Community Oncology ◽  
Oncology Practice

92 Background: A growing body of evidence supports the integration of palliative care as a standard for comprehensive cancer care. Through our experience as an inpatient palliative care provider, with 50% of our population having advanced cancer, we recognized the value proposition to provide continuity in the outpatient setting. Innovative Care Solutions developed a partnership with a large, community oncology program late 2015 for a palliative care multidisciplinary team to be embedded into one location of their practice. Methods: A full-time palliative licensed independent social worker (LISW) was dedicated to educate and engage screening process development. Utilizing the NCCN Distress Thermometer, referrals for care provision were then directed by the LISW to the most appropriate palliative care provider. The LISW addressed communication, goals of care discussions and advance directives. Identification of symptoms, including high level distress or mental health needs, were scheduled to see the palliative physician or advanced practice nurse, available two half days per week within the cancer center. Results: In the first quarter of service, the LISW screened a total of 85 patients, with 54 requiring PC interventions. Complex symptom needs were identified in seventeen percent, thirty percent were seen for psychosocial needs, and twenty percent were seen for completion of an advance directive. Thirty-six percent were seen for medical decision making. Conclusions: Integrating palliative care services in a community-based oncology practice has realized numerous positive patient outcomes and opportunities for further design. Using an evidenced based screening tool, identification of needs in an early access model appear to enable the patient to improve adherence to the medical plan care and avoid ER utilization. Symptom management has shown improved quality of life scores and PPS, and patient’s seen for psychosocial needs are able to explore aspects of person, as opposed to illness, that has improved overall well-being. Further program design will focus on integration of screening for all patients with advanced solid tumor, recurrent/refractory, and formalization of quality data tracking benchmarked to a web-based registry.

scholarly journals Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

2021 ◽  
Vol 18 (11) ◽  
pp. 6040
Author(s):  
Jessica Y. Islam ◽  
Veeral Saraiya ◽  
Rebecca A. Previs ◽  
Tomi Akinyemiju
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Gynecological Cancer ◽  
The United States ◽  
Care Utilization ◽  
Treatment Facility ◽  
Facility Type ◽  
Race Ethnicity ◽  
Distance To Care ◽  
The U.S

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.

scholarly journals Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar

2021 ◽  
Vol 18 (15) ◽  
pp. 7887
Author(s):  
Aye Tinzar Myint ◽  
Sariyamon Tiraphat ◽  
Isareethika Jayasvasti ◽  
Seo Ah Hong ◽  
Vijj Kasemsup
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Rural Areas ◽  
Psychosocial Support ◽  
Care Utilization ◽  
Severe Illness ◽  
Cross Sectional Survey ◽  
Care Services ◽  
Palliative Care Services ◽  
Older Cancer Patients

Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.

scholarly journals Oncology Fellow–Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With Advanced Cancer

2020 ◽  
Vol 16 (8) ◽  
pp. e814-e822 ◽  
Author(s):  
Ramy Sedhom ◽  
Arjun Gupta ◽  
Mirat Shah ◽  
Melinda Hsu ◽  
Marcus Messmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Advanced Cancer ◽  
Metastatic Cancer ◽  
Cancer Center ◽  
Care Utilization ◽  
First Year ◽  
Improvement Project ◽  
Leadership Support ◽  
Ancillary Staff

PURPOSE: ASCO guidelines recommend palliative care (PC) referral for patients with advanced or metastatic cancer. Despite this, implementation has considerable hurdles. First-year oncology fellows at our institution identified low rates of PC utilization in their longitudinal clinic as a metric needing improvement. METHODS: A fellow-led multidisciplinary team aimed to increase PC utilization for patients with advanced cancer followed in he first-year fellows’ clinic from a baseline of 11.5% (5 of 43 patients, July to December of 2018) to 30% over a 6-month period. Utilization was defined as evaluation in the outpatient PC clinic hosted in the cancer center. The team identified the following barriers to referral: orders difficult to find in the electronic medical record (EMR), multiple consulting mechanisms (EMR, by phone, or in person), EMR request not activating formal consult, no centralized scheduler to contact or confirm appointment, and poor awareness of team structure. Plan-Do-Study-Act (PDSA) cycles were implemented based on identified opportunities. Data were obtained from the EMR. RESULTS: The first PDSA cycle included focus groups with stakeholders, standardizing referral process via single order set, identifying a single scheduler with bidirectional communication, and disseminating process changes. PDSA cycles were implemented from January to June of 2019. Rates of PC use increased from 11.5% before the intervention to 48.4% (48 of 99 patients) after the intervention. CONCLUSION: A multidisciplinary approach and classic quality improvement methodology improved PC use in patients with advanced cancer. The pilot succeeded given the small number of fellows, buy-in from stakeholders, and institutional and leadership support. Straightforward EMR interventions and ancillary staff use are effective in addressing underreferrals.

HSR19-076: A Prospective Study of the Usage of Pain Medication, Cost, Alternative Medication Use, and Outcome by Cancer Patients in Real World

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-076
Author(s):  
Praveen Adusumilli ◽  
Vidya Viswanath ◽  
Raghunadha Rao Digumarthi
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Cancer Patients ◽  
Average Cost ◽  
Pain Medication ◽  
Cancer Center ◽  
Medication Cost ◽  
Palliative Care Specialist ◽  
Care Specialist ◽  
A Prospective Study

Introduction: Perception of pain and the need to treat it is highly variable, even amongst oncologists. Availability of pain specialists is an added advantage. This is an analysis of prescription patterns of pain medication and its outcome in cancer patients. Materials and Methods: The center has 8 oncologists and a pain and palliative care specialist. All the patients presenting to the outpatient department of our institute with a diagnosis of cancer were prospectively analyzed for usage of pain medication using a structured questionnaire. Data on diagnosis, stage, treatment given, and outcomes were analyzed. Pain intensity was recorded on visual analogue scale, types of pain medicines used, and their side effects were noted. The average cost of the pain medication purchased in our pharmacy was calculated. Use of alternative medicines was also noted. Results: A total of 1,098 cancer patients were evaluated. Pain was a prominent complaint in 64.6% of patients. Of these, only 89.5% received pain medication. Mild, moderate, and severe pain was seen in 52.1%, 26.7%, and 21.2% respectively. The 3 most common diagnoses were breast cancer in 19.7%, gastrointestinal cancer in 14%, and 12.1% with head and neck cancers. Weak opioids and NSAIDS were most commonly prescribed analgesics in 44.2% and 42.1%, respectively. Morphine was prescribed for 13.7% of patients. The average cost of pain medicines is Re 148 (US $2.25 a month). Side effects from medication were seen in 13.5% of patients, with constipation being the most common. Alternative forms of medicine were reportedly used by 148 patients: Ayurveda by 20.8%, and homeopathy by 12.9%, native medication by 6.1%, Unani by 1.8%. Good relief of pain was reported by 66%, fair relief by 27%, no relief by 6.1%, and worsening by <1%. Conclusion: Pain management is near ideal with the availability of services of pain and palliative care specialist in a cancer center.

Evaluation of Rivaroxaban and Dalteparin in Cancer Associated Thrombosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 432-432
Author(s):  
Ateefa Chaudhury ◽  
Asha Balakrishnan ◽  
Christy Thai ◽  
Bjorn Holmstrom ◽  
Michael V. Jaglal
Keyword(s):  
Cancer Patients ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Cancer Center ◽  
Minor Bleeding ◽  
Efficacy And Safety ◽  
Recurrent Vte ◽  
Chi Square Analysis ◽  
Cancer Associated Thrombosis ◽  
Active Cancer

Abstract Introduction: Venous thromboembolism (VTE) in the form of deep venous thrombosis (DVT) or pulmonary embolism (PE) is a complication of malignancy. Several studies have demonstrated the superiority of dalteparin (Fragmin®), a low molecular weight heparin (LMWH), in comparison to oral vitamin K antagonists in preventing VTE recurrence in the setting of active cancer. LMWH is the preferred treatment of cancer associated thrombosis. However, the cost of LMWH can be prohibitive and the need for daily subcutaneous injections can decrease patients' quality of life. While rivaroxaban (Xarelto®), a Factor Xa inhibitor, has been approved for the treatment and secondary prevention of DVT and PE, there is limited data regarding its use in cancer patients. The objective of our study is to determine the efficacy and safety of rivaroxaban compared to dalteparin in cancer associated thrombosis. Methods: This is a retrospective chart review of cancer patients greater than age 18 treated at H. Lee Moffitt Cancer Center between May 3, 2010 and June 30, 2015 on anticoagulation with rivaroxaban or dalteparin. Patients were excluded if the length of anticoagulant therapy was < 30 days, anticoagulant therapy was initiated > 6 months after VTE diagnosis, the indication for treatment was not DVT/PE, if patients had contraindications to either LMWH or rivaroxaban, or patients were not on treatment doses of therapy. Out of 459 patients identified, 226 patients (107 in the rivaroxaban group, and 119 in the dalteparin group) were eligible for analysis based on our exclusion criteria. Efficacy was determined by the incidence of recurrent VTE, such as recurrent DVT, new fatal or non-fatal PE within 30 days. The secondary endpoint of the study was to determine the safety of rivaroxaban compared to dalteparin in cancer patients for the treatment of VTE. Safety was determined by the incidence and severity of bleeding. Major bleeding was defined as clinically overt if it was associated with a fall in hemoglobin of 2 g/dL or more, required transfusions of ≥ 2 units of packed red blood cells, involved retroperitoneal, intracranial, or critical site bleeding, or if it contributed to death. Minor bleeding was defined as overt bleeding not meeting the criteria for major bleeding but associated with medical intervention, unscheduled contact with a physician, interruption or discontinuation of anticoagulation treatment, or associated with any other discomfort such as pain or impairment of activities of daily life. Descriptive statistical analyses were utilized. Chi square analysis and t- test were performed to compare categorical and continuous variables. All data was analyzed using SPSS version 21.0 statistical software. Results: Rivaroxaban had a similar rate of DVT and PE failure with 1 event versus 2 with dalteparin (p = 0.625). The rivaroxaban group had 0 major and 8 minor bleeds compared to 3 major and 8 minor bleeds in the dalteparin group with p values of 0.09 and 0.86 respectively. Comorbidities and risk factors for thrombosis were similar in both groups as summarized in Table 1. Table. Rivaroxaban vs. Dalteparin: No Significant Differences in the Efficacy and Safety Profile in Cancer Associated Thrombosis RivaroxabanN = 107 DalteparinN =119 P value DVT Failure within 30 days 1 (0.93%) 2 (1.68%) 0.625 PE Failure within 30 days 1 (0.93%) 1 (0.84%) 0.94 Major Bleeding 0 (0 %) 3 (2.5%) 0.09 Minor Bleeding 8 (7.5%) 8 (6.7%) 0.864 Median Age (Yrs) 61 65 0.93 MaleFemale 58 (54.2%) 49 (45.8%) 60 (50.4%) 59 (49.6%) 0.596 Active Cancer 96 (86.5%) 111 (93.2%) 0.350 Surgery within 30 Days 14 (13.1%) 13 (10.9%) 0.684 Hypertension 58 (54.2%) 61 (51.3%) 0.69 Diabetes 14 (13.1%) 14 (11.8%) 0.84 Coronary Artery Disease 6 (5.61%) 11 (9.2%) 0.326 History of Previous DVT 12 (11.2%) 5 (4.2%) 0.074 BMI >30 39 (36.4%) 48 (40.3%) 0.585 Creatinine Clearance (Cr Cl) 30 - 50 Cr Cl 50 - 70 7 (6.5%) 100 (93.3%) 7 (5.9%) 112 (94.1%) 0.837 Conclusions: Our study evaluated the safety and efficacy of rivaroxaban compared to dalteparin in patients with predominantly active cancer treated at a large comprehensive cancer center and found rivaroxaban to be comparable to dalteparin in this cohort. There were no significant differences in regards to recurrent VTE or major/minor bleeding with patients on rivaroxaban or dalteparin in our cohort of patients. Large randomized trials evaluating the efficacy and safety of rivaroxaban in the oncology population are needed to further validate our findings. Disclosures No relevant conflicts of interest to declare.

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