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Potere N, Mahé I, Angchaisuksiri P, Cesarman-Maus G, Tan CW, Rashid A, AlGahtani FH, Imbalzano E, van Es N, Leader A, Olayemi E, Porreca E, Ní Áinle F, Okoye HC, Candeloro M, Mayeur D, Valerio L, Clark RC, Castellucci LA, Barco S, Di Nisio M. Unmet needs and barriers in venous thromboembolism education and awareness among people living with cancer: a global survey. J Thromb Haemost 2024; 22:1973-1983. [PMID: 38582384 DOI: 10.1016/j.jtha.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major preventable cause of morbidity, disability, and mortality in subjects with cancer. A global appraisal of cancer-associated VTE education and awareness is not available. OBJECTIVES To evaluate VTE-related education, awareness, and unmet needs from the perspective of people living with cancer using a quantitative and qualitative approach. METHODS This cross-sectional study used data from an online-based survey covering multidimensional domains of cancer-associated VTE. Data are presented descriptively. Potential differences across participant subgroups were explored. RESULTS Among 2262 patients with cancer from 42 countries worldwide, 55.3% received no VTE education throughout their cancer journey, and an additional 8.2% received education at the time of VTE diagnosis only, leading to 63.5% receiving no or inappropriately delayed education. When education was delivered, only 67.8% received instructions to seek medical attention in case of VTE suspicion, and 36.9% reported scarce understanding. One-third of participants (32.4%) felt psychologically distressed when becoming aware of the potential risks and implications connected with cancer-associated VTE. Most responders (78.8%) deemed VTE awareness highly relevant, but almost half expressed concerns about the quality of education received. While overall consistent, findings in selected survey domains appeared to numerically differ across age group, ethnicity, continent of residence, educational level, metastatic status, and VTE history. CONCLUSION This study involving a large and diverse population of individuals living with cancer identifies important unmet needs in VTE-related education, awareness, and support across healthcare systems globally. These findings unveil multilevel opportunities to expedite patient-centered care in cancer-associated VTE prevention and management.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy.
| | - Isabelle Mahé
- Innovative Therapies in Haemostasis, INSERM UMR_S1140, INNOVTE-FRIN Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Chee Wee Tan
- Department of Hematology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Anila Rashid
- Section of Haematology, Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Farjah H AlGahtani
- Division of Hematology-Oncology, Oncology Center, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | | | - Ettore Porreca
- Department of Innovative Technologies in Medicine and Dentistry, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Fionnuala Ní Áinle
- Department of Hematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland; School of Medicine, University College, Dublin, Ireland
| | - Helen C Okoye
- Department of Hematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Matteo Candeloro
- Department of Innovative Technologies in Medicine and Dentistry, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Didier Mayeur
- Medical Oncology, Transversal Department of Supportive Care, Association Francophone des Soins Oncologiques de Support, Centre Georges-François Leclerc, Dijon, France
| | - Luca Valerio
- Centers for Thrombosis and Hemostasis and Cardiology, University Hospital Mainz, Mainz, Germany
| | - R Cary Clark
- Programs and Education, International Society on Thrombosis and Haemostasis, Carrboro, North Carolina, USA
| | - Lana A Castellucci
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Stefano Barco
- Centers for Thrombosis and Hemostasis and Cardiology, University Hospital Mainz, Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
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Falanga A, Lorusso D, Colombo N, Cormio G, Cosmi B, Scandurra G, Zanagnolo V, Marietta M. Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention. Cancers (Basel) 2024; 16:1769. [PMID: 38730721 PMCID: PMC11083004 DOI: 10.3390/cancers16091769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis. We found that the current understanding and management of venous thromboembolism in gynecological malignancy is largely based on studies on solid cancers in general. Hence, further, larger, and well-designed research in this area is needed.
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Affiliation(s)
- Anna Falanga
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (A.F.); (N.C.)
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (A.F.); (N.C.)
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine (DIM), University “A. Moro”, 70124 Bari, Italy
| | - Benilde Cosmi
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppa Scandurra
- Unità Operativa Oncologia Medica, Ospedale Cannizzaro di Catania, 95126 Catania, Italy;
| | | | - Marco Marietta
- Hematology Unit, Azienda Ospedaliero-Universitaria, 41125 Modena, Italy;
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Sevestre MA, Gaboreau Y, Douriez E, Bichon V, Bozec C, Gendron P, Mayeur D, Scotté F, Mahé I, Sanchez O. Care pathways for patients with cancer-associated thrombosis: From diagnosis to long-term follow-up. Arch Cardiovasc Dis 2024; 117:6-15. [PMID: 38065752 DOI: 10.1016/j.acvd.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Venous thromboembolism (VTE) in patients with cancer is associated with a high risk of bleeding complications and hospitalisation, as well as with increased mortality. Good practice recommendations for diagnosis and treatment of VTE in patients with cancer have been developed by a number of professional bodies. Although these guidelines provide consistent recommendations on what treatment should be offered to patients presenting with cancer-associated thromboembolism (CAT), many questions remain unanswered, in particular about the modalities of management (Who? When? Where?) and, for this reason, we have developed a consensus proposal for an appropriate multidisciplinary care pathway for patients with CAT, which is presented in this article. The proposal was informed by the recent scientific literature retrieved through a systematic literature review. This proposal is centred on the development of a shared care plan individualised to each patient's needs and expectations, patient information and shared decision-making to promote adherence, involvement of all relevant hospital- and community- based healthcare providers in the development and implementation of the care plan, and regular re-evaluation of the treatment strategy.
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Affiliation(s)
- Marie-Antoinette Sevestre
- Service de médecine vasculaire, EA Chimère 7516, CHU Amiens, 80054 Amiens, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Yoann Gaboreau
- Département de médecine générale, faculté de médecine, université Grenoble-Alpes, université de Grenoble, techniques de l'ingénierie médicale et de la complexité (TIMC), Grenoble, France
| | | | - Virginie Bichon
- Service d'oncologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Coralie Bozec
- AFIC, IPA onco-hématologie, centre Eugène-Marquis, centre hospitalier de Dinan, Rennes, France
| | - Pascale Gendron
- ONCORIF, dispositif spécifique régional de cancérologie Île-de-France, Paris, France
| | - Didier Mayeur
- Département d'ocologie médicale, centre Georges-François-Leclerc, Dijon, France
| | - Florian Scotté
- Département interdisciplinaire d'organisation des parcours patients (DIOPP), institut Gustave-Roussy, Villejuif, France
| | - Isabelle Mahé
- Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
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Carrier M, Wang TF. Management of cancer-associated venous thromboembolism from diagnosis to treatment: State of the art and remaining unmet needs. Arch Cardiovasc Dis 2024; 117:1-2. [PMID: 38008658 DOI: 10.1016/j.acvd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Marc Carrier
- Department of Medicine University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Tzu-Fei Wang
- Department of Medicine University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada
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Liu M, Qiu X, Sun Y, Li Q, Wen J, Liu G, Yao Z, Zhu L. Intensify Standardized Anticoagulation for Cancer-associated Pulmonary Embolism: From Single-center Real-world Data. Clin Ther 2023; 45:1236-1243. [PMID: 37838562 DOI: 10.1016/j.clinthera.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/27/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Pulmonary embolism (PE) is a significant contributor to mortality in patients with cancer. Although anticoagulation serves as the cornerstone of treatment for cancer-associated PE, it has not been emphasized in real-world settings. The aim of this study was to examine the impact of suboptimal anticoagulant treatment on the prognosis of cancer-associated PE. METHODS A cohort of 356 individuals newly diagnosed with acute PE were enrolled. The primary outcome of the study was recurrent venous thromboembolism (VTE), and the secondary outcomes were all-cause mortality and major bleeding (consisting of a reduction in the hemoglobin level by at least 20 g/L, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical area or organ or fatal bleeding). FINDINGS Of the total participants, 156 (43.8%) were diagnosed with cancer. A comparison between the cancer and noncancer groups revealed that patients with cancer were more frequently asymptomatic (41.0% vs 4.5%; P < 0.001), less likely to have right ventricular dysfunction (4.5% vs 14.0%; P = 0.001), received less anticoagulant treatment during hospitalization (85.3% vs 98.5%; P < 0.001), and had a shorter duration of anticoagulation (5.02 [7.40] months vs 14.19 [10.65] months; P < 0.001). In addition, patients with cancer were found to be at a higher risk of recurrent VTE (17.3% vs 4.0%; P < 0.001) and all-cause mortality (23.7% vs 10.5%; P = 0.001). Multiple Cox regression analysis indicated that discontinuation of anticoagulation at 3 months was a significant risk factor for recurrent VTE in the cancer group (HR, 15.815; 95% CI, 3.047-82.079; P = 0.001). IMPLICATIONS The brief duration of anticoagulation therapy and elevated likelihood of recurrent VTE serve as cautionary indicators for the need to enhance awareness of standardized anticoagulant treatment for cancer-associated PE. The ultimate goal is to enhance patient prognosis and quality of life.
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Affiliation(s)
- Mingjie Liu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Xianming Qiu
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong, China
| | - Yuanyuan Sun
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Qi Li
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Xia Jin, Dezhou, China
| | - Jing Wen
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Guixiang Liu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Zhouhong Yao
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Ling Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.
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Affiliation(s)
- Isabelle Mahé
- Université Paris Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Médecine Interne, Colombes, France
- Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- INNOVTE, FCRIN, France
| | - Florian Scotté
- Gustave Roussy, Patient Pathway Department, Villejuif, France
| | - Ismail Elalamy
- INNOVTE, FCRIN, France
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l’Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Vessel Biology and Therapeutics,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
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Potere N, Barco S, Mahé I, Cesarman‐Maus G, Angchaisuksiri P, Leader A, Okoye HC, Olayemi E, Ay C, Carrier M, Connors JM, Farmakis IT, Fumagalli RM, Jing Z, Lee LH, McLintock C, Ní Ainle F, Giannakoulas G, Goto S, Guillermo Esposito MC, Jara‐Palomares L, Szlaszynska M, Tan CW, Van Es N, Wang T, Hunt BJ, Di Nisio M. Awareness of venous thromboembolism among patients with cancer: Preliminary findings from a global initiative for World Thrombosis Day. J Thromb Haemost 2022; 20:2964-2971. [PMID: 36201366 PMCID: PMC9828201 DOI: 10.1111/jth.15902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty. METHODS We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT. The survey, available in 14 languages, was promoted and disseminated online through social networks, email newsletters, websites, and media. RESULTS As of September 20, 2022, 749 participants from 27 countries completed the survey. Overall, 61.8% (n = 460) of responders were not aware of their risk of CAT. Among those who received information on CAT, 26.2% (n = 56) were informed only at the time of CAT diagnosis. Over two thirds (69.1%, n = 501) of participants received no education on signs and symptoms of venous thromboembolism (VTE); among those who were educated about the possible clinical manifestations, 58.9% (n = 119) were given instructions to seek consultation in case of VTE suspicion. Two hundred twenty-four respondents (30.9%) had a chance to discuss the potential use of primary thromboprophylaxis with health-care providers. Just over half (58.7%, n = 309) were unaware of the risks of bleeding associated with anticoagulation, despite being involved in anticoagulant-related discussions or exposed to anticoagulants. Most responders (85%, n = 612) valued receiving CAT education as highly relevant; however, 51.7% (n = 375) expressed concerns about insufficient time spent and clarity of education received. CONCLUSIONS This ongoing survey involving cancer patients with diverse ethnic, cultural, and geographical backgrounds highlights important patient knowledge gaps. These findings warrant urgent interventions to improve education and awareness, and reduce CAT burden.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences“G. D'Annunzio” UniversityChietiItaly
| | - Stefano Barco
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
- Center for Thrombosis and HemostasisJohannes Gutenberg UniversityMainzGermany
| | - Isabelle Mahé
- Université Paris CitéHôpital Louis MourierParisFrance
- Innovative Therapies in HaemostasisINSERM UMR_S1140Saint‐EtienneFrance
| | | | | | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Helen C. Okoye
- Department of Haematology and Immunology, College of MedicineUniversity of NigeriaEnuguNigeria
| | | | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and HaemostaseologyMedical University ViennaViennaAustria
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa HospitalOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Jean Marie Connors
- Brigham and Women's Hospital, Hematology DivisionHarvard Medical SchoolBostonUSA
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, AHEPA University HospitalAristotle University of ThessalonikiThessalonikiGreece
| | | | - Zhi‐Cheng Jing
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijingChina
| | - Lai Heng Lee
- Department of HaematologySingapore General HospitalSingapore
| | - Claire McLintock
- National Women's HealthAuckland City HospitalAucklandNew Zealand
| | | | - George Giannakoulas
- Department of Cardiology, AHEPA University HospitalAristotle University of ThessalonikiThessalonikiGreece
| | - Shinya Goto
- Department of MedicineTokai University School of MedicineIseharaJapan
| | | | - Luis Jara‐Palomares
- Unidad Médico‐Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | | | - Chee Wee Tan
- Department of Haematology, Royal Adelaide Hospital, SA Pathology, Adelaide, South Australia, AustraliaUniversity of AdelaideSouth AustraliaAustralia
| | - Nick Van Es
- Amsterdam UMC location University of Amsterdam, Vascular Medicine, Amsterdam, Netherlands; Amsterdam Cardiovascular SciencesPulmonary Hypertension & ThrombosisAmsterdamthe Netherlands
| | - Tzu‐Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa HospitalOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Beverley J. Hunt
- St Thomas' Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology GroupGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences“G. D'Annunzio” UniversityChietiItaly
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