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Clinical and Translational Oncology

, Volume 19, Issue 8, pp 997–1009 | Cite as

FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence

  • P. Jimenez-Fonseca
  • A. Carmona-Bayonas
  • C. Calderon
  • J. Fontcuberta Boj
  • C. Font
  • R. Lecumberri
  • M. Monreal
  • A. J. Muñoz Martín
  • R. Otero
  • A. Rubio
  • P. Ruiz-Artacho
  • C. Suarez Fernández
  • E. Colome
  • P. Pérez Segura
Research Article

Abstract

Introduction

Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines.

Materials and methods

Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis.

Results

Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy.

Conclusion

Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.

Keywords

Cancer-associated thrombosis Delphi consensus Low-molecular weight heparin Prophylaxis Recommendations Treatment Venous thromboembolism 

Notes

Acknowledgements

Carmen González and Andreu Covas (GOT IT) for facilitating this Delphi project. Priscilla Chase Duran for editing and improving this manuscript.

Compliance with ethical standards

This study consisted of a survey of expert opinions and no patient data were collected, so no specific independent ethical or research review or informed consent or approval was necessary.

Conflict of interest

Esteve Colomé works in Laboratories LEO Pharma, SA; he did not answer the questionnaire. The other authors declare that they have no conflict of interest.

Funding

The external consultant that managed the online platform for the realization of the study was funded by LEO Pharma Academy.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  • P. Jimenez-Fonseca
    • 1
  • A. Carmona-Bayonas
    • 2
  • C. Calderon
    • 3
  • J. Fontcuberta Boj
    • 4
  • C. Font
    • 5
  • R. Lecumberri
    • 6
  • M. Monreal
    • 7
  • A. J. Muñoz Martín
    • 8
  • R. Otero
    • 9
  • A. Rubio
    • 10
  • P. Ruiz-Artacho
    • 11
  • C. Suarez Fernández
    • 12
  • E. Colome
    • 13
  • P. Pérez Segura
    • 14
  1. 1.Medical Oncology DepartmentHospital Universitario Central de AsturiasOviedoSpain
  2. 2.Hematology and Medical Oncology Department, UMU, IMIBHospital Universitario Morales MeseguerMurciaSpain
  3. 3.Clinical Psychology and Psychobiology Department, Faculty of PsychologyUniversity of BarcelonaBarcelonaSpain
  4. 4.Unitat d’Hemostàsia i TrombosiHospital Universitari de la Santa Creu i Sant PauBarcelonaSpain
  5. 5.Medical Oncology Department, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid TumorsHospital Universitari ClínicBarcelonaSpain
  6. 6.Hemaotology DepartmentClínica Universidad de NavarraPamplonaSpain
  7. 7.Internal Medicine DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
  8. 8.Medical Oncology DepartmentHospital Universitario Gregorio MarañónMadridSpain
  9. 9.Medical-Surgical Unit for Respiratory Disease, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)SevillaSpain
  10. 10.Pharmacy DepartmentHospital Virgen de la SaludToledoSpain
  11. 11.Emergency DepartmentHospital Universitario Clínico San Carlos, IdISSCMadridSpain
  12. 12.Internal Medicine DepartmentHospital Universitario La PrincesaMadridSpain
  13. 13.Scientific AffairsLEO PharmaBarcelonaSpain
  14. 14.Medical Oncology DepartmentHospital Universitario Clínico San CarlosMadridSpain

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