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Effectiveness of a multidisciplinary care program for the management of venous thromboembolism in cancer patients: a pilot study

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Abstract

Introduction

Treatment of Venous thromboembolism (VTE) in cancer patients is challenging due to higher risk of VTE recurrence or bleeding under anticoagulants. We assessed the effectiveness of a dedicated “Allo-Thrombosis Cancer” multidisciplinary care program (AlloTC-MCP) that incorporated individualized care, regular follow-ups, telephone counselling, and a patient education program.

Methods and materials

From September 2017 to October 2019, 100 consecutive cancer patients with new VTE onset were enrolled in this observational single-center prospective pilot study and received standard (control group, n = first 50 patients enrolled) or AlloTC-MCP care (n = next 50 patients enrolled) over a 6-month VTE treatment follow-up period. Primary end-point was the percentage of adherence to the International Clinical Practice Guidelines (ITAC-CPGs) at 6 (M6) month follow-up.

Results

Among the 100 patients with different cancer types (22% genitourinary, 19% breast, 16% gastrointestinal, 15% lymphoma, 11% lung and 17% others), 51 patients (61%) had metastatic disease and 31 (31%) received chemotherapy alone. Main baseline cancer and VTE clinical characteristics did not differ between the 2 groups. Adherence rates to ITAC-CPGs was significantly higher in the AlloTC-MCP group (100% (M0), 72% (M3) and 68% (M6)) compared with the control group (84% (M0), 8% (M3) and 16% (M6)). Quality of Life (QoL) was significantly improved in the AlloTC-MCP group 6 months after inclusion.

Conclusion

The “AlloTC-MCP” was associated with improved adherence to ITAC-CPGs and merits further expansion.

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References

  1. Heit JA, Spencer FA, White RH (2016) The epidemiology of venous thromboembolism. J Thromb Thrombolysis 41:3–14

    Article  CAS  Google Scholar 

  2. Timp JF, Braekkan SK, Versteeg HH et al (2013) Epidemiology of cancer-associated venous thrombosis. Blood 122:1712–1723

    Article  CAS  Google Scholar 

  3. Chew HK, Wun T, Harvey D et al (2006) Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166:458–464

    Article  Google Scholar 

  4. Horsted F, West J, Grainge MJ (2012) Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 9:e1001275

    Article  Google Scholar 

  5. Marin-Barrera L, Muñoz-Martin AJ, Rios-Herranz E et al (2019) A case-control analysis of the impact of venous thromboembolic disease on quality of life of patients with cancer: quality of life in cancer (Qca) study. Cancers (Basel) 12

  6. Cohoon KP, Ransom JE, Leibson CL et al (2016) Direct medical costs attributable to cancer-associated venous thromboembolism: a population-based longitudinal study. Am J Med 129:1000.e15-1000.e25

    Article  Google Scholar 

  7. Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352

    Article  Google Scholar 

  8. Streiff MB, Holmstrom B, Angelini D et al (2018) NCCN guidelines insights: cancer-associated venous thromboembolic disease, Version 2.2018. J Natl Compr Canc Netw 16:1289–1303

    Article  Google Scholar 

  9. Lyman GH, Bohlke K, Khorana AA et al (2015) Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 33:654–656

    Article  CAS  Google Scholar 

  10. Mandalà M, Falanga A, Roila F (2011) Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 22:vi85–vi92

    Article  Google Scholar 

  11. Farge D, Debourdeau P, Beckers M et al (2013) International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 11:56–70

    Article  CAS  Google Scholar 

  12. Farge D, Bounameaux H, Brenner B et al (2016) International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 17:e452–e466

    Article  CAS  Google Scholar 

  13. Farge D, Frere C, Connors JM et al (2019) 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 20:e566–e581

    Article  Google Scholar 

  14. Mahé I, Chidiac J, Helfer H et al (2016) Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis. J Thromb Haemost 14:2107–2113

    Article  Google Scholar 

  15. Sevestre M-A, Belizna C, Durant C et al (2014) Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc 39:161–168

    Article  Google Scholar 

  16. Wagner EH (1998) Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1:2–4

    CAS  PubMed  Google Scholar 

  17. Coleman K, Austin BT, Brach C et al (2009) Evidence on the chronic care model in the new millennium. Health Aff (Millwood) 28:75–85

    Article  Google Scholar 

  18. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  CAS  Google Scholar 

  19. Del Valle KL, McDonnell ME (2018) Chronic care management services for complex diabetes management: a practical overview. Curr Diab Rep 18:135

    Article  Google Scholar 

  20. Yeoh EK, Wong MCS, Wong ELY et al (2018) Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review. Int J Cardiol 258:279–288

    Article  CAS  Google Scholar 

  21. Llewellyn S (2019) The Chronic Care Model, Kidney Disease, and Primary Care: a Scoping Review. Nephrol Nurs J 46:301–328

    PubMed  Google Scholar 

  22. Mahé I, Puget H, Buzzi JC et al (2016) Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study. Support Care Cancer 24:3369–3377

    Article  Google Scholar 

  23. Prandoni P, Lensing AWA, Piccioli A et al (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484–3488

    Article  CAS  Google Scholar 

  24. Khorana AA, Francis CW, Culakova E et al (2007) Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 5:632–634

    Article  CAS  Google Scholar 

  25. Mahé I, Chidiac J, Bertoletti L et al (2017) The clinical course of venous thromboembolism may differ according to cancer site. Am J Med 130:337–347

    Article  Google Scholar 

  26. Frere C, Benzidia I, Marjanovic Z et al (2019) Recent Advances in the Management of Cancer-Associated Thrombosis: New Hopes but New Challenges. Cancers (Basel) 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357110/

  27. Al-Samkari H, Connors JM (2019) Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy. Blood Adv 3:3770–3779

    Article  Google Scholar 

  28. Kakkar AK, Levine M, Pinedo HM et al (2003) Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 8:381–388

    Article  Google Scholar 

  29. Siragusa S, Arcara C, Malato A et al (2005) Home therapy for deep vein thrombosis and pulmonary embolism in cancer patients. Ann Oncol 16(Suppl 4):iv136-139

    Article  Google Scholar 

  30. Wittkowsky AK (2006) Barriers to the long-term use of low-molecular weight heparins for treatment of cancer-associated thrombosis. J Thromb Haemost 4:2090–2091

    Article  CAS  Google Scholar 

  31. Trujillo-Santos J, Nieto JA, Ruíz-Gamietea A et al (2010) Bleeding complications associated with anticoagulant therapy in patients with cancer. Thromb Res 125(Suppl 2):S58-61

    Article  Google Scholar 

  32. Spirk D, Ugi J, Korte W et al (2011) Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer. The SWIss Venous ThromboEmbolism Registry (SWIVTER) II. Thromb Haemost 105:962–967

    Article  CAS  Google Scholar 

  33. Delate T, Witt DM, Ritzwoller D et al (2012) Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. Oncologist 17:419–427

    Article  CAS  Google Scholar 

  34. Rahme E, Feugère G, Sirois C et al (2013) Anticoagulant use in patients with cancer associated venous thromboembolism: a retrospective cohort study. Thromb Res 131:210–217

    Article  CAS  Google Scholar 

  35. Noble S, Matzdorff A, Maraveyas A et al (2015) Assessing patients’ anticoagulation preferences for the treatment of cancer-associated thrombosis using conjoint methodology. Haematologica 100:1486–1492

    Article  CAS  Google Scholar 

  36. Cajfinger F, Debourdeau P, Lamblin A et al (2016) Low-molecular-weight heparins for cancer-associated thrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study. Thromb Res 144:85–92

    Article  CAS  Google Scholar 

  37. Khorana AA, Yannicelli D, McCrae KR et al (2016) Evaluation of US prescription patterns: are treatment guidelines for cancer-associated venous thromboembolism being followed? Thromb Res 145:51–53

    Article  CAS  Google Scholar 

  38. Noble S, Pease N, Sui J et al (2016) Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise. BMJ Open 6:e013321

    Article  Google Scholar 

  39. Noble S, Prout H, Nelson A (2015) Patients’ experiences of LIving with CANcer-associated thrombosis: the PELICAN study. Patient Prefer Adherence 9:337–345

    Article  Google Scholar 

  40. Font C, Nelson A, Garcia-Fernandez T et al (2018) Patients’ experience of living with cancer-associated thrombosis in Spain (PELICANOS). Support Care Cancer 26:3233–3239

    Article  Google Scholar 

  41. Noble S, Nelson A, Scott J et al (2020) Patient experience of living with cancer-associated thrombosis in Canada (PELICANADA). Res Pract Thromb Haemost 4:154–160

    Article  Google Scholar 

  42. Rabinovich E, Bartholomew JR, Wilks ML et al (2016) Centralizing care of cancer-associated thromboembolism: the cleveland clinic experience. Thromb Res 147:102–103

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Prof. Henri Bounameaux for reading and providing thoughtful comments on this manuscript. We acknowledge the contribution of Kristell Desseaux in data analysis.

Funding

APHP research grant “Parcours de soins 2017”.

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Authors and Affiliations

  1. Internal Medicine: Autoimmune and Vascular Disease Unit (UF04), Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France

    Ilham Benzidia, Benjamin Crichi, Arlette N’Dour, Maxime Sebuhyan, Nassim Ait Abdallah & Dominique Farge

  2. Clinical Research Unit Lariboisière Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Claire Montlahuc

  3. Université de Paris, IRSL, EA-3518, Recherche clinique appliquée à l’hématologie, F-75010, Paris, France

    Hanadi Rafii & Dominique Farge

  4. Department of Medical Oncology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Hélène Gauthier & Christine Le Maignan

  5. C.S.E. Radiology and Medical Imaging Center, 13 Rue Beaurepaire, 75010, Paris, France

    Philippe Benillouche

  6. Department of Anesthesiology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

    Stéphane Villiers

  7. Department of Medicine, McGill University, Montreal, QC, Canada

    Dominique Farge

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  1. Ilham Benzidia
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Correspondence to Dominique Farge.

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Benzidia, I., Crichi, B., Montlahuc, C. et al. Effectiveness of a multidisciplinary care program for the management of venous thromboembolism in cancer patients: a pilot study. J Thromb Thrombolysis 53, 417–424 (2022). https://doi.org/10.1007/s11239-021-02512-5

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