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.
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.
The “AlloTC-MCP” was associated with improved adherence to ITAC-CPGs and merits further expansion.
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Heit JA, Spencer FA, White RH (2016) The epidemiology of venous thromboembolism. J Thromb Thrombolysis 41:3–14
Timp JF, Braekkan SK, Versteeg HH et al (2013) Epidemiology of cancer-associated venous thrombosis. Blood 122:1712–1723
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
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
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
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
Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352
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
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
Mandalà M, Falanga A, Roila F (2011) Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 22:vi85–vi92
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
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
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
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
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
Wagner EH (1998) Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1:2–4
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
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
Del Valle KL, McDonnell ME (2018) Chronic care management services for complex diabetes management: a practical overview. Curr Diab Rep 18:135
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
Llewellyn S (2019) The Chronic Care Model, Kidney Disease, and Primary Care: a Scoping Review. Nephrol Nurs J 46:301–328
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
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
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
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
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/
Al-Samkari H, Connors JM (2019) Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy. Blood Adv 3:3770–3779
Kakkar AK, Levine M, Pinedo HM et al (2003) Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 8:381–388
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
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
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
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
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
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
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
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
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
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
Noble S, Prout H, Nelson A (2015) Patients’ experiences of LIving with CANcer-associated thrombosis: the PELICAN study. Patient Prefer Adherence 9:337–345
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
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
Rabinovich E, Bartholomew JR, Wilks ML et al (2016) Centralizing care of cancer-associated thromboembolism: the cleveland clinic experience. Thromb Res 147:102–103
We thank Prof. Henri Bounameaux for reading and providing thoughtful comments on this manuscript. We acknowledge the contribution of Kristell Desseaux in data analysis.
APHP research grant “Parcours de soins 2017”.
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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 (2021). https://doi.org/10.1007/s11239-021-02512-5
- Venous thromboembolism
- Multidisciplinary care program
- Clinical practice guidelines
- Quality of life