Treatment of Venous Thromboembolism in Ambulatory Cancer Patients in Germany: A Prospective Non-Interventional Study

Abstract

Background: Venous thromboembolism (VTE) is a serious threat for all cancer patients. This study was aimed to assess the VTE treatment of cancer patients in the ambulatory care setting. Patients and Methods: This is a prospective non-interventional study, which includes ambulatory cancer patients from office-based oncologists. A standardized case report form was used to obtain data on patient characteristics, treatment regimens, duration of treatment, and side effects. Results: Specialists from 34 centers included data from 76 patients. The median patient age was 62 years (range 33-81 years). The 4 most common cancer types were breast cancer (32%), colorectal cancer (18%), lymphoma and lung cancer (each 8%). 18% of the acute VTE cases were treated as inpatients, 80% as outpatients, and 99% with low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux. After the acute phase, secondary prophylaxis with LMWH/UFH/fondaparinux was planned in 61% of the patients, with oral anticoagulation in 39%. During acute-phase treatment and secondary prophylaxis, no patient had recurrent VTE. 4 patients (5%) experienced minor bleedings. Conclusions: This study shows that many ambulatory cancer patients with VTE have early tumors, no metastases, and an excellent performance score. Most patients receive LMWHs for secondary prophylaxis, as recommended by the national and international guidelines. Still, a relevant percentage is switched to oral anticoagulants.

Factors Influencing the Choice between DOACs and LMWHs: A Survey of German Physicians on the Treatment of Cancer-Associated Venous Thromboembolism

“…However, considering the large number of participants of the DGHO annual meeting the return rate seemed to be low which was also the impression at the regional educational meetings. This observation is in line with a previous survey on VTE-practice patterns 31,38 where the return rate was only 6%. It could be that new developments in CAT-prophylaxis and treatment are not perceived as a priority issue.…”

“…Patient preferences are in the treating physician's perception much more important and rank higher than guidelines and almost all the other parameters. This gap between evidencebased recommendations and practice patterns has been noted before [31][32][33][34][35][36] and needs to be addressed in the future development of clinical guidelines.…”

Continuation of low‐molecular‐weight heparin treatment for cancer‐related venous thromboembolism: a prospective cohort study in daily clinical practice

“…Studies investigating the efficacy of long‐term LMWH use in cancer patients found discontinuation rates varying from 33% to 58% after 3–6 months, because of complications including recurrent VTE, bleeding, or death . Furthermore, in recent studies, 11–20% of cancer patients switched from LMWH injections to oral anticoagulants within 3–6 months, possibly to avoid the discomfort of injections, or because of a lack of communication among health professionals or a deliberate physician's decision . Thus, detailed information about the burden of daily subcutaneous injections is required.…”

Higher Adherence to Treatment With Low‐Molecular‐Weight‐Heparin Nadroparin Than Enoxaparin Because of Side Effects in Cancer‐Associated Venous Thromboembolism

“…4 This finding was consistent with other smaller, retrospective studies reporting similar percentages of patients who switched to oral anticoagulants within 6 months. 5,6 These studies, however, did not distinguish between LMWH preparations.…”

“…Recent research carried out at our institution has showed that 1 out of 5 patients with cancer‐associated VTE stop LMWH injections because of side effects, mostly due to unacceptable pain at injection site 4 . This finding was consistent with other smaller, retrospective studies reporting similar percentages of patients who switched to oral anticoagulants within 6 months 5,6 . These studies, however, did not distinguish between LMWH preparations.…”