Multidisciplinary Program Improves Knowledge and Dosing in Cancer-Associated Thrombosis

Thromboembolism is a leading cause of death in people with cancer. A presentation at the ASH annual meeting reviewed a multidisciplinary strategy to educate patients with cancer about their risk of thrombosis, as well as the healthcare staff who treat them, in order to improve prevention and treatment. The authors said their approach increased discussions on the topic and improved accuracy of prophylactic treatments.

At the authors’ institution, Newcastle-upon-Tyne Hospitals in the United Kingdom, a new program was introduced and involved three aspects:

• regular teaching for nurses, pharmacists, and physicians
• implementation of new guidelines regarding cancer-associated thrombosis
• educational videos and posters within patient areas

The program, implemented in May 2018, by Sumantha Gabriel, BPharm, and Kate Musgrave, BA, MBBS, MRCP, assessed knowledge and attitudes before and after introduction of the program. Specifically, they evaluated knowledge of clots and thrombosis among people with cancer, discussions with staff concerning risk, and use of antithrombotic drug tinzaparin.

The study enrolled inpatients and outpatients. Patients admitted to the hospital were eligible for the study only if they were hospitalized for at least 24 hours, so that staff had an opportunity to discuss thrombotic risk.

In total, 91 patients participated: 42 before the new program and 49 after the program. Pre-intervention median age was 65 years (range, 21–87); and post-intervention age was  67 years (range 21–86 years). For those admitted to hospital, the median length of admission was three days (range, 1–84 days) in the pre-intervention group and four days (range, 2–33 days) in the post-intervention group. Both groups were 55% male.

Subjects had a variety of cancer diagnoses. In the cohort before the intervention, the most common cancer sites were lung, bowel, and skin. In the cohort studied after the intervention, the most common cancer sites were: breast, skin, and lung. More patients in the pre-intervention group had known metastases (69% versus 45%).

According to the authors, patients had good knowledge of thrombosis before and after the intervention (93% and 84%, respectively). Notably, the number of patients who discussed thrombotic risk with a healthcare professional increased from 24% to 51%. Use of tinzaparin for prophylaxis of thrombosis (among eligible patients) was high during both time periods (81% and 91%, respectively). However, a significant increase occurred in the appropriate se of a higher-risk dose (4,500 units)—from 8% to 75%.

The authors encouraged other institutions to implement multidisciplinary strategies based on regular training and patient education to improve awareness and prevention of thrombosis.