Cancer-associated thrombosis (CAT) poses a frequent and intricate challenge in the management of cancer patients, leading to inconsistencies and suboptimal outcomes as they navigate various healthcare professionals throughout their cancer journey. Recognizing cancer as a significant risk factor for thrombosis, the establishment of a dedicated CAT service becomes imperative to elevate both patient outcomes and overall quality of life. This specialized team aims to enhance the management of cancer patients grappling with thrombosis, offering improved anticoagulation strategies, patient education, and support [1].
Caring for cancer patients with thrombosis is a delicate and complicated practice, requiring a fine balance between the safety and efficacy of anticoagulant treatments. Managing CAT incidents is of the utmost importance for clinicians, patients, and their caregivers, as untreated thrombosis or bleeding with available anticoagulant drugs is associated with drastic consequences [2]. Despite the presence of guidelines, their implementation proves to be slow and unpredictable, and due to limited evidence, recommendations for intricate CAT scenarios remain uncertain. To address these challenges, recent literature underscores the significance of a dedicated CAT service, emphasizing its potential to augment patient care through focused education and training. This summary encapsulates a recent publication addressing this critical topic [1].
Summary of the CAT Service’s Scope:
Anticoagulant Therapy: Tailored treatment for CAT involves anticoagulant therapy, adapting to factors such as cancer type, stage, patient co-morbidities, and concurrent medications. While historically favoring low molecular weight heparin (LMWH), recent evidence suggests the efficacy and safety equivalence of direct oral anticoagulants (DOACs).
Cancer Treatment: Diverse cancer treatments, encompassing chemotherapy, immunotherapy, radiation therapy, and surgery, contribute to CAT risk reduction by diminishing tumors and enhancing blood flow. The situation becomes more complex when these strategies are also linked with an increased risk of bleeding as well as thrombosis, especially when cancer is progressing [3].
Prophylaxis: High-risk patients undergoing surgery, immobilization, or systemic anticancer therapy may receive recommended prophylactic anticoagulant therapy. The majority of cancer patients develop thrombosis in the ambulatory setting. Prevention strategies in this group can improve mortality, morbidity, and overall economic burden. [4]
Management of Bleeding: Given the heightened bleeding risk with anticoagulant therapy, vigilant monitoring and dosage adjustments are indispensable.
Supportive Care: Patients contending with CAT may necessitate supportive care, including pain management, symptom control, and palliative care.
Education and Training: CAT-specialized clinics aspire to educate both patients and healthcare professionals regarding the diagnosis, treatment, and prevention of thrombosis in cancer patients.
Research: Collaboration with healthcare institutions, researchers, and pharmaceutical companies empowers the CAT service to contribute to novel treatments and advancements in patient care [1]. These endeavors need to focus on finding more potent agents with reduced risk of bleeding, like Factor-XI inhibitors, such as abelacimab [5].
Multidisciplinary Expert Panel:
The comprehensive management of CAT requires a multidisciplinary approach integrating anticoagulant therapy, cancer treatment, prophylaxis, bleeding management, and supportive care. This approach involves a diverse panel of specialists, including oncologists, hematologists, pharmacists, and clinical nurse specialists. The overarching goal is to minimize the risk of recurrent thrombosis, mitigate bleeding risks, and ultimately improve patient outcomes and satisfaction [1].
Traditionally, LMWH has been the standard treatment for CAT. However, in recent years, DOACs have gained prominence as effective alternatives for preventing and treating thrombosis in cancer patients, including cases of deep vein thrombosis and pulmonary embolism. Clinical trials have demonstrated their efficacy, showing comparable results to traditional anticoagulants with a similar bleeding risk [4,6].
Despite the promise of DOACs, it’s imperative to acknowledge their limited study across all cancer types, making certain patient subgroups unsuitable for DOAC therapy. Cancer patients, with their increased risk of drug interactions and bleeding due to factors like impaired liver or kidney functions and concurrent medications, necessitate careful monitoring. While DOACs offer a promising avenue for preventing and treating thromboembolism in cancer patients, their use requires meticulous consideration and individualization based on factors such as cancer type, stage, bleeding risk, drug interactions, and co-morbidities [1].
Conclusions
In pursuing enhancing clinic access for patients grappling with CAT, seeking consultation with healthcare providers well-versed in thrombosis in cancer patients is crucial. Proposing the implementation of a CAT service, this solution aims to provide specialized care, improve communication among healthcare professionals, offer patient education and support, and foster research and education in the field.
The primary objective of a CAT-specialized clinic is to elevate the quality of care for cancer patients confronted with thrombosis—a severe and potentially life-threatening complication. This service comprises a collaborative team of oncologists, hematologists, nurses, and pharmacists working synergistically to deliver comprehensive care for those with cancer-associated thrombosis. Key components include research, education, and training, all geared towards reducing thrombosis incidence in cancer patients, enhancing outcomes, and improving overall quality of life.
References
- Gilani, S. Do we need a Dedicated Team to Manage Cancer-Associated Thrombosis (CAT) – Working Beyond Clinical Guidelines. J Med Syst 47, 74 (2023). https://doi.org/10.1007/s10916-023-01970-z
- Song X, Liu Z, Zeng R, et al. Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs). Ann Transl Med. 2021;9(2):162. doi:10.21037/atm-20-8156
- Norbaini Binti Abdol Razak, at al. Cancer-Associated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers (Basel).2018 Oct; 10(10): 380.
- Nigel S Key, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol.2020 Feb 10;38(5):496-520.
- Anthos Therapeutics announces that abelacimab has received FDA fast track designation for the treatment of thrombosis associated with cancer. News release. Anthos Therapeutics. July 11, 2022. Accessed July 11, 2022. https://prn.to/3yVZZos
- Becattini C, Pace U, Pirozzi F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. 2022;140(8):900-908. doi:10.1182/blood.2022015796