Cancer patients face numerous challenges on their journey, and one often overlooked concern is the increased risk of thrombosis formation. Thrombosis is a serious complication with severe consequences, but patients can actively prevent it with the right knowledge and strategies. Empowering cancer patients with information about thrombosis ensures their well-being throughout their cancer experience.
The Connection Between Cancer and Thrombosis
The link between cancer and thrombosis is complex and multifaceted. Cancer itself can trigger a cascade of biological responses that promote blood clot formation. Tumor cells, especially those in an inflammatory and hypoxic environment, release substances that contribute to the formation of clots. Moreover, the interaction between cancer cells and immune cells can induce a prothrombotic state [1-3].
Recognizing the Signs and Symptoms
Understanding the signs and symptoms of thrombosis is crucial in early detection. Patients should be aware of common symptoms such as swelling, pain, warmth, and redness in a specific area, which could indicate the presence of a blood clot. Rapid and accurate recognition of these symptoms allows for timely intervention and can significantly impact outcomes [4].
Deep Vein Thrombosis (DVT):
- Localized Pain: Unexplained pain, tenderness, or discomfort in the leg, often resembling a cramp or soreness.
- Swelling: Notable swelling in one leg, accompanied by warmth and redness.
- Changes in Skin: Skin that appears red and feels warmer than the surrounding area.
Pulmonary Embolism (PE):
- Shortness of Breath: Sudden onset of breathlessness, particularly with exertion.
- Chest Pain: Sharp chest pain exacerbated by deep breaths, coughing, or sneezing.
- Coughing: Coughing up blood or mucus streaked with blood
Acknowledging that thrombosis doesn’t always present with overt symptoms is important. Silent thrombosis, where blood clots develop without causing noticeable signs, is a concerning reality. This phenomenon can be particularly relevant in patients with underlying health conditions or undergoing certain medical treatments [5]. Vigilance and a comprehensive understanding of risk factors are crucial in identifying these cases.
Preventive Measures for Cancer Patients
Empowerment begins with knowledge, and cancer patients can play an active role in preventing thrombosis.
Some preventive measures that should be encouraged are:
Lifestyle Choices and Stay Active
Encourage patients to make positive lifestyle choices that contribute to their overall well-being. Suggest adopting a balanced diet, maintaining a healthy weight, and avoiding smoking. Emphasize the importance of regular physical activity, as approved by the healthcare team. Regular exercise supports healthy blood circulation and reduces the risk of blood clots. For patients who are undergoing hospital stays or recovering from surgery, advise against prolonged periods of immobility. If immobility is unavoidable, recommend simple exercises that can promote blood circulation [6].
Hydration
Highlight the significance of staying hydrated as a key factor in preventing blood clots. Explain that proper hydration supports optimal blood flow and helps prevent the thickening of blood, which can contribute to clot formation. Encourage patients to maintain adequate fluid intake throughout the day [7].
Medication Management and Open Communication
When discussing anticoagulant medications, stress the importance of adherence to healthcare provider instructions. Patients should be educated on these medications’ purpose, benefits, and potential side effects. Emphasize the role that medication plays in reducing the risk of thrombosis.
Promote open and honest communication between patients and the healthcare team. Encourage patients to share details about their cancer treatments, surgeries, and medications. By understanding these factors, the healthcare team can provide tailored guidance to minimize the risk of thrombosis and ensure the patient’s safety and well-being [8].
Engaging in Shared Decision-Making
Cancer patients are unique individuals with their own set of circumstances and preferences. Shared decision-making between patients and healthcare providers is essential when considering thromboprophylaxis options. Patients should be informed about the benefits, risks, and alternatives to different preventive measures, allowing them to make choices that align with their values and goals [8].
Education as an Empowerment Tool: Incorporating Technology and Support
Equipping cancer patients with knowledge is a potent tool for empowerment. Healthcare providers should take a patient-centric approach to education, using clear language and visual aids to enhance understanding. Explaining the risks, causes, and preventive strategies in an accessible manner empowers patients to participate in their own care actively.
Modern technology offers innovative ways to educate and empower patients. Videos, infographics, and electronic medical records can simplify complex information and make it more engaging. Additionally, involving caregivers and family members in the education process can provide patients with a strong support system to help recognize and respond to potential clotting symptoms.
The EMPOWER study aimed to assess the impact of a video tool on patient care and healthcare resource utilization about cancer-associated thrombosis (CAT) [9]. This mixed-method study comprised three components analyzed before and after the integration of the video over 3 months in the clinical setting:
Patient Presentation Time: Prior to the video’s introduction, patients took nearly nine days on average to seek medical attention after experiencing venous thromboembolism symptoms. This delay in presentation raised concerns due to the potential progression of blood clots. Prompt initiation of anticoagulation therapy is crucial to minimize morbidity, mortality, and the risk of post-thrombotic syndrome [9].
Impact on Time to Seek Medical Attention: The video significantly reduced patients’ time to seek medical help by approximately two-thirds. After the video’s incorporation, the interval between symptom development and clinic presentation decreased to 3 days [9].
Radiology Scan Requests: The study observed no statistically significant increase in the number of radiology scan requests following the video’s implementation. The percentage of positive venous thromboembolism scans remained similar before and after the video. However, scans were requested earlier after the video was introduced, indicating that the video did not lead to an unnecessary strain on radiology resources [9].
Patient and Medical Staff Perception: Questionnaires collected from both patients and medical staff revealed improvements in knowledge and attitudes towards CAT after the video’s integration. A significant knowledge gap about CAT was identified among nurses, who tended to prioritize sepsis-related information for patients. However, the video contributed to enhanced awareness among nurses, leading to changes in their practice and a desire for ongoing education in this area [9].
The findings of the EMPOWER study underscore the value of educational interventions, such as the video, in reducing delays in seeking medical attention for CAT symptoms and enhancing healthcare professionals’ knowledge and practices in this critical aspect of cancer care.
Conclusions: The Impact of Empowerment
Empowered cancer patients are better equipped to navigate their cancer journey while actively reducing the risk of thrombosis. Patients take charge of their health and well-being by understanding the connection between cancer and blood clots, recognizing symptoms, and implementing preventive measures.
In the fight against cancer, knowledge truly is power. Empowerment through education empowers patients to become partners in their care, fostering a sense of control and confidence in their ability to mitigate risks and enhance their overall quality of life.
References
- Bick RL. Cancer-associated thrombosis. N Engl J Med. 2003;349(2):109-111.
- Kim AS, Khorana AA, McCrae KR. Mechanisms and biomarkers of cancer-associated thrombosis. Transl Res. 2020;225:33-53.
- Shah S, Karathanasi A, Revythis A, Ioannidou E, Boussios S. Cancer-Associated Thrombosis: A New Light on an Old Story. Diseases. 2021;9(2):34. Published 2021 May 4.
- Khorana AA, Mackman N, Falanga A, et al. Cancer-associated venous thromboembolism. Nat Rev Dis Primers. 2022;8(1):11. doi:10.1038/s41572-022-00336-y.
- Shi Y, Wang T, Yuan Y, et al. Silent Pulmonary Embolism in Deep Vein Thrombosis: Relationship and Risk Factors. Clin Appl Thromb Hemost. 2022;28:10760296221131034. doi:10.1177/10760296221131034
- Falanga A, Girvalaki C, Monreal M, Easaw JC, Young A. How well do European patients understand cancer-associated thrombosis? A patient survey. Cancer Treat Res Commun. 2022;31:100557. doi:10.1016/j.ctarc.2022.100557
- Liu M, Wang G, Li Y, et al. Efficacy and safety of thromboprophylaxis in cancer patients: a systematic review and meta-analysis. Ther Adv Med Oncol. 2020;12:1758835920907540. Published 2020 Mar 18. doi:10.1177/1758835920907540
- Musgrave KM, Power K, Laffan M, O’Donnell JS, Thachil J, Maraveyas A. Practical treatment guidance for cancer-associated thrombosis – Managing the challenging patient: A consensus statement. Crit Rev Oncol Hematol. 2022;171:103599. doi:10.1016/j.critrevonc.2022.103599
- Baddeley E, Torrens-Burton A, Newman A, et al. A mixed-methods study to evaluate a patient-designed tool to reduce harm from cancer-associated thrombosis: The EMPOWER study. Res Pract Thromb Haemost. 2021;5(5):e12545.