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MASCC Hemostasis Study Group

Leadership

Chair: Carmen Escalante, MD (cescalan@mdanderson.org) - USA
Vice-Chair: Thomas Butler, MD (tbutler@health.southalabama.edu) - USA
Vice-Chair: Carme Font, MD (cfont@clinic.ub.es) - Spain

Study Group Minutes
2017 Minutes  - Annual Meeting - Washington, D.C.

Mission and Goals

The mission of the Hemostasis Study Group is to provide guidance and guidelines to healthcare providers regarding bleeding and clotting complications in cancer patients from diagnosis to the end of life. The goals of the group are (1) an increased awareness of abnormalities in the coagulation system at the time of cancer diagnosis, through treatment, and at the end of life, and (2) an increased availability of evidence-based treatment to patients with bleeding or clotting complications during treatment and at the end of life. To these ends, the Group has set the following objectives:

  • To keep up to date with current guidelines regarding treating cancer patients with bleeding and clotting problems related to their disease;
  • To evaluate current guidelines for their merit and deficiencies in providing adequate treatment to cancer patients with coagulation problems;
  • To focus on anticoagulation treatment and quality of life in cancer patients in both hospital and hospice settings.

Research Highlights

The Clinical Course of Venous Thromboembolism May Differ With Cancer Site
Carme Font is one of a large group of investigators who have collaborated on a study of differences in the clinical course of venous thromboembolism (VTE) in relation to specific cancer sites. The study included data from almost 4000 adult patients with active cancer. Significant differences in the clinical profile of VTE-related outcomes were associated with tumor location. The findings suggest that individualized anticoagulation strategies for cancer-related VTE could improve outcomes and quality of life, while reducing treatment costs. >> Read more.

Incidental Venous Thromboembolism in Cancer Patients on Routine CT Scans
In a prospective cohort study, Carmen Escalante et al. investigated the prevalence of incidental venous thromboemtolism (VTE) in almost 1100 adult cancer patients on routine staging CT scans of the chest, abdomen, or pelvis. The research team also documented symptoms associated with incidental VTEs and determined the incidence of VTE recurrence in these patients after 3 and 6 months. >> Read more.

Romiplostim for the Management of Chemotherapy-Induced Thrombocytopenia
Chemotherapy-induced thrombocytopenia (CIT) can interfere with the optimal course of chemotherapy by necessitating schedule delays and dosage reductions. Some patients experience more severe or persistent thrombocytopenia than others, and their responses are neither well understood nor predictable. Both the prevention and management of CIT are critical in order for patients to benefit fully from chemotherapy. Recently, Dr. Rekha Parameswaran and colleagues reported on the successful use of weekly romiplostim for reducing CIT. Their review included both response to romiplostim therapy and toxicity assessment.  >> Read more

Outpatient Management of Pulmonary Embolism in Cancer
Dr. Carme Font and colleagues in Spain conducted a prospective cohort study to determine the feasibility of outpatient treatment for patients with cancer and sudden, symptomatic vs. incidental PE. They assessed thromboembolism recurrence, major bleeding, and all-cause mortality. The authors also compared the performance of four different prognostic scales in predicting mortality and identifying patients who might be treated at home. The results suggest that a large proportion of patients with cancer and PE can be safely treated as outpatients, particularly those with incidental PE. >> Read more

Now Recruiting Participants!

Treatment Adherence, Quality of Life, and Resource Utilization during Anticoagulant Therapy for Cancer-Related VTE

Cristhiam Rojas Hernandez, a member of the Hemostasis Study Group, is the principal investigator of a clinical research project titled “Measurement of Adherence and Health-related Quality of Life, and Health-care Resource Utilization during Anticoagulation Therapy in Cancer-related Venous Thromboembolism.”

Cancer-related venous thromboembolism (VTE) is a prevalent problem that occurs in 20%-25% of patients with a malignancy. It causes significant morbidity and it is one of the most important causes of mortality in cancer (Khorana AA et al., 2007, Yu YB et al., 2012). The current standard of care for treatment of cancer-related VTE is parenteral anticoagulation for at least several months (Lee AY and Peterson EA., 2013; Lyman GH, Khorana AA, et al., 2013, Farge D, Bounameaux H et al., 2016).

There are no extensive data on the treatment adherence, acceptability and health-related quality of life (HRQL) in patients with cancer who require long-term anticoagulation therapy. In qualitative studies, patients have reported acceptance of parenteral long-term anticoagulation for VTE treatment despite a variety of symptoms related to VTE and anticoagulation treatment, some of them described as distressing (Noble SI and Finlay IG, 2005; Seaman S, Nelson A, Noble S, 2014).

The objectives of the study are to assess self-reported adherence and the HRQL change at different long-term time points during anticoagulation treatment of cancer-related VTE associated with different anticoagulation strategies. The approach is innovative, since it will provide information regarding two important aspects of long term anticoagulation:

  1. Clinical practice evaluation of the impact of long-term anticoagulation in cancer-related VTE on HRQL.
  2. A prospective and long-term evaluation of adherence to anticoagulation in cancer, where current available data are limited to cross-sectional studies.

Eligibility Criteria

  • Adult (≥ 18 years), female or male.
  • Confirmed symptomatic or incidental VTE.
  • Cancer (other than basal-cell or squamous-cell carcinoma of the skin), either active or diagnosed within 2 years prior to VTE. The diagnosis of cancer must be objectively documented by histopathologic diagnosis.
  • Intention of long-term treatment (at least 3 months) with anticoagulation.

Participants will be enrolled in the study within the first 72 hours after initiation of anticoagulation. They must be able to provide informed consent and complete study survey tools.

Exclusion Criteria

  • Indication for anticoagulation other than cancer-related VTE.
  • An Eastern Cooperative Oncology Group (ECOG) Performance Status of 4 at the time of study enrollment.
  • Life expectancy < 3 months.

Cris Rojas Hernandez is Assistant Professor of Pulmonary Medicine at the MD Anderson Cancer Center in Houston, Texas. For more information about the study, please contact him at cmrojas@mdanderson.org.

2017 Workshop

2017 Annual Meeting Workshop, June 22, Washington, DC
Update on Venous Thromboembolism: Approach and Challenges

This workshop, held jointly by the Hemostasis and Education Study Groups, brought together a multinational group of experts to review current evidence and needed knowledge regarding cancer-associated venous thromboembolism (VTE). It included discussions of the clinical challenges and promoted the education of patients, providers, and family members. Workshop presentations are listed below and slide sets are available for review. Workshop Chairs: Carme Font, Carmen Escalante, Thomas Butler, Paz Fernández-Ortega

 Workshop Presentations & Slides

Primary Thromboprophylaxis for Cancer Outpatients on Chemotherapy: Case Study
Carme Font, MD, Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain

Primary Thromboprophylaxis in Ambulatory Cancer Patients: Current Guidelines and Updated Evidence
Taylor Butler, PharmD, BCOP, Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA

Patient-Centered Treatment of Cancer-Associated VTE. Does One Size Fit All?  
Simon Noble, MD, FRCP, Cardiff University, Wales, UK

Shared Decision-Making in Anticoagulation: Patient, Provider, Family / Friends
Annie Young, University of Warwick and University Hospitals Coventry and Warwickshire, Great Britain, UK

Update on Direct Oral Anticoagulants: A Perspective Beyond the Cancer VTE Guidelines
Chrishiam M. Rojas-Hernandez, MD, MD Anderson Cancer Center,  Houston, Texas. USA

Challenging Case Study: VTE Treatment — “How Long Is Long Enough?”
Thomas W. Butler, MD, FACP, University of South Alabama, Mitchell Cancer Institute, Mobile, Alabama, USA

Best Practices: Approaches to Educating and Engaging Patients on VTE Prevention
by Judy Phillips, DNP, FNP-BC, AOCN, Cancer Care of Western North Carolina, Lenoir-Rhyne University, North Carolina, USA

Recent Member Publications

Recent Study Group member publications related to bleeding and clotting complications in cancer patients.

Practice Resources: Guidelines

National Comprehensive Cancer Network Guidelines on Cancer-Associated Venous Thromboembolic Disease

American Society of Clinical Oncology Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer Update

Management of Venous Thromboemtolism (VTE) in Cancer Patients: ESMO Clinical Practice Guidelines

Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians (not specifically for cancer patients)

Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report (not exclusively for cancer patients)

Practice Resources: Upcoming Events

VTE Dublin 2017: Diagnostic & Therapeutic Advances
September 15-16, 2017
Croke Park, Dublin, Ireland

This year’s program includes a presentation on cancer-associated thrombosis by MASCC member Simon Noble of Cardiff University. Other topics include thromboprophylaxis, superficial vein and calf vein thrombosis, bleeding risk in VTE patients, multidisciplinary care of PE, diagnostic and therapeutic advances, DVT thrombolysis and treatment, obesity and VTE, and the patient experience. A pre-conference, 2-day ultrasound workshop will cover bedside ultrasound applications in VTE. For information and registration:https://www.vtedublin.org

2nd International RIETE Meeting
October 19-20, 2017
Seville Spain

Meet other RIETE investigators and discuss issues concerning the diagnosis, treatment, and outcome of patients with VTE. This year’s meeting will focus exclusively on cancer and VTE.
RIETE (Registro Informatizado de Enfermedad TromboEmbólica) is an international registry of consecutive patients with acute VTE. For information and registration:http://trombo.info/profesionales/2nd-international-riete-meeting/

American Society of Hematology 59th Annual Meeting
December 9-12, 2017
Atlanta, Georgia

With a dual focus on both malignant and nonmalignant hematology, the meeting will provide an invaluable educational experience and the opportunity to review thousands of scientific abstracts highlighting updates in the hottest topics in hematology. Network with top minds in the field as well as a global community of more than 25,000 hematology professionals from every subspecialty. For information and registration: http://www.hematology.org/Annual-Meeting/

Thrombosis and Hemostasis Societies of North America (THSNA)
March 8-10, 2018
San DieGo, California, USA

THSNA holds a biannual scientific meeting to focus on both basic and clinical research on thrombosis and hemostasis. This summit is a collaboration of the fifteen leading non-profit organizations in both fields. THSNA 2018 will provide a focused forum for over 1,500 attendees with an interest in bleeding and clotting disorders to network, learn, and share across disciplines and disease states. For information and registration: http://www.thsna.org/2018/index.php

2018 International Conference on Thrombosis and Hemostasis: Issues in Cancer (ICTHIC)
April 13-15, 2018
Bergamo, Italy

Topics at ICTHIC 2018 will include hemostasis and cancer, epidemiology of thrombosis in cancer, clinical risk models for VTE and prognosis in cancer, treatment of VTE in cancer patients, targets for CAT therapy, dealing with bleeding in cancer, complex hemostatic conditions, thromboprophylaxis in cancer patients, and new anticoagulants. For information and registration: https://www.icthic.com/en

Webcast

What's New in the Management of Blood Clots for Cancer Patients 
Richard J. Gralla, MD, Rekha Parameswaran, MD, David A. Slosky, MD, Carolyn Messner, DSW, MSW. 
This 2012 webcast on the management of blood clots for cancer patients is available at Cancercare.org. You can view the webcast online or download an MP3 file. Topics include new treatments for venous thromboembolism, clinical trials and treatment options, the role of the FDA, and new clinical management strategies.


Please contact the Study Group Chairs above with your questions.
MASCC Study Group Coordinator, Don Gubitosa