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PROFILE: Hemostasis Study Group

October 2017
The prevention and management of thrombosis and hemorrhage present unique challenges in cancer patients. Cancer can trigger a number of coagulation abnormalities that increase the risk of thrombosis and hemorrhage. Cancer and the hemostatic system are interconnected in several ways, with each disease state having the potential to affect the progression of the other. In addition, some cancer treatments have prothrombotic effects. While many new approaches are under development, there remains a need for improved risk assessment and for increased visibility of the risks among cancer patients, their caregivers, and healthcare providers.

The Hemostasis Study Group is led by Carmen Escalante, Chair, and Vice-Chairs Thomas W. Butler and Carme Font. The Group currently comprises 24 members, representing Australia, Greece, Pakistan, the Republic of South Korea, Serbia, Spain, the United Kingdom, and the United States. The Study Group is dedicated to improving the prevention and management of coagulation disorders in cancer patients by promoting clinical and epidemiological research and by providing guidance and guidelines to healthcare providers regarding bleeding and clotting complications from cancer diagnosis to the end of life. Its goals are to promote multidisciplinary approaches for the development of useful tools for clinicians, promote patient-centered clinical research, increase awareness of coagulation abnormalities in people with cancer, and increase the availability of evidence-based treatments for people with such bleeding or clotting complications. The Group also serves as an information resource for all MASCC members and aims to develop collaborations with other MASCC Study Groups, such as Education, Neutropenia, Infection & Myelosuppression, and Rehabilitation, Survivorship & Quality of Life.

To meet its goals, the Study Group has set forth the following objectives:

  • To keep up to date with current evidence-based guidelines regarding the treatment of cancer patients with bleeding and clotting problems related to their disease;
  • To evaluate existing management guidelines for merit and adequacy;
  • To promote multinational and multidisciplinary cooperative networks among those involved in the care of cancer patients with thrombotic and bleeding complications, including physicians, nurses, pharmacists, psychologists, and other professionals involved in patient education.
  • To focus on anticoagulation treatment and quality of life for cancer patients in different settings during the cancer journey: VTE prevention and management; outpatient and inpatient settings; VTE and bleeding complications in patients receiving active cancer-specific treatments, as well as those receiving palliative care.

Recent Activities

Workshop. Most recently, the Hemostasis Study Group, in collaboration with MASCC’s Education Study Group, offered a workshop on Venous Thromboembolism at the 2017 MASCC/ISOO Annual Meeting in Washington, DC. The workshop 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. All of the slides from the workshop presentations are available at the Hemostasis Study Group page on the MASCC website.

Guideline Development.  The Study Group is currently engaged in developing guidelines for the management of various aspects of VTE, with special attention to educational and quality-of-life dimensions for patients and healthcare providers. This effort is in its beginning stages and volunteers are needed to work on this important project. If you have an interest, please contact Thein Oo  or Taylor Butler.

Publications.  Research by Study Group members includes work on prediction and risk assessment, clinical features and outcomes in patients with cancer-related incidental and symptomatic PE, the clinical course of VTE by cancer site, clinical factors that affect the rates of PE and bleeding in patients with VTE, management of PE and VTE, and much more. Recent publications can be accessed at the Hemostasis Study Group web page, which also carries highlights of recent and ongoing research by Study Group members, practice resources, and upcoming meetings in the area of VTE and hematology.

Study Group Communications and Website Development.  The Study Group’s leaders hold regular virtual meetings to discuss ongoing projects and opportunities and updates are regularly sent to members. The leaders are interested in increasing communication channels within the Study Group and seeing more members become involved in the ongoing work of the group. The Study Group leaders have been updating the Hemostasis web page and plan to continue with regular updates of publications, research, workshops, and projects. The web page content also includes upcoming international meetings and events related to VTE and current evidence-based VTE guidelines. The leaders are currently seeking a volunteer to serve as a website liaison, who will coordinate postings and help keep the site up to date in collaboration with MASCC’s Web Editor, Toni Clark. Please contact any of the Study Group leaders (see bios and emails below) if you would like to participate in this way.

Plans for the Future

The Study Group plans to develop educational materials on the subject of VTE and other aspects of hemostasis for patients, caregivers, and clinicians. An Education subgroup has been formed to collaborate with MASCC’s Education Study Group. Anyone interested in contributing to this effort should contact Paz Fernández-Ortega or Judy Phillips of the Education Study Group.

Research Participants Wanted. Study Group member Cristhiam Rojas Hernandez is now recruiting adult participants for a study of treatment adherence, quality of life, and resource utilization during anticoagulant therapy for cancer-related VTE. See the Hemostasis Study Group web page for more information about the study, including eligibility and exclusion criteria. Or contact Cris.

Get Involved!

Study Group leaders Carmen Escalante, Carme Font, and Thomas Butler look forward to hearing from anyone who is interested in joining the group and participating in its current and future projects. If you are already a member, invite a colleague to join the Study Group!

The Study Group leaders have submitted proposals for a workshop and parallel session at the 2018 MASCC Annual Meeting and look forward to seeing members old and new in Vienna.

Study Group Leaders

Carmen_EscalanteStudy Group Chair Carmen Escalante, MD, FACP is Professor and Chair, Department of General Internal Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center in Houston, Texas, USA. She is also Professor, Texas A&M Health Science Center College of Medicine, Bryan, College Station, Texas and Associate Professor, Department of Internal Medicine at the University of Texas Health Science Center in Houston. In addition to current research on VTE in cancer patients, other current research projects include studies of cancer-related fatigue, treatment of fatigue in breast cancer patients, hypertension as an adverse effect of axitinib, and the relationship between fatigue and apathy in cancer patients. She has been voted one of the Best Doctors in America (2011-2012, US News and World Reports) and Top Doctor in Houston, Texas in 2013. Her most recent publications include a prospective cohort study of cancer patients diagnosed with incidental VTE on routine computed tomography scans (Support Care Cancer 25 (5):1571-1577, 2017) and a clinical assessment of cancer-related fatigue (JCOM 24 (5) :217-227, 2017).

Thomas_ButlerVice Chair Thomas W. Butler, MD is a Senior Staff Medical Oncologist and Associate Professor of Interdisciplinary Clinical Oncology at the USA Mitchell Cancer Institute, in Mobile, Alabama, USA. He is also Associate Professor in the Department of Internal Medicine & Department of Physician Assistant Studies, at the University of South Alabama in Mobile, and he serves as Coordinator of the Multidisciplinary Cancer Conference at the Mitchell Cancer Institute. Tom’s research and clinical interests include malignancies of the blood, chronic lymphomas, breast cancer, and head and neck cancer. His most recent publications include a studies of neoadjuvant chemotherapy in women with breast cancer, treatment for refractory diffuse large B-cell lymphoma, and advance care planning in relation to patient treatment preferences and quality of care at the end of life.

carmen_fontVice Chair Carme Font, MD, PhD is a Senior Specialist in Internal Medicine at the Hospital Clinic of Barcelona, in Barcelona, Spain. She serves in the Medical Oncology Department as attending physician in Supportive Care in Cancer, mainly for unscheduled visits at the Outpatient Cancer Clinics and the Emergency Department, and occasionally also in the Medical Oncology inpatient wards. Her main areas of interest are promotion of outpatient management of acute, cancer-related complications, promotion of patient-centered medicine, febrile neutropenia and other acute infections in cancer patients; and cancer-associated thrombosis. Carme regularly teaches at the University of Barcelona as Assistant Professor in issues related to supportive cancer care. She actively participates as a member and clinical researcher of the Thrombosis & Cancer Study Group of the Spanish Medical Oncology Association (SEOM) and of the international Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry. She is a coauthor of more than 50 peer-reviewed publications.