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Clinical interventions can prevent, minimize impact of VTE
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March is DVT Awareness Month.
Venous thromboembolism is an important cause of morbidity and mortality in patients with cancer.
Beth Waldron
Stephan Moll
Consider these statistics from the medical literature:
- VTE occurs in 4% to 20% of patients, and it is one of the leading causes of death in patients with cancer.
- The risk for VTE is increased 6.5-fold in patients with cancer.
- Patients with cancer account for 20% of all patients with VTE. Patients who receive chemotherapy account for as much as 13% of the total burden of VTE.
- Patients with the highest 1-year incidence rate of VTE are those with advanced disease of the brain, lung, uterus, bladder, pancreas, stomach and kidney.
- The rate of VTE is four to 13 times higher among patients with metastatic disease than with localized disease.
- VTE is a leading preventable cause of hospital deaths.
- One-half of VTE patients will have long-term complications, such as post-thrombotic syndrome, and one-third will have a recurrence within 10 years.
- An estimated $10 billion in medical costs in the United States each year can be attributed to VTE.
Recognizing that VTE represents “a major public health problem, exacting a significant human and economic toll on the nation,” the Surgeon General’s Office in 2008 issued a report, titled “The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism.”
The report states that, although much is known about how to prevent and minimize the long-term health impact of VTE, this knowledge is not being applied in a systematic way.
The “‘Call to Action” identified gaps in the application and awareness of evidence-based clinical interventions. It recommended a multipronged approach to address the gap, including enhanced education for both patients and clinicians.
“We must disseminate information more widely about the availability of effective interventions to prevent and treat DVT/PE,” Steven Galson, MD, acting US Surgeon General, said at the time.
To address the need for patient and health care professional education, an Internet-based resource was created at the University of North Carolina at Chapel Hill called Clot Connect (online at clotconnect.org). The resource, made possible through a grant from the CDC, serves as a national clearinghouse for reliable, clinically relevant information about thrombosis and anticoagulation.
Awareness messages
Informational and educational resources available include:
- Guidelines.
Key “cancer and VTE” clinical care guidelines, as well as other VTE guidelines, are available at www.clotconnect.org/healthcare-professionals/md-resources. They include guidelines released by the American College of Chest Physicians in 2012, National Comprehensive Cancer Network in 2010 and ASCO in 2007.
- VTE brochure for patients.
Clot Connect published a comprehensive 30-page booklet for patients newly diagnosed with VTE. The booklet answers many commonly asked questions. A link to the guide can be found at http://files.www.clotconnect.org/DVT_and_PE.pdf.
- Newsletter.
Health care professionals and patients can sign up at www.clotconnect.org for a free monthly newsletter that highlights VTE and anticoagulation developments and clinically relevant blog posts.
References:
Baglin TP. J Clin Pathol. 1997;50:609-610.
Beckman MG. Am J Prev Med. 2010;38:S495-501.
Gross SD. Incidence based cost-estimates require population based incidence data. 2012. Available at www.cdc.gov/ncbddd/Grosse/cost-grosse-Thrombosis.pdf. Accessed on March 1, 2013.
Heit JA. Arch Intern Med. 2000;160:809-815.
Lyman GH. J Clin Oncol. 2007;25:5490-5505.
Mandalà M. Ann Oncol. 2010;Suppl5:v274-276.
US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. 2008. Available at: www.surgeongeneral.gov/library/calls/deepvein/call-to-action-on-dvt-2008.pdf. Accessed on March 1, 2013.
Acknowledgement: The Clot Connect project has been made possible through a grant from the CDC (Grant # U01 DD000292-01).
For more information:
Stephan Moll, MD, is an associate professor in the Department of Medicine and Division of Hematology-Oncology at the University of North Carolina School of Medicine in Chapel Hill, N.C., and medical director of the Clot Connect patient and health care professional education program (www.clotconnect.org), an initiative of the University of North Carolina Hemophilia and Thrombosis Center. He may be reached at UNC Hemophilia and Thrombosis Center, 170 Manning Drive, 3rd Floor, Physicians Office Building, Campus Box 7035, Chapel Hill, NC 27599-7016; email: smoll@med.unc.edu.
Beth Waldron, MA, is the program director of the UNC Blood Clot Outreach Program at the University of North Carolina at Chapel Hill and the Clot Connect program.
Disclosure: Moll has been a consultant for Boehringer Ingelheim, Daiichi and Janssen. Waldron reports no relevant financial disclosures.