Data on long-term venous thromboembolism (VTE) prophylaxis in cancer outpatients remain scarce. In the absence of consistent treatment guidelines, our objective was to describe clinical practice and to identify factors influencing the use of thromboprophylaxis.
CAT AXIS was a multicenter cross-sectional study based on the completion of physician-profile questionnaires and the assessment of 10 e-mailed credible clinical scenarios of lung, colon and breast cancer by each of participants using the case-vignettes validated method.
A total of 224 physicians participated allowing the completion and the analysis of 2,085 case vignettes corresponding to 765, 703 and 617 fictive clinical scenarios on lung, colon and breast cancers, respectively. The overall rate of thromboprophylaxis was 680/2085 (32.6%) among participants with a comparable proportion for the three types of cancer. Low-molecular-weight heparin (LMWH) was the most frequently used, by 92.7%, 93.8% and 83.9% of participants for lung, colon and breast cancer, respectively; treatment duration of ≥ 3 months was prescribed by 74.4% of participants. Multivariate analysis of factors influencing thromboprophylaxis based on patient’s characteristics is summarized in Table.rnTable:
1562P Factors influencing the prescription of thromboprophylaxisrn
|rn||Lung cancerrn||Colon cancerrn||Breast cancerrn|
|OR [95% CI]||p||OR [95% CI]||p||OR [95% CI]||prn|
|ECOG index score: 3 vs 0-2rn||3.3 [2.4; 4.6]rn|
In the absence of clear guidance, the use of thromboprophylaxis remains low and rather empiric even though the selection of LMWH by the majority of participants and treatment duration seems appropriate based on available data to date. ECOG index, metastatic malignancy, chemotherapy and history of thrombosis were significantly associated with the decision to use thromboprophylaxis in most situations.
Clinical trial identification
Legal entity responsible for the study
F. Scotté: Roche, Vifor, MSD, TEVA, Norgine, Prostrakan, Leo pharma, Janssen, Hospira, Boehringer, Sanofi, AMGEN, Pierre Fabre Oncologie, TESARO D. Mayeur: Leo Pharma, Pfizer G. Meyer: Investigator (uncompensated) in clinical trials for: Daiichi Sankyo; Bayer; Sanofi Aventis; Leo Pharm; BMS-Pfizer, Daiichi Sankyo; Boehringer-Ingelheim, Bayer All other authors have declared no conflicts of interest.