Prophylaxis and treatment of thrombosis in oncology patients – development of a toolkit to aid clinical decision-making

Introduction Venous thromboembolism (VTE) is an established health care problem associated with patients suffering from cancer. Cancer is an independent risk factor for VTE, with an odds ratio second only to surgery. It is estimated to be the second leading cause of death in the cancer patient. Treatment of VTE can lead to delays or breaks in treatment, increased need for hospitalisation and an increased economic burden on the patient. Assessment of risk and a guideline to aid treatment in this patient cohort should improve outcomes in this patient group. Aims To develop and assess use of a guideline and toolkit based on best available evidence for risk screening and management of thrombosis in the oncology patient. Methods Following a baseline audit to assess VTE risk/occurrence and prophylaxis prescribing, a guideline and toolkit to address needs was developed and implemented. This was followed by a repeat audit to assess application of information provided in the toolkit in addition to survey on user satisfaction. Results Two of the 65 patients screened post-implementation had a toolkit in their medical notes. Use of the toolkit as a reference guide improved prescribing of appropriate VTE prophylaxis, from 20.5% to 62.9%, p<0.0125, and concurrently reduced the incidence of cases where VTE prophylaxis was not prescribed during admission, from 41.0% to 17.1%, p<0.0125. There was no difference in the sample populations regarding diagnosis of VTE or management of same. When the populations were assessed for other factors potentially attributing to VTE diagnosis, a Khorana Score of 3 or higher, advanced disease and the presence of comorbidities were associated with increased levels of risk. Conclusion Use of a toolkit aided raised awareness among staff and improved patient education on VTE risk. Redesign of the toolkit, along with addition of haematological cancers for assessment, will further aid use and improve prescribing of anticoagulation.