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FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence

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Abstract

Introduction

Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines.

Materials and methods

Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis.

Results

Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy.

Conclusion

Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.

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Acknowledgements

Carmen González and Andreu Covas (GOT IT) for facilitating this Delphi project. Priscilla Chase Duran for editing and improving this manuscript.

Author information

Authors and Affiliations

  1. Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    P. Jimenez-Fonseca

  2. Hematology and Medical Oncology Department, UMU, IMIB, Hospital Universitario Morales Meseguer, Murcia, Spain

    A. Carmona-Bayonas

  3. Clinical Psychology and Psychobiology Department, Faculty of Psychology, University of Barcelona, Barcelona, Spain

    C. Calderon

  4. Unitat d’Hemostàsia i Trombosi, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain

    J. Fontcuberta Boj

  5. Medical Oncology Department, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Universitari Clínic, Barcelona, Spain

    C. Font

  6. Hemaotology Department, Clínica Universidad de Navarra, Pamplona, Spain

    R. Lecumberri

  7. Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

    M. Monreal

  8. Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain

    A. J. Muñoz Martín

  9. Medical-Surgical Unit for Respiratory Disease, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Sevilla, Spain

    R. Otero

  10. Pharmacy Department, Hospital Virgen de la Salud, Toledo, Spain

    A. Rubio

  11. Emergency Department, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain

    P. Ruiz-Artacho

  12. Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain

    C. Suarez Fernández

  13. Scientific Affairs, LEO Pharma, Barcelona, S.A, Spain

    E. Colome

  14. Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain

    P. Pérez Segura

Authors
  1. P. Jimenez-Fonseca
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  2. A. Carmona-Bayonas
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  3. C. Calderon
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  4. J. Fontcuberta Boj
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  5. C. Font
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  6. R. Lecumberri
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  7. M. Monreal
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  8. A. J. Muñoz Martín
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  9. R. Otero
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  10. A. Rubio
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  11. P. Ruiz-Artacho
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  12. C. Suarez Fernández
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  13. E. Colome
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  14. P. Pérez Segura
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Corresponding author

Correspondence to P. Jimenez-Fonseca.

Ethics declarations

This study consisted of a survey of expert opinions and no patient data were collected, so no specific independent ethical or research review or informed consent or approval was necessary.

Conflict of interest

Esteve Colomé works in Laboratories LEO Pharma, SA; he did not answer the questionnaire. The other authors declare that they have no conflict of interest.

Funding

The external consultant that managed the online platform for the realization of the study was funded by LEO Pharma Academy.

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Jimenez-Fonseca, P., Carmona-Bayonas, A., Calderon, C. et al. FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence. Clin Transl Oncol 19, 997–1009 (2017). https://doi.org/10.1007/s12094-017-1632-3

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  • DOI: https://doi.org/10.1007/s12094-017-1632-3

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