Summary
Objectives: To determine the attitude of physicians towards the ASCO evidence-based clinical
practice guidelines for venous thromboembolism (VTE) prophylaxis and treatment in
patients with cancer.
Methods: The ASCO guideline was published in Jan. 2015. Two specialists in in the field assembled
a list of arguments for and against each of the ASCO recommendations. ASCO recommendations
and pro & con arguments were presented to physicians attending 3 educational seminars
on hemostasis in cancer patients. After the presentation each attendee was asked to
fill out a questionnaire on how much he agreed with the recommendations and the pro
& con arguments.
Results: A total of 89 physicians attended the three meetings. 56 questionnaires were returned.
The ASCO recommendation with the highest degree of support was that patients undergoing
major cancer surgery should receive prophylaxis for 7–10 days and for four weeks after
major abdominal or pelvic surgery with high-risk features (84 % Pro). The recommendation
with the lowest degree of support was that anticoagulation should not be used to extend
survival of patients with cancer in the absence of other indications (56 % Pro = indifference).
Arguments based on A) the scientific evidence underlying each recommendation, B) on
clinical practicability and patients’ preferences/adherence, C) on the desire to avoid
toxicity, malpractice litigation, and cost concerns, ranked equally.
Conclusion: The degree of support for ASCO guideline recommendations on prophylaxis and treatment
of VTE in cancer is variable. For some key recommendations it is close to indifference.
Scientific evidence for a recommendation is just one decision factor among others.
Our study underscores the need to further promote educational activities on VTE prophylaxis
and treatment in cancer patients particularly among all physicians caring for cancer
patients.
Keywords
Cancer associated venous thromboembolism - VTE - ASCO guidelines
