Announcement
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Oncology Provider Practices and Perspectives on Ambulatory Thromboprophylaxis Christina Di Carlo1, Zayya Zendo1, Beatrice Floris2, Maria Chaudhry2, Moe El-Zein2, Fatima Hamad2, Cristian Iannicello2, Andrea Cervi1, 3. 11Schulich School of Medicine & Dentistry, London, ON, Canada.2University of Windsor, Windsor, ON, Canada.3Department of Medical Oncology, Windsor Regional Cancer Center, Windsor, ON, Canada |
Abstract
Background: Cancer-associated thrombosis (CAT) is the second leading cause of death among patients receiving systemic therapy. Despite robust evidence and guidelines supporting the use of pharmacologic thromboprophylaxis to prevent CAT, uptake in ambulatory oncology practice remains limited. Objectives: The primary objective of this study is to assess knowledge, attitudes, and clinical practices of patient-facing oncology providers regarding thromboprophylaxis in ambulatory cancer care. We also aim to identify perceived barriers and facilitators to performing thrombosis risk stratification and prescribing thromboprophylaxis. Methods: This descriptive, mixed-methods study was conducted in a large community teaching hospital in Southwestern Ontario, Canada. Patient-facing oncology providers, including physicians, nurse practitioners, registered nurses, and pharmacists, were invited to complete a digital, anonymous survey consisting of multiple choice and open-ended questions, as well as fictional patient scenarios. Results: A total of 30 oncology providers completed the survey, including 13 physicians, 3 nurse practitioners, 5 pharmacists, and 9 registered nurses, specializing in 14 distinct disease sites. Overall, 23% of respondents reported solid tumor oncology as their primary practice, 30% primarily work in malignant hematology, and 47% reported involvement in both. Providers reported discussing the risks of CAT with 40% of their patients, and the risks and benefits of thromboprophylaxis with 35% of patients. They further estimated that 30% of their patients are currently receiving thromboprophylaxis. Among respondents who prescribe thromboprophylaxis, 75% identified apixaban as their preferred agent, with a typical recommended duration of 6 months. While 73% reported at least some familiarity with CAT risk stratification tools [i.e. Khorana Risk Score (KRS)], 47% had never utilized a tool in practice. The most commonly cited barriers to prescribing thromboprophylaxis included limited clinic time (40%), lack of guideline familiarity (30%), concerns about bleeding risk (30%), limited familiarity with risk assessment tools (26%), and concerns regarding drug interactions (13%). Most respondents (70–80%) indicated that they do not consider sex, gender, or racial identity when making thromboprophylaxis decisions. When provided a fictional scenario of a patient with metastatic pancreatic cancer, elevated body mass index (BMI), and leukocytosis (KRS 4), 75% of respondents were likely or very likely to prescribe thromboprophylaxis. When the same scenario included underlying anemia (hemoglobin 90 g/L), this proportion decreased to 66%. In a second scenario of a patient with ovarian cancer, normal BMI, and normal leukocyte count (KRS 1), 29% of respondents were likely or very likely to prescribe thromboprophylaxis. This proportion increased to 87.5% when the scenario was modified to include a history of provoked pulmonary embolism. In a third scenario of a patient with metastatic colorectal cancer starting bevacizumab-based systemic therapy, only 17% of respondents were likely to prescribe thromboprophylaxis. Conclusion: These findings highlight substantial variability in provider familiarity of CAT risk assessment tools and the use of thromboprophylaxis in ambulatory oncology practice. Multiple barriers to CAT risk assessments and discussions of thromboprophylaxis were identified, underscoring opportunities for targeted education and workflow optimization to improve thromboprophylaxis decision-making in ambulatory oncology settings.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.