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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
| Development of a Multidisciplinary Program for the Prevention of Venous Thrombosis in Ambulatory Patients with Cancer Jocelyn Veals1, Kendra Prasad1, Andrea Cervi1, 2. 1Schulich School of Medicine & Dentistry, London, ON, Canada.2Department of Medical Oncology, Windsor Regional Cancer Center, Windsor, ON, Canada |
Abstract
Background: Venous thromboembolism (VTE) is the second leading cause of death among patients with cancer and contributes to treatment delays, major bleeding, reduced quality of life, and increased healthcare expenditures. Low-dose anticoagulation can reduce VTE rates in ambulatory patients with cancer, and major guidelines recommend prophylaxis for high-risk individuals starting systemic therapy. Despite these recommendations, fewer than 5% of patients at leading cancer centres undergo outpatient thrombosis risk assessment. Barriers to implementing thromboprophylaxis guidelines include limited provider awareness, concerns about bleeding risk, and time or financial constraints. A successful model integrating hematologists, thrombosis specialists, nurses, and pharmacists has been described in an academic centre with extensive specialist support. However, strategies are needed in community settings, where the majority of cancer patients receive treatment. Objectives: This study aims to evaluate the feasibility of a novel multidisciplinary VTE prevention program at a large community cancer centre in Southwestern Ontario. Specifically, we will examine: The proportion of ambulatory cancer patients starting systemic therapy who undergo CAT risk stratification, and receive pharmacologic thromboprophylaxis; and The frequency of documented patient counseling on cancer-associated VTE risk. Methods: This feasibility study includes a 1-year pre-implementation period (Oct 1, 2022–Oct 1, 2023) and a 6-month post-implementation period (Nov 25, 2024–May 25, 2025). Primary outcomes include thromboprophylaxis prescription rates and delivery of patient education. Secondary analyses will evaluate associations between patient characteristics (e.g., age, sex, comorbidities, VTE or bleeding history) and the likelihood of prescribing thromboprophylaxis. Results: To date, 448 patients have been included in the analysis; 405 in the pre-VTE prophylaxis implementation phase and 43 in the post-implementation phase. Most patients were 61-75 years old (49.8%) and female (56.9%). The most common malignancies were breast (90, 20.1%), lung (83, 18.5%), and hematologic cancers (65, 14.5%); 8 (1.8%) patients had more than one primary cancer. In the pre-implementation phase, 99 patients (24.5%) met criteria for pharmacologic thromboprophylaxis (median Khorana Risk Score [KRS] 2); however, only one patient received a prescription. Documentation of patient education on risks of cancer-associated thrombosis was uncommon, occurring in only 9 patients (2.2%). During the post-implementation phase (n=43 patients), 11 patients (26%) met criteria for ambulatory thromboprophylaxis (median KRS 2). Documentation of patient education occurred in 9 cases (82% of eligible patients), and thromboprophylaxis prescription was provided to 5 patients (55.6%). Apixaban was used in all instances where prophylaxis was provided. Conclusion: Early implementation of a multidisciplinary VTE prevention program in a community cancer centre was associated with meaningful improvements in documented patient education and thromboprophylaxis prescribing among high-risk outpatients. While pre-implementation rates of patient education and prescribing were low (2.2% and 1.0%, respectively), early post-implementation findings demonstrate marked improvement, with documented education rising to 82% and prophylaxis prescribing increasing to 55.6% among eligible patients. Results suggest the model is feasible outside academic centres. Future work will assess sustainability, explore provider-level barriers, and evaluate clinical outcomes such as VTE and bleeding to determine the program’s longer-term impact.
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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.