SIDEBAR: Expect Questions from Your Patients

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The current lack of awareness about the high risk of venous thromboembolism (VTE) among people being treated for cancer as outpatients means “there’s a great role for provider education,” Alok Khorana, MD, told The ASCO Post. Here are Dr. Khorana’s answers to some likely questions from patients.

Who is at high risk for developing blot clots?

The study reported at the 2011 ASH Annual Meeting showed that almost 80% of blood clots that occur in patients with cancer develop among those being treated as outpatients. Some outpatients, however, are at higher risk than others—those whose primary site of cancer is the stomach, pancreas, brain, or testicles, and those with lymphoma and myeloma. Outpatients with lower risk of developing venous thromboembolism include those with breast or head and neck cancers.

What are signs and symptoms of VTE that need to be reported?

If a patient gets pain and swelling in one leg, which is asymmetrical compared to the other leg, if there is sudden onset of chest pain or shortness of breath, or if the patient has cough or blood streaks in the sputum, these are all signs of either a deep vein thrombosis or a pulmonary embolism. That is something they should report and discuss with their provider as soon as possible.

Is there anything outpatients can do to reduce the risk of developing blood clots?

No, there is not. In general, we want patients to be conditioned and be mobile as much as possible, and that’s a good preventive measure in the inpatient setting. It is not clear that that works in the outpatient setting because the risk factors are so different. There really are no lifestyle factors that you could change to ameliorate that risk. Because outpatients are often out and about, it is not practical for them to wear compression stockings and use various mechanical devices suggested for inpatients to reduce the risk of venous thromboembolism. But a heightened awareness of the symptoms is very important.

What happens if outpatients are diagnosed with a blood clot?

If outpatients do have a clot, they usually do not need to be hospitalized. With the low-molecular-weight heparin, it is now very easy to treat these patients as outpatients. Exceptions would include patients who are medically unstable or have a big pulmonary embolism that is causing strain on the heart. ■

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Several studies are investigating low-molecular-weight heparins to reduce the risk of venous thromboembolism (VTE) among patients with cancer. “I enrolled patients in SAVE-ONCO,” Alok Khorana, MD, said, “but that trial used drug called semuloparin, which is not currently available in the United...




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