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The challenges of managing cancer related venous thromboembolism in the palliative care setting

Correspondence to:
Dr S Noble, Department of Palliative Medicine, Ward B6N, Royal Gwent Hospital, Cardiff Rd, Newport, NP20 2UB, UK; simon.noble{at}gwent.wales.nhs.uk

Cancer patients with venous thromboembolism (VTE) pose particular management challenges since they have an increased risk of bleeding and recurrent thrombosis compared to the non-cancer population. Also, as the disease progresses so do the hazards of anticoagulation, and patients in the palliative stages of their cancer could be viewed as a separate disease group with respect to diagnosis and management. As the focus from curative treatment moves towards symptom control, physicians face several challenges in providing the most appropriate care. Palliative care patients have rarely been included in research on VTE and the supporting evidence needs to be extrapolated cautiously. Quality of life aspects of VTE and their management may be a more appropriate outcome measure in this stage of disease than radiological end points. This paper looks at the challenges facing professionals in the management of VTE in the advanced cancer patient.

Abbreviations: CTPA, computed tomographic pulmonary angiography; DVT, deep vein thrombosis; INR, international normalised ratio; LITE, Long-term Innohep Treatment evaluation; LMWH, low molecular weight heparin; PE, pulmonary embolus; SPCU, Specialist palliative care unit; VTE, venous thromboembolism; V/Q scan, ventilation/perfusion lung scintigraphy

Keywords: cancer; hospice; low molecular weight heparin; LMWH; palliative care; venous thromboembolism