Approximately a fifth of all diagnoses of Venous Thromboembolism (VTE) occur in patients with malignancy. 20% of patients with Cancer Associated Thrombosis (CAT) receive an IVCF annually. Insertion is guided by several practice guidelines, which do not comment on the use of IVCF’s in malignancy. Documented adherence to these guidelines is known to be variable. We aimed to see was there a variation in the management of VTE among Medical Oncologists/Haematologists and Respiratory physicians, regarding IVCF use in the setting of suspected and confirmed malignancy.
Medical Oncologists, Haematologists and Respiratory physicians were surveyed with four theoretical cases. The survey was in part circulated by the Thoracic Society of Australia and New Zealand (TSANZ).
Case 1: Post-operative patient develops a symptomatic PE and DVT
Case 2: Patient with gynaecological malignancy develops a PE before cancer related surgery
Case 3: Patient with recurrent VTE despite anticoagulation
Case 4: Patient with metastatic malignancy with extensive VTE.
There were 56 responses, 32 Respiratory physicians (57%) and 24 Medical Oncologists/Haematologists (43%). 77% were consultants and 23% were advanced trainees. A decision to insert an IVCF was made 33% of the time. Case 1; 30 (21 Respiratory physicians: 9 Medical Oncologists/Haematologists), Case 2; 21 (13:8), Case 3; 11 (3:8) and Case 4; 12 (8:4). Medical Oncologists were less likely to insert an IVCF for Case 1, and more likely to do so for case 3. In Case 1, physicians preferring to delay anticoagulation post-surgery were 8 times more likely to insert an IVCF. Compliance with guidelines was variable.
The heterogeneity in responses highlights the variations in VTE management especially in CAT. International Societies should consider addressing IVCF use specifically in the setting of CAT. Particularly as the use of IVCFs may infer a survival advantage, in patients with recurrent VTE on anticoagulation.