Quality statement 5: Investigations for cancer

Quality statement

People with unprovoked deep vein thrombosis or pulmonary embolism who are not already known to have cancer are offered timely investigations for cancer.

Rationale

A significant proportion of people with a new unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) may have an undiagnosed cancer. In addition, the occurrence of cancer‑related venous thromboembolic disease (VTE) is associated with a poorer prognosis. Therefore it is critical for the optimal management of unprovoked DVT or PE (in a person in whom no obvious risk factors for DVT or PE have been identified) to establish whether they may have an underlying cancer.

Quality measures

Structure

Evidence of local arrangements to ensure people with unprovoked DVT or PE who are not already known to have cancer are offered investigations for cancer.

Data source: Local data collection.

Process

The proportion of people with unprovoked DVT or PE who are not already known to have cancer who receive investigations for cancer.

Numerator – the number of people in the denominator who receive investigations for cancer.

Denominator – the number of people with unprovoked DVT or PE who are not already known to have cancer.

Data source: Local data collection.

Outcome

Incidence of cancer detected after unprovoked DVT or PE.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure systems are in place for people with unprovoked DVT or PE who are not already known to have cancer to be offered investigations for cancer.

Healthcare professionals ensure people with unprovoked DVT or PE who are not already known to have cancer are offered investigations for cancer.

Commissioners ensure they commission services that offer people with unprovoked DVT or PE who are not already known to have cancer investigations for cancer.

People who have an unprovoked (with no obvious cause) deep vein thrombosis or pulmonary embolism and who are not already known to have cancer are offered tests for cancer.

Definitions

Unprovoked DVT or PE

DVT or PE in a person with no recent (within 3 months) major clinical risk factor for VTE – such as surgery, trauma, significant immobility (bedbound, unable to walk unaided or likely to spend a substantial proportion of the day in bed or in a chair), pregnancy or puerperium – and who is not having hormonal therapy (combined oral contraceptive pill or hormone replacement therapy). [NICE's guideline on venous thromboembolic diseases, terms used in this guideline section]

Investigations for cancer

Investigations in people with unprovoked DVT or PE who are not already known to have cancer to determine whether the VTE could be related to a previously undetected cancer. The specific investigations are:

  • medical history review

  • baseline blood tests, including full blood count, renal and hepatic function, PT and APTT (prothrombin time and activated partial thromboplastin time)

  • physical examination.

[NICE's guideline on venous thromboembolic diseases, recommendation 1.8.1]

Timely investigations for cancer

The 2‑week wait standard for cancers guarantees that everyone referred urgently with suspected cancer will be able to be seen by a specialist or in a diagnostic clinic within 2 weeks from the date of decision to refer. Therefore the investigations for cancer should be carried out within 2 weeks of being ordered. [NHS England's Guide to NHS waiting times in England]