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 measure

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.

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.

Outcome: Incidence of cancer detected after unprovoked DVT or PE.

What the quality statement means for each audience

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.

Source guidance

NICE guideline CG144 recommendation 1.5.1.

Data source

Structure: Local data collection.

Process: Local data collection. Contained within NICE guideline CG144 clinical audit tools (treatment of venous thromboembolism and investigations for cancer), standard 5.

Outcome: Local data collection.

Definitions

Unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) is defined as a DVT or PE in a person with no antecedent major clinical risk factor for VTE who is not having hormonal therapy (oral contraceptive or hormone replacement therapy). People with active cancer or a family history of VTE should also be considered as having an unprovoked episode because these underlying risks will remain unchanged in the person. However people with active cancer are not included in this statement.

Investigations for cancer In this context, investigations for cancer refer to investigations in people with unprovoked deep vein thrombosis or pulmonary embolism who are not already known to have cancer to determine whether the VTE could be related to a previously undetected cancer. In the context of this quality statement the specific investigations are:

  • a physical examination (guided by the patient's full history)

  • chest X‑ray (according to baseline risk)

  • blood tests (full blood count, serum calcium and liver function tests)

  • urinalysis.

Timely investigations for cancer

The 2‑week wait standard for cancers guarantees that everyone referred urgently with suspected cancer would 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.