Quality statement 7: Treatment of people with active cancer

Quality statement

People with active cancer and confirmed proximal deep vein thrombosis or pulmonary embolism are offered anticoagulation therapy.

Rationale

In people with cancer, anticoagulation can lead to improved prognosis including a reduction in the risk of recurrent deep vein thrombosis (DVT) or pulmonary embolism (PE).

Quality measure

Structure: Evidence of local arrangements to ensure people with active cancer and confirmed proximal DVT or PE are offered anticoagulation therapy.

Process: The proportion of people with active cancer and confirmed proximal DVT or PE who receive anticoagulation therapy.

Numerator – the number of people in the denominator who receive anticoagulation therapy.

Denominator – the number of people with active cancer and confirmed proximal DVT or PE.

Outcome – Incidence of recurrent DVT or PE in patients with cancer and VTE who have completed anticoagulation therapy.

What the quality statement means for each audience

Service providers ensure systems are in place for people with active cancer and confirmed proximal DVT or PE to be offered anticoagulation therapy.

Healthcare professionals ensure people with active cancer and confirmed proximal DVT or PE are offered anticoagulation therapy.

Commissioners ensure they commission services that offer people with active cancer and confirmed proximal DVT or PE anticoagulation therapy.

People with active cancer who have a deep vein thrombosis or pulmonary embolism are offered treatment with an anticoagulant (a drug that helps stop blood clots forming or enlarging and makes it less likely that a blood clot will come loose and travel to the lungs).

Source guidance

NICE guideline CG144 recommendation 1.2.2 (key priority for implementation).

NICE technology appraisal guidance 261.

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), standards 2a and 2b.

Outcome: Local data collection.

Definitions

Active cancer was defined by the Guideline Development Group (after considering the evidence available) as cancer: receiving active antimitotic treatment; or diagnosed within the past 6 months; or recurrent or metastatic; or inoperable.

This definition excludes squamous skin cancer and basal cell carcinoma.

Proximal DVT

DVT in the popliteal vein or above; proximal DVT in this context refers to 'above‑knee DVT'.

Anticoagulation therapy For active cancer anticoagulation therapy can include treatment with LMWH or rivaroxaban given in accordance with the summary of product characteristics.