Quality standard

Quality statement 9: Follow‑up for people with cancer

Quality statement

People with active cancer who receive anticoagulation therapy have a review within 6 months of confirmed proximal deep vein thrombosis or pulmonary embolism to discuss the risks and benefits of continuing anticoagulation therapy.

Rationale

As anticoagulation therapy carries potential risks such as bleeding there is a need to ensure the therapy remains beneficial. For people who have had a confirmed diagnosis of proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) and who have cancer, a review should take place.

Note that treating DVT or PE in people with active cancer is an off-label use for most anticoagulants. See Prescribing medicines for more information.

Quality measures

Structure

Evidence of local arrangements to ensure people with cancer who have had a confirmed proximal DVT or PE and who receive anticoagulation are reviewed within 6 months of diagnosis to discuss the risks and benefits of continuing anticoagulation therapy.

Data source: Local data collection.

Process

The proportion of people with cancer who have had a confirmed proximal DVT or PE and receive anticoagulation therapy who have a review within 6 months of diagnosis to discuss the risks and benefits of continuing anticoagulation therapy.

Numerator – the number of people in the denominator who receive a review within 6 months of diagnosis to discuss the risks and benefits of continuing anticoagulation therapy.

Denominator – the number of people who have received anticoagulation therapy following a confirmed diagnosis of proximal DVT or PE at least 6 months previously and who have a diagnosis of cancer.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure systems are in place for people with cancer and who have had a confirmed proximal DVT or PE to be offered a review to discuss the risks and benefits of continuing anticoagulation therapy.

Healthcare professionals ensure people with cancer who have had a confirmed proximal DVT or PE are offered a review to discuss the risks and benefits of continuing anticoagulation therapy.

Commissioners ensure they commission services that offer people with cancer who have had a confirmed proximal DVT or PE a review to discuss the risks and benefits of continuing anticoagulation therapy.

People with cancer who have had deep vein thrombosis or pulmonary embolism and who are having treatment with an anticoagulant (a drug that 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) are offered a review to discuss the risks and benefits of continuing treatment with an anticoagulant.

Definitions

Timing of review

Healthcare professionals need to consider the summary of product characteristics to determine the timing of the review and duration of treatment required for the anticoagulant received. [Expert opinion]

Proximal DVT

Deep vein thrombosis at or above the level of the popliteal trifurcation area. [NICE's guideline on venous thromboembolic diseases, terms used in this guideline section]