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[2],[3].

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.

Quality measure

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.

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.

What the quality statement means for each audience

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.

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), standard 2c.

Definition

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.



[2] At the time of publication of NICE guideline CG144 (June 2012) some types of LMWH did not have a UK marketing authorisation for 6 months of treatment of DVT or PE in patients with cancer. Prescribers should consult the summary of product characteristics for the individual LMWH and make appropriate adjustments for severe renal impairment or established renal failure. Informed consent for off-label use should be obtained and documented.

[3] Although this use is common in UK clinical practice, at the time of publication of NICE guideline CG144 (June 2012) none of the anticoagulants had a UK marketing authorisation for the treatment of DVT or PE beyond 6 months in patients with cancer. Informed consent for off-label use should be obtained and documented.