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).

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 active cancer and confirmed proximal DVT or PE are offered anticoagulation therapy.

Data source: Local data collection.

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.

Data source: Local data collection.

Outcome

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

Data source: Local data collection.

What the quality statement means for different audiences

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

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline NG158 (2020), recommendations 1.3.15, 1.3.17 and 1.3.18

Definitions

Active cancer

Receiving active antimitotic treatment; or diagnosed within the past 6 months; or recurrent or metastatic; or inoperable. Excludes squamous skin cancer and basal cell carcinoma. [NICE's guideline on venous thromboembolic diseases, terms used in this guideline section]

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]

Anticoagulation therapy

For people with active cancer and confirmed proximal DVT or PE, consider a direct-acting oral anticoagulant. If this is unsuitable consider a low molecular weight heparin (LMWH) alone or LMWH concurrently with a vitamin K antagonist (VKA) for at least 5 days, or until the INR is at least 2.0 in 2 consecutive readings, followed by a VKA on its own.

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. [NICE's guideline on venous thromboembolic diseases, recommendations 1.3.17 and 1.3.18]