Scientific publications

FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence

Feb 27, 2017 | Magazine: Clinical&Translational Oncology

Jimenez-Fonseca P (1), Carmona-Bayonas A (2), Calderon C (3), Fontcuberta Boj J (4), Font C (5), Lecumberri R (6), Monreal M (7), Muñoz Martín AJ (8), Otero R (9), Rubio A (10), Ruiz-Artacho P (11), Suarez Fernández C (12), Colome E (13), Pérez Segura P (14).


INTRODUCTION:
Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines.

MATERIALS AND METHODS:
Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis.

RESULTS:
Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy.

CONCLUSION:
Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.

CITATION  Clin Transl Oncol. 2017 Aug;19(8):997-1009.
doi: 10.1007/s12094-017-1632-3. Epub 2017 Feb 27