Cancer-associated thrombosis is a very common complication of the cancer journey and we’ve got strong evidence now to manage this. We know that using low molecular weight heparins is better than using warfarin, for example. So we know a lot about how best to treat cancer-associated thrombosis but very little research has been done as to how it actually impacts on the patient as part of their cancer journey.
So we’ve had a presentation today, or I did a presentation, which looked specifically at patients’ experience of living with cancer-associated thrombosis. The reason we went into medicine was to look after patients so if any part of our practice is not putting the patient first we’re just not doing our job properly. Sometimes we can become so focussed on the data that we actually lose sight of the person that we apply the data to. So, for example, as clinicians we sometimes make our own assumptions as to what the patient will think. With respect to cancer-associated thrombosis there’s a perception that a daily injection of low molecular weight heparin is unpleasant and is unwanted by the patient. Yet we’ve done research where we specifically listened to the patient voice and they’ve said that in the context of the cancer journey, the low molecular weight heparin was an acceptable intervention. Now, if we look at the opinions of clinicians, they would have said patients wouldn’t want it. So all we’ve done is ask patients.
Do you believe this could change clinical practice?
Putting the patient first is absolutely vital in our daily routine as clinicians. If we don’t understand what the patient is going through, how can we be able to discuss with them the treatment options and make sure the options are individualised for their need? We only need to look at cancer treatments which are becoming so individualised on the basis of genetic mutations and markers in the tumour biopsies to see that personalised medicine is a reality now. So therefore we shouldn’t just personalise medicine based on genetic markers, we should also personalise it on the patient themselves, their experiences, their expectations and also their needs.
What can we expect in the future for cardio-oncology?
Cancer-associated thrombosis is not going to go away. We have data which shows that people are living longer with metastatic disease and they’re receiving more chemotherapy, both of which are risk factors for developing thrombosis. So too are we seeing the incidence of cancer-associated thrombosis increasing. So therefore it’s going to become more and more part of clinicians practice, not only in the field of oncology but also in the general physician’s world and also that of the surgeon.
The take home message is that we need to use the best evidence possible to inform our practice and then with that evidence we need to communicate it to our patients, thereby being able to make a decision based on their needs and expectations.
What can the patients do?
Patients need to feel empowered to ask questions. As clinicians we need to remember that our patients are not experts in the field but they will have access to information and sometimes access to misinformation. Our job is to hear their stories, hear their questions and be able to address them, recognising that the questions they ask are important to them.
