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  • Medical oncologists’ and palliative care physicians’ opinions towards thromboprophylaxis for inpatients with advanced cancer: a cross-sectional study

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Original research
Medical oncologists’ and palliative care physicians’ opinions towards thromboprophylaxis for inpatients with advanced cancer: a cross-sectional study
  1. Breffni Hannon1,2,
  2. Nathan Taback3,
  3. Camilla Zimmermann1,2,
  4. John Granton2,4 and
  5. Monika Krzyzanowska2,5
  1. 1 Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  2. 2 Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
  4. 4 Respiratory Medicine, University Health Network, Toronto, Ontario, Canada
  5. 5 Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Breffni Hannon, Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; breffni.hannon{at}uhn.ca

Abstract

Background Patients with advanced cancer are increasingly discharged from inpatient settings following focused symptom management admissions. Thromboprophylaxis (TP) is recommended for patients with cancer admitted to acute care settings; less is known about TP use in palliative care (PC) settings. This study explored the opinions of Canadian medical oncologists (MO) and PC physicians regarding the use of TP for inpatients with advanced cancer.

Methods A fractional factorial survey designed to evaluate the impact of patient factors (age, clinical setting, reason for admission, pre-admission performance status (Eastern Cooperative Oncology Group; ECOG), and risk of bleeding on anticoagulation) and physician demographics on recommending TP was administered by email to Canadian MO and PC physicians. Each respondent received eight vignettes randomly selected from a set of 32. Hierarchical regression was used to evaluate the odds of prescribing TP adjusted for patient factors.

Results 606 MO and 491 PC physicians were surveyed; response rates were 11.1% and 15.0%, respectively. MO were predominantly male (59.7%); PC female (60.3%); most worked in academic environments (90.3% MO; 73.9% PC). Multivariable hierarchical logistic regression demonstrated that all patient factors except age were associated with prescribing TP (ORs range: from 1.34 (95% CI 1.01 to 1.77) for good ECOG, to 2.53 (95% CI 1.9 to 3.37), for reversible reason for admission). Controlling for these factors, medical specialty was independently associated with recommending TP (OR for MO 2.09 (95% CI 1.56 to 2.8)).

Conclusions MO have higher odds of recommending TP for inpatients with advanced cancer than PC physicians. Further research exploring the drivers of these differing practices is warranted.

  • thromboprophylaxis
  • advanced cancer
  • palliative care
  • medical oncology
  • inpatients
  • venous thromboembolism

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bmjspcare-2019-001861

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors BH designed, planned and conducted the study with support from NT, CZ, MK and JG. All authors reviewed the results and contributed to the completed manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.