Saving Lives of Cancer Patients by Addressing Cancer-Associated Thrombosis

The European Thrombosis and Haemostasis Alliance (ETHA) welcomes the proposed EU research mission on cancer and firmly believes that to reduce death and disability from cancer across Europe, cancer-associated thrombosis must become a priority.

Cancer is a strong risk factor for developing thrombosis (blood clots): research indicates that cancer patients have a four times higher risk than the general population of developing thrombosis. Thrombosis is also a serious complication, cancer-associated thrombosis is a leading cause of death in cancer patients.

An EU research mission on cancer can have a significant impact on reducing cancer mortality by addressing horizontal risk factors that affect mortality from all cancers, such as cancer-associated thrombosis.

ETHA strongly supports the potential of an EU research mission on cancer and understands this research mission will necessarily be in service of a larger societal goal, such as reducing cancer deaths and disability. It is our expectation that this overarching objective would be supported through various intermediate targets / milestones. This position paper relates to the formulation of the intermediate targets for an EU research mission on cancer.

1. Research objective must include cancer-associated thrombosis
When developing the target areas for an EU cancer mission, it is essential to optimize elements that explore interventions known to improve overall cancer survival rates. Venous thromboembolism (VTE) is a common complication in patients with cancer. VTE is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE) cancer. Reducing the rate of VTE in cancer patients would reduce overall death and disability among cancer patients and would decrease use of health care resources.

The risk of death for cancer patients with VTE is more than 3- to 4- fold greater than for non-cancer patients with VTE, yet the severity of cancer-associated thrombosis is often underestimated, and prevention strategies are overlooked. In a study of 235,149 cancer cases, 3775 (1.6%) were diagnosed with venous thromboembolism within 2 years, 463 (12%) at the time cancer was diagnosed and 3312 (88%) subsequently. Death from cancer is significantly and consistently greater among patients who have developed VTE as compared to cancer patients who have not. It is thus important that any research activity on improving death and disability from cancer also improves the understanding of blood clot formation in cancer patients.

2. Must involve several related scientific disciplines
We understand that a significant aim of the research missions should be facilitation of collaboration across different sectors, scientific disciplines and actors and that missions should not be guided by a single technology or approach. This type of strong horizontal integration is entirely appropriate for meeting an overall target objective of reduced cancer mortality, and ETHA would welcome a system which allows stronger linkages across sectors and scientific disciplines because it would best enable researchers to address the impact of thrombosis in cancer.

When considering various research policy instruments, it is crucial that the policy mix is sufficiently flexible and allows researchers to decide on the best way to reduce cancer mortality. ETHA advocates that a portfolio approach of multiple research instruments includes activities to improve our understanding of better and more efficacious diagnosis, prevention and treatment of blood clots associated with cancer. At the same time, it must also address methods to implement risk-assessment of thrombosis in patients with cancer and appropriate prophylaxis in hospitals regardless of cancer type, to meet the goal of reducing cancer mortality.

3. Potential to achieve positive spillovers from addressing common risk factors in cancer
In Europe, there are approximately 544,000 VTE-related deaths every year, 60 percent of which occur during or after hospitalization, making it a leading preventable cause of hospital death. It is estimated that of all cases of VTE, an estimated 15-20% occur in cancer patients, or up to 2 million cancer-related VTE cases worldwide each year. Tackling cancer-associated thrombosis as part of a cancer research mission can therefore also be expected to have a positive effect on outcomes for non-cancer-associated VTE.

This would correspond with the intention behind the design of a research mission to take into consideration positive spillovers into other sectors. ETHA therefore calls on EU policy-makers to seize the opportunity to address cancer-associated thrombosis as this could generate positive impact in addressing patient safety interventions that may be effective in different contexts. This could also improve the overall survival rates not only from cancer but also from many other risk factors for clotting, including in cardiovascular, hematological and pulmonary diseases.

4. Stakeholder participation is essential
It is critical that the formulation process of the mission allows for a high degree of public involvement and that the mission is governed in such a way that it allows for stakeholder participation. We therefore recommend that there are regular opportunities for civil society to provide feedback on the design of the mission, and that stakeholder participation is ensured in order to achieve the vision of accomplishing a truly cross-sectoral and cross-disciplinary research mission on cancer. This will create large-spread community support and engagement.

Summary
ETHA therefore calls on all policy-makers to adopt a research mission on cancer that incorporates horizontal mortality drivers for all cancers. Stronger EU cooperation in the field of cancer and cancer-associated thrombosis is vital to for the health and economic progress of the EU, and ETHA is ready to work with all stakeholders to ensure that an EU research mission is delivered in way that maximizes the health of European citizens.

About ETHA:
The European Thrombosis and Haemostasis Alliance (ETHA) is made up of eminent clinicians and researchers from European national and international societies representing those working in the field of thrombotic and bleeding disorders. We have come together to give the European thrombosis and haemostasis community an allied voice and provide input to EU health and patient safety strategies; make recommendations on EU research programme funding and encourage sharing and adoption of best practices in the treatment and prevention of thrombotic and bleeding disorders across Member States. Learn more at etha.eu.

About Thrombosis:
Thrombosis, also known as blood clots, is the formation of potentially deadly blood clots in an artery (arterial thrombosis) or vein (venous thrombosis). It is the underlying cause of heart attack, thromboembolic stroke, and venous thromboembolism (VTE), the top three cardiovascular killers.

About Cancer-Associated Thrombosis:
Cancer-associated thrombosis (CAT) is the formation of a blood clot inside a blood vessel that is associated with cancer.

Contact:
For any inquiries, please contact [email protected] or Sture Alne / ETHA secretariat on +32 488568225.