Joint Statement on Cancer-Associated Thrombosis with the European Cancer Patient Coalition
On World Thrombosis Day 2020, the European Thrombosis and Haemostasis Alliance (ETHA) and European Cancer Patient Coalition (ECPC) jointly call upon the European Commission to recognise the importance of cancer-associated thrombosis (CAT) in the upcoming Europe’s Beating Cancer Plan and Cancer Mission.
Cancer is a strong risk factor for developing thrombosis (blood clots): research indicates that cancer patients have a 2- to 20-fold higher risk of developing venous thromboembolism (VTE) than non-cancer patients.[1] VTE is a leading cause of death and disability worldwide;[2] in Europe, there are 544,000 VTE-related deaths every year.[3] Cancer-associated thrombosis remains the number one cause of death during chemotherapy and the second leading cause of all cancer deaths (after disease progression). Although potentially fatal, CAT is both preventable and treatable, provided it is caught in time: up to 60 percent of VTE cases occur during or after hospitalisation, making it a leading preventable cause of hospital death.[4]
As thrombosis is a horizontal risk factor in cancer, affecting patients of all cancer types, at all cancer stages, both the Europe’s Beating Cancer Plan and the Cancer Mission must jointly mitigate its impact at every step of the cancer journey in order to improve patient outcomes and reduce deaths from cancer. The ETHA and ECPC call for action within both the Europe’s Beating Cancer Plan and the Cancer Mission to improve understanding of this common comorbidity and its effect on cancer outcomes in Europe and to apply existing patient safety tools to advance cancer diagnosis, care and outcomes.
In order to reduce the VTE-related morbidity and mortality of cancer patients, the Europe’s Beating Cancer Plan should ensure that all cancer patients benefit from prevention, early diagnosis and effective and safe treatment of VTE. This is consistent with Health Commissioner Stella Kyriakides’ mission letter, which mandates her to “propose actions to strengthen our approach at every key stage of the disease” in the Europe’s Beating Cancer Plan.
Early detection & diagnosis
Thrombosis risk-assessment and appropriate prophylaxis in patients newly diagnosed with cancer can contribute to fewer life-threatening complications. In many patients, cancer is detected following a blood clot, which can serve as early warning signs of cancer and be a major source of negative outcomes in cancer patients. Screening for blood clots can improve earlier diagnosis of cancer.
Treatment and care
Cancer patients could already be safer using existing technologies if tools like thrombotic risk-assessment and thromboprophylaxis were consistently available. Unfortunately, best practices for thrombosis risk assessment are not consistently adhered to or are differently applied across Europe, causing large divergences in patient outcomes.
Quality of life for cancer patients, survivors and carers
Cancer-associated thrombosis is a major contributor to chronic disability and loss of working days for cancer patients who experience non-fatal clots. As cancer patients have a higher recurrence risk of thrombosis than non-cancer patients, managing this comorbidity is of high importance for the patient’s quality of life after treatment – yet a Patient Survey carried out by ECPC in 2018 revealed very low awareness about CAT among cancer patients in Europe[5].
As a complement to clinical best practice, the Cancer Mission should ensure that research funding is allocated to improving the understanding of the interplay between cancer and blood clotting, at all stages of the patient journey. The recommendations below are priority areas for research funding on blood clotting as part of the Cancer Mission.
Recommendation 1: Launch UNCAN.eu – a European Initiative to Understand Cancer
While the relationship is well-documented, there are remaining gaps in scientific understanding of how blood clots form as cancers initiate, develop and spread.
Recommendation 4: Optimise existing screening programmes and develop novel approaches for screening and early detection
Thrombosis risk-assessment and appropriate prophylaxis in patients newly diagnosed with cancer will mean fewer life-threatening complications in cancer patients.
Recommendation 5: Advance and implement personalised medicine approaches for all cancer patients in Europe
Existing tools like thrombotic risk-assessment and thromboprophylaxis are not consistently available as part of personalised cancer care.
Recommendation 8: Create a European Cancer Patient Digital Centre where cancer patients and survivors can deposit and share their data for personalised care
Despite its prevalence, data on the incidence and treatment of thrombosis in cancer patients is patchy across Europe.
The ETHA and ECPC stand as willing sources of information on how to minimise the impact of clotting disorders in cancer patients, such as clinical best practice guides and risk assessment tools. Both the ETHA and ECPC look forward to continuing discussions on the development of the Europe’s Beating Cancer Plan and Cancer Mission.
About the 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.
About ECPC
With over 450 members, European Cancer Patient Coalition (ECPC) is proud to be the largest European umbrella cancer patients’ association, covering all EU member states and many other European and non-European countries. ECPC represents patients affected by all types of cancers, from the rarest to the most common.
[1] ECPC & LEO Pharma. Cancer- Associated Thrombosis (CAT), A neglected cause of cancer death: actions needed to increase health outcomes and reduce mortality.
[2] https://www.worldthrombosisday.org/issue/vte/
[3] Heit, JA. Poster 68 presented at: American Society of Hematology, 47th Annual Meeting, Atlanta, GA, December 10-13, 2005.
[4] Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaisier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modeling of observational studies. BMJ Qual Saf 2013; 22;809-15. Retrieved from: http://qualitysafety.bmj.com/content/22/10/809.full.pdf+html
[5] https://ecpc.org/wp-content/uploads/2019/08/ECPC-Thrombosis-CAT-Awareness-Survey-Report-1.pdf