Venous Thromboembolism in Advanced Disease A clinical guide

There is increasing recognition of the burden of venous thromboembolism (VTE) in patients with advanced incurable disease and the clinical, ethical, and philosophical challenges they may pose. With a growing elderly population and oncological therapies helping patients live longer with malignant disease, VTE is likely to be an ongoing problem. Whilst presentation, diagnosis, and treatment of VTE in general medicine is well established, its management within the palliative care setting is less clear-cut. Clinical presentation is often masked by other palliative symptoms, and symptoms can be consistent with those of other conditions; diagnosis is therefore underappreciated, and the condition can be difficult to manage. Bringing together contributions from international experts in the field of VTE and palliative care, this book explores the increasing challenges faced by healthcare professionals when managing VTE in advanced disease. Topics such as the epidemiology and pathogenesis of the condition are discussed. It appraises the current evidence informing the prevention, diagnosis, and treatment of VTE, with particular emphasis on its application to patients with incurable malignancy and non-malignant disease. Chapters are illustrated with key learning points and, where appropriate, case studies are presented to illustrate the decision-making processes that may occur when balancing the evidence with its impact on patient quality of life. This practical resource is invaluable for healthcare professionals working in all areas of medicine where patients with advanced cancer and non-malignant disease are cared for.

1. The challenge for palliative care. 2. Epidemiology of venous thromboembolism. 3. Pathogenesis of venous thromboembolism in cancer. 4. Diagnosis of deep-vein thrombosis and pulmonary embolism in cancer patients. 5. Anticoagulants: current and future therapeutic options. 6. Treatment and secondary prevention. 7. Primary thromboprophylaxis in the advanced cancer patient. 8. Clinical decision making - treatment of venous thromboembolism (VTE) in patients with advanced cancer. 9. Venous thromboembolism in non-malignant disease.

Dr Simon Noble is a Clinical Senior Lecturer and Honorary Consultant in Palliative Medicine, Cardiff University and the Royal Gwent Hospital in Wales. His research interests include the management of venous thromboembolism in advanced cancer and the anticancer effects of low molecular weight heparins. He has chaired the APM Task group for the management of VTE in palliative care and is a Trustee of Lifeblood: a UK-based thrombosis charity. Dr Miriam Johnson is a Senior Lecturer in Palliative Medicine at Hull-York Medical School and Honorary Consultant to St. Catherine's Hospice, North Yorkshire, UK. Her research interests include the management of venous thromboembolism in advanced cancer, which formed the basis of her MD thesis. Her other research interests include the palliative care of patients with end stage heart failure, and the symptom management of breathlessness. She was part of the APM Task group for the management of VTE in palliative care. Dr Lee is the co-principal investigator of the CLOT study (Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer), a landmark study that established low-molecular-weight heparin as the treatment of choice for preventing recurrent venous thromboembolism in cancer patients. Her current research activities include studies in catheter-related thromobosis, diagnosis of deep vein thrombosis and pulmonary embolism in pregnant women, and thromboprophylaxis in patients undergoing major orthpaedic surgery. She is also involved in translational research exploring the role of coagulation in cancer biology. She is a co-chair of the subcommittee on Hemostasis and Malignancy of the International Society of Thrombosis and Haemostasis and has chaired various educational sessions at annual meetings at the American Society of Hematology and the American Society of Clinical Oncology.