Is long-term low-molecular-weight heparin acceptable to palliative care patients in the treatment of cancer related venous thromboembolism? A qualitative study

Abstract

Venous thromboembolism (VTE) is common in patients with terminal cancer. Current treatment practice with warfarin has a high incidence of complications, including bleeding, poor control and recurrent VTE. Long-term low-molecular-weight heparin (LMWH) therapy is safer and more efficacious in this patient group, but there are concerns that daily therapy may have a negative impact on quality of life. A qualitative study was carried out to determine whether LMWH was acceptable in palliative care patients, both in the community and in-patient units. Forty palliative care patients receiving LMWH for VTE were interviewed. Participants found LMWH to be an acceptable intervention, allowing them freedom from blood tests and optimism regarding their care. It was considered a preferable therapy to warfarin, which had a negative impact on participant's quality of life. The findings of this study support the use of LMWH, first line in the treatment of established VTE in the palliative care setting.

Keywords

acceptability cancer low-molecular-weight heparin palliative care qualitative venous thromboembolism

Get full access to this article

View all access options for this article.

References

Bick RL . Alterations of haemostasis with malignancy . Semin Thromb Hemost 1978; 5: 1–26 .

Sproul EE . Carcinoma and venous thrombosis: the frequency of association of carcinoma in the body or tail of the pancreas with multiple venous thrombosis . Am J Cancer 1938; 34: 566–585 .

Ambrus JL , Ambrus CM , Pickren JW . Causes of death in cancer patients . J Med 1975; 6: 61–64 .

Johnson MJ , Sproule MW , Paul J . The prevalence and associated variables of deep venous thrombosis in patients with advanced cancer . Clinical Oncology 1999; 11: 105–110 .

Hyers TM , Agnelli G , Hull RD , et al. Antithrombotic therapy for venous thromboembolic disease . Chest 2001; 119 (Suppl): 176–193 .

Johnson MJ . Problems of anticoagulation within a palliative care setting: an audit of hospice patients taking warfarin . Palliat Med 1997; 11: 306–312 .

Johnson MJ , Sherry K . How do palliative physicians manage venous thromboembolism? Palliat Med 1997; 11: 462–468 .

Lee AY , Levine M , Baker RI , et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer . N Engl J Med 2003; 349: 146–153 .

Levine M . Low-molecular weight heparin or oral anticoagulation for secondary prevention of deep vein thrombosis in cancer patients . Semin Thromb Hemost 2003; 29 (Suppl 1): 9–11 .

10.

Hull RD , Pineo GF , Mah AF , Brant RF , for the LITE study investigators. A randomised trial evaluating long-term low molecular weight heparin therapy for three months versus intravenous heparin followed by warfarin sodium . Blood 2002; 100: 556–556 (abstract).

11.

Meyer G , Marjanovic Z , Valcke J , Lorcerie B . Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer . Arch Intern Med 2002; 162: 1729–1735 .

12.

Thromboprophylaxis in advanced malignancy: a survey of specialist palliative care inpatient units across the British Isles . Noble SIR, Wheatley V. 9th International Symposium on Thromboembolism, Seville, June 2002.

13.

Glaser B , Strauss A . The discovery of grounded theory. London: Aldine Press , 1967.