Cancer patients have a particularly high risk of developing VTE, with approximately 5-20% of patients developing the condition. Fortunately, the risk of VTE can be reduced with the use of medication called prophylactic anticoagulation. Several organizations have issued recommendations on the use of prophylactic anticoagulation in cancer patients at a high risk for VTE, however the implementation of these recommendations has faced numerous hurdles.

In previous work, UVM Cancer Center clinicians successfully implemented a VTE prevention program – The Vermont Model – to increase the rate of prophylactic anticoagulation in high VTE risk cancer patients. In the academic setting, this model increased the rate of VTE outpatient education to 95% and importantly 94% of high-risk patients received prophylactic anticoagulation.

In their new work published in Lancet Regional Health - Americas, UVM Cancer Center members Steven Ades MD MSc, Karlyn Martin MD, Ryan Thomas MD, and Chris Holmes MD PhD, together with Medical Center colleagues Jacob Barker PharmD, and Karen Libby BSN, collaborated with the community oncology practice, New England Cancer Specialists, to evaluate the effectiveness of the Vermont Model in a community oncology setting. Under the model, 100% of patients received VTE education and 98% underwent VTE risk assessment. Of patients who were identified to have a high risk for VTE, 27% initiated anticoagulation treatment. 

The authors analyzed barriers to initiation of treatment for high-risk patients from both the provider and patient perspectives. Providers indicated concerns about the combined list of medications, current bleeding, planned procedures, and discomfort with a new care process. Patients indicated issues with insurance, personal preference, and feeling overwhelmed at the time of the offer impacted their decisions about treatment. While this model successfully increased the rates of education and risk assessment, the study highlights the need to better understand how to overcome barriers to treatment initiation in high risk VTE patients in the community oncology setting. 

Future work will focus on simplification of the risk assessment process, patient-focused decision-making resources, and the incorporation of medication-related bleeding risk assessment to support both providers and patients in initiating anticoagulation treatment for patients at high-risk for VTE. 

You can read the full publication here.