Riondino Silvia, Ferroni Patrizia, Del Monte Girolamo, Formica Vincenzo, Guadagni Fiorella, Roselli Mario
Department of Systems Medicine, Medical Oncology, University of Rome, Tor Vergata, 00133 Rome, Italy.
Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, 00166 Rome, Italy.
Cancers (Basel). 2020 May 6;12(5):1167. doi: 10.3390/cancers12051167.
Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed and if such a care takes place early in the course of the disease, combining standard oncology care and palliative care. In these settings, venous thromboembolism (VTE) represents a difficult medical challenge, for the requirement of acute treatments and for the strong impact on anticancer therapies that might be delayed or, even, totally discontinued. Moreover, cancer patients not only display high rates of VTE occurrence/recurrence but are also more prone to bleeding and this forces clinicians to optimize treatment strategies, balancing between hemorrhages and thrombus formation. VTE prevention is, therefore, regarded as a double-edged sword. Indeed, while on one hand the appropriate use of antithrombotic agents can reduce VTE occurrence, on the other it significantly increases the bleeding risk, especially in the frail patients who present with multiple co-morbidities and poly-therapy that can interact with anticoagulant drugs. For these reasons, thromboprophylaxis should start while active cancer treatment is ongoing, according to a simultaneous care model in a patient-centered perspective.
同步护理代表了正在接受积极抗肿瘤治疗的癌症患者早期支持性护理与姑息治疗之间的理想整合。癌症患者需要综合的临床、社会和心理管理，只有保证从医院到家庭的护理连续性，并且在疾病过程早期进行这种护理，将标准肿瘤护理与姑息治疗相结合，才能有效。在这些情况下，静脉血栓栓塞（VTE）是一项艰巨的医学挑战，因为需要进行急性治疗，且对可能延迟甚至完全中断的抗癌治疗有很大影响。此外，癌症患者不仅VTE发生/复发率高，而且更容易出血，这迫使临床医生优化治疗策略，在出血和血栓形成之间取得平衡。因此，VTE预防被视为一把双刃剑。确实，一方面，适当使用抗血栓药物可以降低VTE的发生率，但另一方面，它会显著增加出血风险，尤其是在患有多种合并症且接受多种治疗、可能与抗凝药物相互作用的体弱患者中。出于这些原因，应根据以患者为中心的同步护理模式，在积极的癌症治疗进行期间开始血栓预防。
