Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
Hacettepe Cancer Institute, Hacettepe University, Ankara, Turkey.
Support Care Cancer. 2021 Mar;29(3):1699-1709. doi: 10.1007/s00520-020-05669-6. Epub 2020 Aug 10.
Cancer-associated venous thromboembolism (VTE) can cause many unfavorable health outcomes. Many institutions have published guidelines, but implementation of these guidelines in cancer clinics is still under investigation. This study aimed to evaluate the guideline adherence and identify potential gaps between the recommendations and their implications in clinics.
A prospective study was conducted between September and December 2018 at oncology inpatient and ambulatory settings. The guideline adherence rate was assessed for inpatients during hospital stay by using 8 criteria developed based on the National Comprehensive Cancer Network (NCCN) Guideline on Cancer Associated Venous Thromboembolic Disease Version 1.2018. Guideline-based recommendations were proposed to the consultant physician in case of non-adherence. Khorana risk scores were calculated for each patient at outpatient clinics. In cases where the score was found to be ≥ 3, the consultant physician was informed.
A total of 100 inpatients and 200 ambulatory patients were included in the study. The guideline adherence rates ranged between 59 and 100% for 5 out of 8 pre-defined criteria, whereas the rate for others remained at 0-1%. A significant increase was observed in the adherence rates for initiation of prophylaxis at admission and determination of correct dose of an anticoagulant after recommendations being implemented (p < 0.001, McNemar test). Eleven patients were identified as at high-risk of VTE at ambulatory setting; however, an initiation of an anticoagulant was not considered by the consultant physicians.
There are potential problems in implementation of guideline recommendations, which leads to low adherence rate. Therefore, liason with pharmacists and consultants for individual risk assessment and monitoring of patients will help to increase guideline adherence rates.
癌症相关静脉血栓栓塞症（VTE）可导致许多不良健康后果。许多机构已经发布了指南，但癌症诊所对这些指南的实施情况仍在调查中。本研究旨在评估指南的依从性，并确定建议与临床实践之间的潜在差距。
2018 年 9 月至 12 月在肿瘤住院和门诊环境中进行了一项前瞻性研究。通过使用基于美国国家综合癌症网络（NCCN）癌症相关静脉血栓栓塞疾病指南第 1.2018 版制定的 8 个标准，评估住院患者在住院期间的指南依从率。对于不遵守的情况，向顾问医生提出基于指南的建议。在门诊时为每位患者计算 Khorana 风险评分。如果发现评分≥3，则告知顾问医生。
共有 100 名住院患者和 200 名门诊患者纳入研究。8 项预定义标准中的 5 项的指南依从率在 59%至 100%之间，而其他标准的依从率仍为 0-1%。在实施建议后，入院时开始预防和确定抗凝剂正确剂量的依从率显著增加（p<0.001，McNemar 检验）。在门诊环境中发现 11 例患者存在 VTE 高风险，但顾问医生未考虑开始抗凝治疗。
指南建议的实施存在潜在问题，导致依从率较低。因此，与药剂师和顾问进行联系，对患者进行个体风险评估和监测，将有助于提高指南的依从率。
