A survey of physician perception and practices regarding pharmacological thromboprophylaxis use during chemotherapy for bladder cancer
Andrew Amenyogbe1, Francis Lemire1, David Yachnin2, Marc Carrier2,3, Kristen McAlpine4, Rodney H. Breau1,2, Dominick Bosse2,5, Tzu-Fei Wang2,3, Christopher Morash1, Ilias Cagiannos1, Luke T. Lavallée1,2.
1Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada; 2The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; 3Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; 4Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; 5Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
Introduction: Patients with bladder cancer have a high risk of venous thromboembolism (VTE); furthermore, chemotherapy has been shown to increase this risk. Among patients receiving chemotherapy, there is Level 1 evidence to support the use of thromboprophylaxis. However, we hypothesized that patients with bladder cancer in Canada are not routinely offered this treatment. We aimed to characterize practice patterns and perceptions of Canadian experts regarding thromboprophylaxis for patients with bladder cancer.
Methods: In this prospective, cross-sectional study, a survey questionnaire was distributed to Canadian urologic and medical oncologists who manage advanced bladder cancer. Our survey explored thieir opinions regarding VTE rates, use of risk stratification scores, use of prophylaxis in different treatment settings, and interest in additional clinical trials. Physicians were invited to answer the survey between July and September 2021.
Results: Seventy physicians were invited and 36 (51%) completed the survey, including 20 (67%) urologists and 16 (42%) medical oncologists (demographics are listed in Table 1). Most respondents (97%) believed that exposure to platinum chemotherapy increases the risk of VTE (Figure 1). For patients receiving neoadjuvant chemotherapy, 94% of respondents estimated the risk of VTE to be 10% or higher. Despite that, 69% indicated they do not routinely recommend thromboprophylaxis (Figure 2). Most physicians (36%) were deferring that decision to another physician, while 32% believe there is not enough evidence (Figure 3). We found similar results for patients undergoing induction of chemotherapy. Ninety-four percent of respondents were interested in participating in a thromboprophylaxis trial.
Conclusions: Patients with bladder cancer receiving chemotherapy are not routinely offered thromboprophylaxis. We found strong interest among Canadian physicians to participate in clinical trials examining this topic.
