Cancer Care

It is estimated that up to 20% of cancer patients may develop venous thromboembolism (VTE) at some time in their cancer journey. Cancer-associated VTE can lead to hospitalizations, morbidity, delayed cancer treatment, and mortality. Optimal prevention and management of cancer-associated thrombosis (CAT) is of utmost importance. Cancer patients face unique challenges and comorbidities that can lead to increased risks and concerns with anticoagulation. Oncological, surgical, and anesthesiologist teams from the six AP-HP. Nord hospitals are involved in the specific management of CAT.

The most complicated cases are discussed in a monthly multidisciplinary thrombosis board (MTB), with a specific computed sheet to prospectively register and present clinical cases in each hospital. Diagnosis, biological exploration (hemostasis), and therapeutic counseling are addressed at this MTB, or by direct contact with the referent team of each hospital, with a high-level knowledge of the patients’ profiles on each site, mostly related to the specificities of cancers managed on this site.

Pr. Mahé is an internationally renowned expert in the treatment of CAT, while Pr. Ajzenberg is an expert in the biological exploration of hemostasis diseases and abnormalities. Referent oncologists and specialists (pulmonologists, cardiologists, internists, and hematologists) also participate in this MTB and in the routine care of such patients.

Large clinical research randomized studies are sponsored by the AP-HP Nord in this field, exploring both the duration and type of anti-thrombotic drugs in cancer patients in relation with adverse events and recurrence risk. An emblematic ongoing trial is the phase III international APICAT trial (principal investigator: Pr. Mahé), which tests two levels of apixaban dosing for extended treatment in cancer patients.

The strength of this study is that it involves all clinical (intensive care unit, emergency department, pulmonology, cardiology), radiological (nuclear medicine, CT-scan, echocardiography), and biological (hemostasis, genetics, and immunology laboratories) facilities on each hospital site and benefits from a large recruitment of cancer patients (more than 16,000 new patients each year), with all tumor types represented (specifically those with the highest rate of thrombosis: digestive, H&N, urological, and lung cancers). Many of these patients undergo surgical resection procedures, which tend to favor venous thrombosis and require a specific involvement of anesthesiologists and intensivists in prevention and management.

In addition, the Lariboisière Hospital hosts a specific outpatient clinic called “CREATIF” for patients who have difficulties equilibrating their anticoagulant treatment, while a similar structure called “the anticoagulant clinic” and managed by hematologists (Dr. De Raucourt) for patients with liver vascular disease exists in Beaujon Hospital. Specialists in vascular medicine from the internal medicine departments in Louis Mourier (Pr. Mahé), Bichat (Pr. Ajzenberg, Dr. Alexandra), and Saint-Louis Hospitals (Dr. Gauthier) provide specialized counseling for patients taken in charge in various clinical departments. Therapeutic education programs labelled by the regional health agency focus on patients anticoagulated for any reason, including for CAT. Pr. Mahé is the head of the patient association “anticoag PASS S2D”.