Research Papers:
Quality of life in cancer patients undergoing anticoagulant treatment with LMWH for venous thromboembolism: the QUAVITEC study on behalf of the Groupe Francophone Thrombose et Cancer (GFTC)
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Abstract
Dominique Farge1, Francis Cajfinger2, Nicolas Falvo3, Toufek Berremili4, Francis Couturaud5, Okba Bensaoula6, Lionel Védrine7, Hocine Bensalha1, Isabelle Bonnet8, Denis Péré-Vergé9, Marie Coudurier10, Veronique Li11, Hanadi Rafii1, Ilham Benzidia1, Jean M. Connors12,* and Matthieu Resche-Rigon13,*
1Assistance Publique-Hopitaux de Paris, Saint-Louis Hospital, Internal Medicine, Autoimmune and Vascular Disease Unit, UF 04, Diderot University, Paris, France
2Medical Oncology, Hôpital Pitié-Salpêtrière, Paris, France
3Département de Pathologie Vasculaire, CHU Dijon, Dijon Cedex, France
4Department of Cardiology, Annecy Hospital, Annecy, France
5Brest University Hospital, CHU de Brest, Brest, France
6Department of Oncology, CLCC Curie Institute, Centre Rene Huguenin, Saint Cloud, France
7Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France
8Department of Oncology, Hospital of Valenciennes, Valenciennes, France
9CH Saint Joseph Saint Luc, Lyon, France
10Chambéry CH, Chambéry, France
11CH Thonon-Les-Bains, Thonon-les-Bains, France
12Hematology Division, Harvard Medical School, Boston, MA, USA
13Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint-Louis, Paris, France
*These authors contributed equally to this work
Correspondence to:
Dominique Farge, email: [email protected]
Keywords: cancer thrombosis; venous thromboembolism; anticoagulation therapy; quality of life; LMWH
Received: March 30, 2018 Accepted: May 02, 2018 Published: June 05, 2018
ABSTRACT
Background: Clinical guidelines recommend at least 3-months low molecular weight heparin (LMWH) treatment for established venous thromboembolism (VTE) in cancer patients. However, no study has analyzed the impact of 3–6 months of LMWH therapy on quality-of-life (QoL) in cancer patients.
Results: Among 400 cancer patients included at M0, 88.8% received long-term LMWH. Using a random-effects linear regression model with time as covariate, QoL scores in the MOS SF-36 (Global HRQoL, 1.3-fold per month [95% confidence interval (CI) 0.81–1.79], p < 0.0001) and EORTC QLQ-C30 (global health status/qol, 2.25-fold per month [95% CI 1.63–2.88]; p < 0.0001) questionnaires significantly improved over the 6-month study period in patients treated with LMWH, while VEINES-QOL scores did not change. In the MOS SF-36 and EORTC QLQ-C30, the following factors were associated with change in QoL: symptomatic VTE, cancer dissemination and histological type. Factors pertaining to reduced mobility were also identified as significant predictors of QoL outcomes, including being bedridden in the MOS SF-36 and ECOG score ≥ 2 in the EORTC QLQ-C30. Presence of acute infection and not undergoing anti-angiogenic therapy were additional factors associated with QoL improvement in the EORTC QLQ-C30.
Methods: QUAVITEC, a prospective, longitudinal, multicenter study, recruited all consecutive eligible adult cancer patients with objectively confirmed VTE between February 2011 and 2012. Patients were asked to answer three QoL questionnaires at anticoagulant treatment initiation (M0) and at 3 (M3) and 6 (M6)-month follow-ups.
Conclusion: QUAVITEC is the first study to show that QoL was improved in cancer patients receiving long-term LMWH treatment for established VTE.
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