Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study

Abstract

Therapy for cancer associated-venous thromboembolism (VTE) includes long term anticoagulation, which may have substantial impact on the health-related quality of life (HRQL) of patients. We assessed patient-reported outcomes to characterize the HRQL associated with VTE treatment and to begin to examine those HRQL elements impacting anticoagulation adherence (AA). MethodsParticipants were adult cancer patients with con rmed symptomatic acute lower extremity deep venous thrombosis. Patients were excluded if there was an indication for anticoagulation other than VTE, ECOG performance status > 3 or life expectancy < 3 months. Participants were assessed with a self-reported adherence tool. HRQL was measured with a 6-domain questionnaire using a seven-point Likert scale.Evaluations were performed at 30 days and 3 months after enrollment. For the primary objective, an overall adherence rate was calculated at each time point of evaluation. For the HRQL domains, nonparametric testing was used to compare results between subgroups. Results74 patients were enrolled. AA and HRQL at 30 days and 3 months were assessed in 50 and 36 participants, respectively. At 30 days the AA rate was 90% and at 3 months it was 83%. In regard to HRQL, patients suffered frequent and moderate-severe distress in the domains of emotional and physical symptoms, sleep disturbance and limitations to physical activity. An association between emotional or physical distress and AA was observed. ConclusionPatients with VTE suffer a substantial impairment of their HRQL. Increased distress correlated with better AA. These results can be used to inform additional research aimed at developing novel strategies to improve AA. BackgroundUp to 15% of all cancer patients develop venous thromboembolism (VTE) every year, and cancerassociated VTE causes signi cant morbidity and mortality [12,34]. The current standard of care for treatment of cancer associated-VTE is anticoagulation using low molecular weight heparin (LMWH) and/or direct oral anticoagulants (DOAC) for as long as cancer is active or the patient is receiving antineoplastic therapy [6,15,17, 18]. There are accumulating data, using both general and VTE-speci c