NUR 03.2 - Cancer Screening Investigations in Unprovoked Venous Thromboembolism

Tuesday, July 12, 2022

4:50 PM – 5:10 PM

Location: ExCel Center, ICC Capital Suite Room 17

Presentation Format: In-Person

Co-Author(s)

Emma Gee, MSc

Nurse Consultant
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Presenting Author(s)

Simon Guppy, BSc (Hons)

DVT Clinical Nurse Specialist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Co-Author(s)

AG

Anna Gazes

DVT Clinical Nurse Specialist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
SD

Sinead Duffy

Lead Anticoagulation Nurse Specialist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
RP

Raj K. Patel

Haematology Consultant
Kings College Hospital
London, England, United Kingdom
Lara N. Roberts, MD

Haematology Consultant
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Julia Czuprynska, MBBS MRCP FRCPath

Haematology Consultant
King's College Hospital
London, England, United Kingdom
Roopen Arya, MA PhD FRCP FRCPath

Professor of Thrombosis and Haemostasis
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Background: Incidence of occult cancer in unprovoked venous thromboembolism (VTE) has been reported at around 5-10%1-2. Age, previous VTE, chronic lung disease and smoking status are considered important factors in predicting occult malignancy in unprovoked VTE but there is no validated risk assessment tool3-4. The outpatient DVT clinic at a London teaching hospital has its own cancer screening strategy for patients presenting with unprovoked VTE.

Aims: To assess adherence to the local cancer screening approach and the yield of routine chest x-ray (CXR), bone profile, prostate specific antigen (PSA) tests (in males) and a local cancer screening questionnaire (CSQ) in detecting occult cancer in unprovoked VTE.

Methods: Using hospital electronic patient records, all unprovoked DVT diagnosed via the nurse-led DVT clinic in 2021 (n=153) were reviewed. Investigations and their outcomes were recorded to determine rates of occult cancer detection.

Results: 131/153 (87%) patients with unprovoked VTE had a CXR, ten (7%) of which were abnormal. Two patients required further investigation, no malignancy detected.
132/153 (86%) patients had a bone profile, 16 (12%) of which were mildly abnormal and not investigated.
78/92 (85%) of males had a PSA, 32 (41%) of which were elevated, and led to a prostate cancer diagnosis.
137 (91%) patients underwent CSQ. Eleven (8%) patients required further investigation. One was diagnosed with renal cell cancer, one with endometrial thickening (awaiting further investigation).
Within six months of unprovoked DVT, five (3.2%) patients had suspected/confirmed cancer diagnoses, four (2.6%) of which were detected by the cancer screening strategy.

Conclusion(s): CXR and bone profile not detect any occult cancer in patients with unprovoked VTE. Further work is needed to evaluate how best to incorporate routine investigations into a cancer screening strategy.