Awareness, preferences, and experiences of thrombosis and thromboprophylaxis in adults commencing systemic anticancer therapies: TARGET-TP trial.

person Marliese Alexander Pharmacy Department, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia info_outline Marliese Alexander, Samuel John Harris, Javier Torres, Craig Underhill, Sharad Sharma, Nora Lee, Hui-Li Wong, Richard Wilhelm Eek, Michael Michael, Jeanne Tie, Jennifer Rogers, Rachael Patrick, Alexander Graham Heriot, David Ball, Michael Patrick MacManus, Rory Wolfe, Benjamin J. Solomon, Kate Burbury

Authors person Marliese Alexander Pharmacy Department, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia info_outline Marliese Alexander, Samuel John Harris, Javier Torres, Craig Underhill, Sharad Sharma, Nora Lee, Hui-Li Wong, Richard Wilhelm Eek, Michael Michael, Jeanne Tie, Jennifer Rogers, Rachael Patrick, Alexander Graham Heriot, David Ball, Michael Patrick MacManus, Rory Wolfe, Benjamin J. Solomon, Kate Burbury Organizations Pharmacy Department, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia, Bendigo Cancer Centre, Bendigo Health, Bendigo, VIC, Australia, Goulburn Valley Health, Shepparton, VIC, Australia, Border Medical Oncology Research Unit, Albury Wodonga Regional Cancer Centre & Rural Medical School, Albury Campus, University of New South Wales, Albury-Wodonga, NSW, Australia, Ballarat Regional Integrated Cancer Centre, Ballarat Health Services, Ballarat, VIC, Australia, Department of Haematology, Peter MacCallum Cancer Centre, Victoria, Australia, Melbourne, Australia, Department of Medical Oncology, Peter MacCallum Cancer Centre and The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia, Border Medical Oncology Research Unit, Albury Wodonga Regional Cancer Centre, Albury Wodonga, NSW, Australia, Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia, Department of Medical Oncology, Peter MacCallum Cancer Centre and Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia, Pharmacy Department, Peter MacCallum Cancer Centre, Victoria, Australia, Melbourne, Australia, University of East Anglia, Norwich, United Kingdom, Department of Cancer Surgery, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia, Department of Radiation Oncology, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia, Department of Radiation Oncology, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia, Department of Medical Oncology and Research Division, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia, Department of Haematology, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia Abstract Disclosures Research Funding Other Foundation Peter MacCallum Cancer Foundation, Victorian Cancer Agency, Australian National Health and Medical Research Council. Background: While a leading cause of morbidity and mortality in cancer, prior studies report low awareness of cancer-associated thrombosis (CAT) among adults with cancer. Despite multiple guideline endorsed thromboprophylaxis (TP) agents and evolving data for personalised TP strategies, objective willingness to engage and preferences for care within ambulatory settings, have yet been elucidated. Methods: Individuals commencing systemic anticancer therapies lung and gastrointestinal cancers enrolled in the TARGET-TP trial of risk-directed ambulatory TP (ANZCTRN12618000811202) reported awareness, preferences, and engagement (related to CAT and TP) at enrolment, using a 6-item study specific survey. Participants were informed regarding the impact of CAT and the rationale for the study as part of the consent process however surveys were completed prior to clot risk-assessment, before being allocated and informed of trial arm (observation or intervention), and with instruction to answer based on knowledge and beliefs before participating in the consent process. Experiences with TP were assessed longitudinally in trial participants randomised to enoxaparin, using the validated 15-item Anti-Clot Treatment Scale (ACTS). Results were reported descriptively, compared over time and among subgroups of interest - including cancer type, new vs previously treated, age, sex, stage and treatment centre (specialist/general). Results: Data from 273/328 (83%) trial participants who completed surveys were evaluated. One third (34%) reported being unaware of CAT, but, given information, nearly all (99%) were willing to be proactive to prevent clots, including use of anticoagulants (97%): oral (92%) vs injectable (82%). Individuals reported willingness to use injectable (vs oral) in hypothetical situations where the injectable agent offered greater efficacy (91%), reduced bleeding risk (86%), or was less likely to interact with cancer medicines (87%). Results were similar among subgroups except individuals with lung cancer who reported higher CAT awareness if receiving care at specialist vs general hospital (79% vs 56%, P = 0.02). Among 83/100 (83%) trial participants randomised to enoxaparin TP who completed at least one ACTS survey, burdens of TP were infrequently reported: high burden (4%), any burden (19%). The most burdensome aspect was inconvenience of daily treatment, and least burdensome aspect related to perceived bleeding risks. More than 86% of individuals reported benefits of TP. Perceived burdens/benefits were consistent over the 6-month reporting period and within subgroups. Conclusions: Findings demonstrate gaps in supportive cancer care education across health services that if overcome present an opportunity to harness an overwhelming willingness of individuals with cancer to proactively engage in clot prevention strategies. Clinical trial information: ANZCTRN12618000811202.

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