Venous thromboembolism (VTE) is a major cause of death and morbidity in patients with cancer. Low molecular weight heparin (LMWH) has been the backbone of the treatment of cancer associated thrombosis (CAT). Direct-acting oral anticoagulants (DOAC) have shown efficacy and safety not inferior to LMWH and most recent guidelines included DOACs as an option for the CAT treatment.
The aim of the survey was to better understand the prescription trends of DOACs in patients with cancers in Italy, especially gynaecological cancers (GCs). The survey was made of 21 questions and the last 4 questions were addressed to doctors involved in Gynecological Oncology. An invitation to complete the survey was sent by e-mail to 691 MITO (Multicentre Italian Trials in Ovarian cancer and gynaecologic malignancies) and 2093 AIOM (Associazione Italiana di Oncologia Medica) members on 13 October 2021 and 14 October 2021, respectively. Respondents completed the survey by 15 November 2021.
Overall, 113 medical doctors (MDs) completed the questionnaire and 69 of them were involved in Gynecological Oncology. Most of the respondents (46, 41%) were aged 30-40 years old, worked in a Public Hospital (59, 52.2%), were Medical Oncologists (86, 76.1%) and, at the time of the survey, were not allowed by Italian Regulations to prescribe a DOAC (108, 96%). LMWH was widely the preferred choice for the treatment of CAT (104, 92%). However, 89 (78.8%) of the respondents stated that they had prescribed or asked another specialist to prescribe a DOAC for CAT. The major concern about DOACs was the difficulty to verify the therapeutic effect/absence of antidotes in case of severe bleeding (37.9%). In patient with GCs, DOACs were used with Niraparib, Olaparib and Rucaparib in less than 10 patients by 23%, 20% and 9% of the respondents, respectively. They seemed to be more confident in the use of immune checkpoint inhibitors (ICIs) with a DOAC, indeed 10.2% (7/69) have employed them in more than 10 patients.
DOACs are still poorly prescribed in patients with cancer, especially for GCs.
The authors.
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All authors have declared no conflicts of interest.