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Oral anticoagulation is preferable to injected, but only if it is safe and effective: An interview study of patient and carer experience of oral and injected anticoagulant therapy for cancer-associated thrombosis in the select-d trial

Hutchinson, Ann; Rees, Sophie; Young, Annie; Maraveyas, Anthony; Date, Kathryn; Johnson, Miriam

Authors

Sophie Rees

Annie Young

Anthony Maraveyas

Kathryn Date



Abstract

Background
Cancer patients have a 4 to 5 fold greater risk of thrombosis than the general population. Recommended treatment for cancer-associated thrombosis is 3 to 6 months of low-molecular-weight heparin. The ‘select-d’ trial is an open-label randomised, multi-centre pilot trial in patients with cancer-associated thrombosis, utilising dalteparin (low-molecular-weight heparin) vs rivaroxaban (a direct oral anticoagulant), to assess effectiveness and safety.
Aim
To explore patient and informal carers’ experiences of cancer-associated thrombosis and their experience and understanding of the risk-benefit of thrombosis treatment.
Design
Qualitative sub-study of the select-d trial, using semi-structured interviews. Interviews were audio-recorded and transcribed. Data were analysed using Framework Analysis.
Participants
Participants were purposively sampled (n=37 patients; 46% male; age 40 to 89; 9 with carer present).
Results
Three themes were found: experience of cancer-associated thrombosis; experience of anticoagulation and risk-benefit balance of the two modes of administration. Some were shocked by their thrombosis diagnosis (most were unaware of their risk), but others found it insignificant compared with cancer. Most patients found tablets more convenient, but injections were acceptable in the context of having cancer. Whilst most were happy to follow medical advice, others weighed preference on the basis of effectiveness.
Conclusions
Lack of awareness of thrombosis risk is concerning; cancer patients must be informed to enable prompt help-seeking. Tablets could provide a welcome choice for patients if there is equivalent risk-benefit to injected anticoagulants. Patients trust their clinicians to tailor their treatment. Future research could explore the effect of routine information-giving about the risk of thrombosis.

Journal Article Type Article
Publication Date May 1, 2019
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 33
Issue 5
Pages 510-517
APA6 Citation Hutchinson, A., Rees, S., Young, A., Maraveyas, A., Date, K., & Johnson, M. (2019). Oral anticoagulation is preferable to injected, but only if it is safe and effective: An interview study of patient and carer experience of oral and injected anticoagulant therapy for cancer-associated thrombosis in the select-d trial. Palliative medicine, 33(5), 510-517. https://doi.org/10.1177/0269216318815377
DOI https://doi.org/10.1177/0269216318815377
Keywords Thrombosis; Anticoagulants; Neoplasms; Injections; Tablets; Interview; Direct oral anticoagulants; Low molecular-weight heparins
Publisher URL https://journals.sagepub.com/doi/10.1177/0269216318815377

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Copyright Statement
©2018 The authors

This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).





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