The key to reducing EU cancer deaths

Thrombosis is the second biggest cause of preventable death in cancer patients. [napocska/Shutterstock]

The European Commission is likely to miss its target of decreasing cancer deaths by 15% by 2020. But a focus on thrombosis, the subject of a global awareness campaign today, could turn things around.

Receiving a cancer diagnosis is one of the scariest experiences a person can go through. In the blink of an eye, your life changes.

However, depending on the cancer’s stage, there are many things a person can do to work toward a good outcome. Cancer kills – it is the leading cause of death worldwide. But many of those deaths are not from cancer itself, instead, they are the result of other conditions caused directly or indirectly by cancer. Managing those conditions can often be a patient’s best hope of survival.

Thrombosis, a blood clot that forms within a deep vein, is the second most common cause of preventable death in cancer patients, after infection. People with cancer have a higher than normal risk of developing a blood clot in their veins. Yet the condition remains under-reported, seldom discussed and often misdiagnosed.

The clot usually forms in the leg. If untreated, part of the clot can break off and travel to the lungs, blocking blood flow.

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“There is a link between tumour production and growth” of blood clots, explains Doctor Ismaïl Elalamy, head of the haematology department at Tenon University Hospital in Paris. The same forces that create a tumour can also create a clot.

According to the UK Government`s All-Party Parliamentary Thrombosis Group, only 54% of patients receiving chemotherapy are made aware of the associated risk of thrombosis. Only 41% of UK hospital trusts have a policy for managing cancer-associated thrombosis.

The lack of awareness makes a big difference because the condition is not without symptoms. In fact, the symptoms can be quite intense. These include swelling in the leg area, redness on a leg or arm, or a warm or heavy sensation in the leg. But many patients mistakenly attribute these symptoms to side-effects of chemotherapy.

The European Cancer Patient Coalition has launched a campaign to educate cancer patients about the risks of cancer-association thrombosis and the associated symptoms. The campaign is also targeting policymakers. A focus on thrombosis could significantly reduce cancer deaths, they say.

“Thrombosis should be addressed by first emphasising actions in the field of raising awareness among healthcare professionals, policy-makers and patients,” says Francesco De Lorenzo, the coalition’s president. “Once awareness is improved, then it would be more efficient to explore together with patient organisations the specific targets on reducing thrombosis deaths.”

2020 approaching

In 2009, the European Commission set a goal of reducing cancer-related deaths by 15% by 2020 – as part of a strategy of action against cancer. Since then, cancer survival rates have increased, with much of the reason being technology development. Improvements in early diagnosis, screening and prevention has also played a significant role.

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While the overall risk of getting cancer in Europe seems to have stabilised, the overall risk of dying from cancer is declining, with degrees of change varying by country and by the type of cancer. But though deaths are declining, they are not doing so at a rate that suggests the 2020 target will be met.

De Lorenzo says that the Commission’s target was “very ambitious”, and so perhaps it isn’t surprising that it’s unlikely to be met. But a focus on thrombosis, given that it is both the second-biggest cause and underdiagnosed, could help the EU get there.

“Both at European and national level, policy-makers should increase awareness of the risks of thrombosis for cancer patients by targeting patients and healthcare professionals, especially general practitioners,” he says. “At national level, policy-makers could incentivise continuous training for medical professionals. Cross-country fellowship programmes could also be envisaged for the exchange of medical information.”

The coalition is lobbying national governments to include more specific topics in their national cancer plans, and Commission pressure or even coordination on this front could make a big difference. Harmonising existing guidelines on thrombosis prevention, early diagnosis and treatment between member states would also be helpful, De Lorenzo says.

Identifying those at risk

The EU could also get involved in funding some innovative new research in the field. Doctor Elalamy is currently undertaking research into how to identify those patients who are more at risk.

“There are markers of this hypercapability” to create the clots, he explains. “Our plan is to be able to identify through these markers who is more at risk of thrombosis, and who has a poorer prognosis.”

“If we are able to stratify the risk, we can therefore propose a shield to block this formation.” Patients at higher risk could be told not to exercise or drink alcohol, two factors that can exacerbate the chances of developing thrombosis

In the end, health systems are still national and mostly a member state competence. The European Commission currently has no specific programme for thrombosis awareness, according to a spokesperson. But the issue is taken into account in its general strategy for cancer treatments and their complications.

As the Commission mulls a post-2020 cancer mortality strategy, a closer focus on Thrombosis could perhaps save lives.

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