Title:
Women, Thrombosis, and Cancer Strategies to Improve and Measure Outcomes A Global CME Initiative
Release date:
June 12, 2017
Expiration date:
June 11, 2018
Topics:
Hematology, Intensive Care, Oncology
Primary Audiences:
Oncologists, obstetricians and gynecologists, and other specialists and family physicians with an interest in thrombosis in women with cancer
Activity Format:
Patient Case Studies
Credits:
13 CME credits, RCPSC MOC Section 1

Needs Assessment

To consult the Needs Assessment, click here.

Activity Abstract

Venous thromboembolism (VTE) in cancer is associated with poor prognosis and shortened survival. The risk of developing VTE and experiencing VTE recurrence is higher in patients with cancer. These individuals also have more bleeding complications compared to non-cancer patients. Many of the treatment concerns associated with the management and prevention of VTE in cancer apply to both women and men, and evidence-based clinical practice guidelines are developed without distinguishing between the sexes. However, a number of health considerations warrant a more personalized approach to VTE treatment and prophylaxis in women with cancer, particularly during pregnancy and in the use of hormonal treatments.

This case-based educational program will provide physicians with an up-to-date overview of VTE in cancer, including recommendations from 2016 international clinical practice guidelines for the treatment and prophylaxis of VTE in cancer patients. The program will also review 12 challenging clinical scenarios in women with VTE and cancer, providing appropriate treatment and prevention strategies. Learners will complete practice assessments before and after the learning activity, which will involve reviewing data from their female patients with a diagnosis of cancer and thrombosis. The comparison between the pre-/post-activity practice assessments will determine whether participation in the educational initiative successfully produced changes in behaviour. A self-reflective exercise will conclude the program and summarize the impact of the educational program on clinical practice.

Learning Objectives

Overview of Women, Thrombosis and Cancer
At the end of this module, participants will be able to:
  • Describe the risks and consequences of VTE, including DVT, PE, and CRT in women with cancer
  • Establish personalized VTE prophylaxis in women with cancer in both surgical and medical settings
  • Evaluate challenging clinical scenarios specific to women with cancer and thrombosis, including hormonal therapies and pregnancy
  • Apply appropriate prophylaxis and treatment of VTE, including CRT, in patients with cancer, as recommended by theInternational clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Module 1. VTE in Surgical Cancer: Cervical Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate treatment of VTE in a woman diagnosed with early-stage cervical cancer
  • Evaluate strategies for appropriate perioperative VTE prophylaxis

Module 2. VTE in Surgical Cancer: Endometrial Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate thromboprophylaxis for a woman undergoing hysterectomy for endometrial cancer
  • Evaluate use of extended prophylaxis
  • Evaluate alternate strategies if anticoagulant treatment was contraindicated

Module 3. VTE in Surgical Cancer: Colorectal Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate thromboprophylaxis for a woman undergoing colorectal surgery for cancer
  • Evaluate strategies for appropriate treatment of established VTE

Module 4. VTE in Surgical Cancer: Colorectal Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate thromboprophylaxis for women undergoing laparoscopy for colorectal cancer
  • Evaluate strategies for appropriate treatment of established VTE

Module 5. Catheter-Related Thrombosis: Early-stage Breast Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate prophylaxis and treatment strategies for VTE in a woman with early-stage breast cancer undergoing chemotherapy administered via CVC
  • Evaluate appropriate strategies to manage VTE recurrence

Module 6. Catheter-Related Thrombosis: Ovarian Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate prophylaxis and treatment strategies for VTE in a woman with ovarian cancer undergoing chemotherapy administered via a PICC line

Module 7. VTE in Medical Cancer: Advanced Breast Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate VTE treatment strategies in a woman with metastatic breast cancer undergoing systemic chemotherapy
  • Evaluate the association between tamoxifen treatment and risk of developing VTE

Module 8. VTE in Medical Cancer: Advanced Breast Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate VTE treatment strategies in a woman with metastatic breast cancer undergoing systemic chemotherapy
  • Evaluate the association between tamoxifen treatment and risk of developing VTE

Module 9. VTE in Medical Cancer: Advanced Lung Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate thromboprophylaxis and VTE treatment strategies in a woman with advanced non-small-cell lung cancer undergoing chemotherapy
  • Evaluate the association of HRT and risk of developing VTE
  • Review strategies for treatment of VTE in the presence of severe renal failure

Module 10. VTE in Medical Cancer: Advanced Pancreatic Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate thromboprophylaxis in a woman with reduced mobility and advanced pancreatic cancer undergoing chemotherapy
  • Evaluate the risk of VTE associated with HRT and ESAs

Module 11.VTE in Pregnancy: Thyroid Cancer Patient
At the end of this module, participants will be able to:
  • Apply appropriate VTE treatment strategies in a young woman with thyroid cancer
  • Evaluate the association of oral contraceptives and the risk of developing VTE
  • Assess the management approach if the patient were to become pregnant

Module 12. VTE in Pregnancy: Melanoma Cancer Patient
At the end of this module, participants will be able to:
  • Assess use of VTE prophylaxis in a young woman with melanoma
  • Evaluate VTE management approach if the patient were to become pregnant, or if the patient was already pregnant at diagnosis

Faculty and Disclosures

Co-Chairs (ITAC-CME)
Pr. Henri Bounameaux (Switzerland)
Dean of Faculty of Medicine, University of Geneva, Switzerland
Receipt of honoraria or consultation fees: Bayer Pharma (Switzerland)

Pr. Dominique Farge-Bancel (France)
Professor of Internal Medicine and Vascular Disease, St Louis Hospital, APHP, Paris 7 University, France
Receipt of grants/research supports: LEO Pharma
Receipt of honoraria or consultation fees: Aspen Pharmacare, Daiichi Sankyo, Pfizer, Sanofi, GlaxoSmithKline

Canadian Chair
Pr. James Douketis
Professor, Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Canada
Associate Director, Clinical Teaching Unit, St. Joseph's Hospital, Hamilton, Canada
Staff Physician, Clinical Thromboembolism and General Internal Medicine Services, St. Joseph’s Hospital, Hamilton, Canada
Receipt of grants/research supports: Boehringer Ingelheim
Receipt of honoraria or consultation fees: AGEN Biomedical, Astra Zeneca, Bayer,
Biotie Therapies, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen-Ortho, Pfizer, Portola, Sanofi, The Medicines Company

Steering Committee (ITAC-CME)
Pr. Rupert Bauersachs (Germany)
Professor and Doctor, Vascular Medicine, Klinikum Damstadt GmbH, Darmstadt, Germany
Receipt of honoraria or consultation fees: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo
Participation in a company-sponsored speaker's bureau: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, LEO Pharma

Pr. Benjamin Brenner (Israel)
Director, Institute of Hematology and Bone Marrow Transplantation, Rambam Medical Centre, Haifa, Israel
Participation in a company-sponsored speaker's bureau: Aspen Pharmacare, Bayer Pharmaceuticals, Daiichi Sankyo, Pfizer, ROVI Laboratories, Sanofi

Dr. Philippe Debourdeau (France)
Oncologist, Institut Sainte Catherine, Avignon, France
Receipt of grants/research supports: Sanofi
Receipt of honoraria or consultation fees: Aspen Pharmacare
Participation in a company-sponsored speaker's bureau: Aspen Pharmacare, Daiichi Sankyo, Pfizer

Pr. Manuel Monréal (Spain)
Hospital Universitario Germans Trias i Pujol, Servicio de Medicina Interna, Ctra. de Canyet, Spain
Receipt of grants/research supports: Bayer Pharma AG, Sanofi
Receipt of honoraria or consultation fees: Bayer, Boehringer Ingelheim, Daiichi Sankyo, LEO Pharma
Participation in a company sponsored speaker's bureau: Bayer, Daiichi Sankyo, LEO Pharma, Sanofi

Pr. Ingrid Pabinger (Austria)
Professor of Hemostaseology, Medical University of Vienna, Vienna, Austria
Receipt of honoraria or consultation fees: Bayer, Boehringer Ingelheim, Pfizer

Consultant (ITAC-CME)
Rt. Hon. Pr. Lord Ajay Kakkar (United Kingdom)
Professor of Surgery, University College London, London, UK
Receipt of grants/research supports: Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo Europe, Eisai, Pfizer, Sanofi S.A.
Receipt of honoraria or consultation fees: Bayer HealthCare, Boehringer Ingelheim, Daiichi Sankyo Europe, Sanofi S.A

Commercial Support

This activity is supported by an unrestricted educational grant from Aspen Pharmacare.

Other Sponsoring Organization

This CME/CPD activity is sponsored by the not-for-profit professional organization, ITAC-CME, which has provided access to its mobile app, “International Clinical Practice Guidelines for the Treatment and Prophylaxis of Venous Thromboembolism in Patients with Cancer” on this website. This mobile app is based on the international clinical guidelines that form the basis of the prophylaxis and treatment recommendations in the Learning Modules in this CME/CPD activity.

Accreditation and Credit Designation

This event is approved for up to 13 credits by the Office for Continuing Professional Development (CPD). The Office for CPD, Faculty of Medicine, McGill University is fully accredited by the Committee on Accreditation of Canadian Medical Education (CACME).

This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada.

Through an agreement between the Royal College of Physicians and Surgeons of Canada and the American Medical Association, physicians may convert Royal College MOC credits to AMA PRA Category 1 Credits™. Information on the process to convert Royal College MOC credit to AMA credit can be found at http://www.ama-assn.org/go/internationalcme.

Each physician should claim only credit commensurate with the extent of their participation in the activity.

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity.

This activity is designed to be completed within the time designated on the title page; Learners should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, Learners must complete the activity online during the valid credit period that is noted on the title page.

Instructions for Claiming Credits

Note that the credit you receive is based on your user profile.
  1. Read the target audience, learning objectives, and author disclosures on this page.
  2. Prior to studying a module, you must complete the pre-activity test associated with the module.
  3. Study the educational content of each module you would like to complete.
  4. Complete the post-activity test at the end of each module you choose to study in order to receive a Certificate of Completion and claim credit.
  5. Complete the activity Evaluation for the module to provide feedback for future programming.
  6. Click “Claim Credit” and follow the instructions to print out the Certificate of Completion. Note that you cannot alter the Certificate. Keep this Certificate in your files.

Hardware/Software Requirements

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More Information

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