Abstract
Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognitive impairment, anemia, thrombocytopenia, mobility, nutritional status, Eastern Cooperative Oncology Group grade, risk of falls, and reduced life expectancy. In the absence of specific clinical studies current anticoagulant treatment guidelines for the management are not fully applicable to frail patients with cancer. The anticoagulant treatment should therefore benefit from a tailored approach based on an algorithm that takes into account the specificities of the malignant disease.
Highlights
According to the American Medical Association (AMA), the term “frailty” characterizes “the group of patients that presents the most complex and challenging problems to the physician and all health care professionals”, because they have a higher susceptibility to adverse outcomes such as mortality and institutionalization [1]
Given the similarities regarding age and frailty in and cancer patients we found appropriate
Given the similarities regarding age and frailty in atrial fibrillation (AF) and cancer patients we found to adapt the to AFadapt algorithm to algorithm patients with cancer taking into account specific frailty contributing appropriate the AF
Summary
According to the American Medical Association (AMA), the term “frailty” characterizes “the group of patients that presents the most complex and challenging problems to the physician and all health care professionals”, because they have a higher susceptibility to adverse outcomes such as mortality and institutionalization [1]. Among the observed heterogeneity of viewpoints, a definition focusing on five domains with the corresponding criteria including nutritional status (loss of bodyweight), energy (exhaustion), physical activity (leisure time activity), and strength (grip strength) is frequently used [3] This allows defining the frail phenotype and identifying older persons at elevated risk for numerous adverse outcomes. Regarding the use of anticoagulants several situations at risk representing multiple challenges for the management of frail patients have been considered They include chronic kidney disease (CKD), underweight or malnutrition, falls, cognitive impairment, multi-medication, pregnancy and cancer [4]. All these situations may apply to patients with cancer to define frailty. The aim of this review was to identify main contributors to frailty in patients with cancer at risk of VTE and to discuss a decision-making algorithm for the management of the anticoagulant treatment in these patients
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