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Support Care Cancer. 2019 May 1. doi: 10.1007/s00520-019-04815-z. [Epub ahead of print]

Factors influencing patient's perception of long-term treatment with low-molecular-weight heparins for cancer-associated thrombosis: an updated analysis of TROPIQUE, a prospective observational study.

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Unité de soins de support, Institut Sainte Catherine, 250 chemin de baigne pieds CS 80005, 84918, Avignon, France.
Laboratoire Interuniversitaire de Psychologie, Université Grenoble Alpes, BP 47-38040, Grenoble Cedex 9, France.
Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire, Hôpital St-Louis, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Université Denis Diderot, Paris, France.
Groupe Francophone Thrombose et Cancer, Paris, France.
Institut Curie, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint Cloud, France.
Service Oncologie Hôpital Claude Huriez, Rue Michel Polonowski, 59037, Lille, France.
Service de Médecine interne Hôpital du Bocage, 2 Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France.
Centre anti cancéreux Centre G.F. Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France.
Unité de pathologie vasculaire, Hôpital Emile Muller, 20 rue du Docteur Laennec, 68070, Mulhouse cedex 01, France.
Service d'oncologie, Hôpital américain de Paris, 63 boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.



Our objective was to compare patient's expectations to their experience and to identify factors predictive of patient's perception of long-term LMWH for the treatment of cancer-associated thrombosis (CAT).


Results from the validated Perception Anticoagulant Treatment Questionnaires (PACTQ) completed before inclusion (PACTQ1 for expectations) and at the end (PACTQ2 for convenience and satisfaction) of the 6-month TROPIQUE study were studied with principal component analysis. Possible predictive factors of improved perception of LMWH treatment were analyzed with the Kruskall-Wallis test.


Among 409 included patients treated with LMWH, 269 PACT-Q1 and 139 PACT-Q2 were evaluable for treatment perception. Patients had high expectations (A1-A7 score of 26.7 ± 3.5, max = 35). Treatment cost (A7 = 1.90 ± 1.31) and concern about a mistake in anticoagulation (A5 = 1.93 ± 1.12) had little importance while LMWH treatment was considered easy to use (A4 = 4.20 ± 0.93). Six-month treatment with LMWH was associated with a high rate of convenience (B1-B11, C1-C2 = 55.1 ± 8.38, max = 65) and a high satisfaction score (D1-D7 = 25.1 ± 4.32, max = 35). Patients' confidence in treatment and perception of possible LMWH side effects were moderate while perception of autonomy and independence significantly improved at the end of the study compared to inclusion. PACT-Q2 satisfaction score was low in patients who experienced bleeding (PACT-Q2 24.1 ± 3.3 vs. 25.1 ± 4.3). LMWH twice daily tended to be found less convenient compared than once daily (53.3 ± 7.2 vs. 55.0 ± 8.3).


CAT patients had a good perception of the 6-month LMWH treatment when comparing expectations and experience. Using a quantitative scale validated in the general population for VTE and subcutaneous injection and including a large number of patients, bleeding complications and LMWH twice daily were associated with a nonsignificant trend towards a worsen perception.


Acceptability; Cancer; Experience; LMWH; Quality of life; Venous thromboembolism


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