Online Exclusive Article

The Experience of Patients With Cancer Who Develop Venous Thromboembolism: An Exploratory Study

Alison Mockler

Brigit O'Brien


Jessica Emed

Gina Ciccotosto

venous thromboembolism
ONF 2012, 39(3), E233-E240. DOI: 10.1188/12.ONF.E233-E240

Purpose/Objectives: To better understand the experience of venous thromboembolism (VTE) from the points of view of patients with cancer during various stages of the cancer experience.

Research Approach: Qualitative, descriptive.

Setting: Various inpatient and outpatient units of a large urban university-affiliated hospital in Montreal, Quebec, Canada.

Participants: Purposive sample of 10 participants who were anticipating, had recently undergone, or were currently undergoing cancer treatment and who had received a VTE diagnosis within the past year.

Methodologic Approach: Semistructured interviews were transcribed verbatim. Thematic analysis of data revealed themes contributing to understanding the lived experience of VTE during cancer care.

Main Research Variables: The experience of patients with cancer who develop VTE.

Findings: Patients' initial reaction to VTE included VTE as a life-threat, past experience with VTE, and VTE as the "cherry on the sundae" in light of other cancer-related health issues. Patients' coping with VTE also included three themes: VTE being overshadowed by unresolved cancer-related concerns, VTE as a setback in cancer care, and attitudes about VTE treatment.

Conclusions: This study contributes new insight into the experience of patients with cancer who develop VTE. The most salient finding was that patients having no prior VTE knowledge experienced VTE as more challenging. Future studies comparing experiences with VTE across the various stages of cancer care are needed.

Interpretation: Study findings suggest that patient education about VTE would be useful for the initial reaction and subsequent coping phases of VTE, thus representing an important target area for nursing intervention.

Jump to a section

    References

    Bastable, S. B. (Ed.). (2006). Essentials of patient education. Sudbury, MA: Jones and Bartlett.
    Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. London, England: Sage.
    Burnard, P. (1991). A method of analyzing interview transcripts in qualitative research. Nurse Education Today, 11, 461-466.
    Cunningham, M. S., White, B., & O'Donnell, J. (2006). Prevention and management of venous thromboembolism in people with cancer: A review of the evidence. Clinical Oncology, 18, 145-151.
    Debourdeau, P., Elalamy, I., de Raignac, A., Meria, P., Gornet, J. M., Amah, Y., … Farge, D. (2008). Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: Why hesitate any longer? Supportive Care in Cancer, 16, 1333-1341. doi:10.1007/s00520-008-0491-4
    Dolan, S., & Fitch, M. (2007). The management of venous thromboembolism in cancer patients. British Journal of Nursing, 16, 1308-1312.
    Elman, E. E., & Kahn, S. R. (2006). The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: A systematic review. Thrombosis Research, 117, 609-614.
    Etchegary, H., Wilson, B., Brehaut, J., Lott, A., Langlois, N., & Wells, P. S. (2008). Psychosocial aspects of venous thromboembolic disease: An exploratory study. Thrombosis Research, 122, 491-500.
    Fiandaca, D., Bucciarelli, P., Martinelli, I., Tantardini, F., Clemente, C., & Mannucci, P. M. (2006). Psychological impact of thrombosis in the young. Internal Emergency Medicine, 1, 119-126.
    Geerts, W. H., Bergqvist, D., Pineo, G. F., Heit, J. A., Samama, C. M., Lassen, M. R., … Ray, J. G. (2008). Prevention of venous thromboembolism. Chest, 133, 381-453. doi:10.1378/chest.08-0656
    Haddad, T. C., & Greeno, E. (2006). Chemotherapy-induced thrombosis. Thrombosis Research, 118, 555-568.
    Heit, J. A., Cohen, A. T., & Anderson, A. J. (2005). Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the U. S. Blood, 106(11), 267.
    Heit, J. A., Mohr, D. N., Silverstein, M. D., Petterson, T. M., O'Fallon, W. M., & Melton, L. J. (2000). Predictors of recurrence after deep vein thrombosis and pulmonary embolism—A population-based cohort study. Archives of Internal Medicine, 160, 761-768.
    Johnson, M. J., Walker, I. D., Sproule, M. W., & Conkie, J. (1999). Abnormal coagulation and deep venous thrombosis in patients with advanced cancer. Clinical Laboratory Haematology, 21, 51-54.
    Kahn, S. R., Ducruet, T., Lamping, D. L., Arsenault, L., Miron, M. J., Roussin, A., … Shrier, I. (2005). Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Archives of Internal Medicine, 165, 1173-1178.
    Kahn, S. R., & Ginsberg, J. S. (2002). The post-thrombotic syndrome: Current knowledge, controversies, and directions for future research. Blood Reviews, 16, 155-165.
    Kahn, S. R., Hirsch, A., & Shrier, I. (2002). Effect of post-thrombotic syndrome on health-related quality of life after deep venous thrombosis. Archives of Internal Medicine, 162, 1144-1148.
    Kahn, S. R., Solymoss, S., Lamping, D. L., & Abenhaim, L. (2000). Long-term outcomes after deep vein thrombosis: Postphlebitic syndrome and quality of life. Journal of General Internal Medicine, 15, 425-429. doi:10.1046/j.1525-1497.2000.06419.x
    Lee, A. Y., Levine, M. N., Baker, R. I., Bowden, C., Kakkar, A. K., Prins, M., … Gent, M. (2003). Low molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. New England Journal of Medicine, 349, 146-153.
    Lesage, S., McGee, M., & Emed, J. (2008). Knowledge of venous thromboembolism prevention among hospitalized patients. Journal of Vascular Nursing, 26(4), 109-117. doi:10.1016/j.jvn.2008.09.005
    Linkins, L. A. (2008). Management of venous thromboembolism in patients with cancer. Vascular Health Risk Management, 4, 279-287.
    MacMillan Cancer Support. (2006). Worried sick: The emotional impact of cancer. Report on survey by opinion leader research. Retrieved from http://www.macmillan.org.uk/Documents/Support_Material/Get_involved/Campaigns/Impact_of_cancer_english.pdf
    Moore, T., Norman, P., Harris, P. R., & Makris, M. (2006). Cognitive appraisals and psychological distress following venous thromboembolic disease: An application of the theory of cognitive adaptation. Social Science Medicine, 63, 2395-2406.
    Morrison, R. (2006). Venous thromboembolism: Scope of the problem and the nurse's role in risk assessment and prevention. Journal of Vascular Nursing, 24(3), 82-90. doi:10.1016/j.jvn.2006.05.002
    Morse, J. M. (2000). Determining sample size. Qualitative Health Research, 10, 3-5.
    Morse, J. M., & Field, P. A. (1995). Principles of data collection. In D. Foster & G. Dickens (Eds.), Qualitative research methods for health professionals (pp. 89-124). Thousand Oaks, CA: Sage.
    Noble, S. I., & Finlay, I. G. (2005). Is long-term low-molecular-weight heparin acceptable to palliative care patients in the treatment of cancer related venous thromboembolism? A qualitative study. Palliative Medicine, 19(3), 197-201. doi:10.1191/0269216305pm1008oa
    Polit, D. F., & Beck, C. T. (2008). Essentials of nursing research: Methods, appraisal, and utilization. Philadelphia, PA: Lippincott Williams and Wilkins.
    Poon, L. W., Basford, L., Dowser, C., & Booth, A. (2003). Coping with comorbidities. In L. W. Poon, S. H. Gueldner, & B. M. Sprouse (Eds.), Successful aging and adaptation with chronic diseases (pp. 147-192). New York, NY: Springer.
    Prandoni, P., Lensing, A. W., Piccioli, A., Bernardi, E., Simioni, P., Girolami, B., … Girolami, A. (2002). Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood, 100, 3484-3488. doi:10.1182/blood-2002-01-0108
    Rubin, H. J., & Rubin, I. S. (2005). Designing main questions and probes. In T. Alpern, A. Bruckner, P. Oman, & M. A. Vail (Eds.), Qualitative interviewing: The art of hearing data (pp. 152-172). Thousand Oaks, CA: Sage.
    Sousou, T., & Khorana, A. A. (2010). Cancer patients and awareness of venous thromboembolism. Cancer Investigation, 28, 44-55.
    Stanton, A. L. (2006). Psychosocial concerns and interventions for cancer survivors. Journal Clinical Oncology, 24, 5132-5137.
    Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: Their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20, 3137-3148.
    Turton, P., & Cooke, H. (2000). Meeting the needs of people with cancer for support and self-management. Complementary Therapies in Nursing and Midwifery, 6, 130-137. doi:10.1054/ctnm.2000.0487
    van Korlaar, I. M., Vossen, S., Rosendaal, F. R., Bovill, E. G., Cushman, M., Naud, S., & Kaptein, A. A. (2004). The impact of venous thrombosis on quality of life. Thrombosis Research, 114, 11-18.
    van't Spijker, A., Trijsburg, R. W., & Duivenvoorden, H. J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine, 59, 280-293
    Winterling, J., Sidenvall, B., Gilmelius, B., & Nordin, K. (2009). Expectations for the recovery period after cancer treatment: A qualitative study. European Journal of Cancer Care, 18, 585-593.