Abdullah, Omar Riyadh (2021) Venous thromboembolism in bladder cancer : scope of the problem and patients' perspectives (VTE-BC). PhD thesis, University of Warwick.

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Abstract

Introduction:
Venous thromboembolism (VTE) presents a challenge in the management of cancer patients and is a common cause of morbidity and mortality. Bladder cancer (BC) patients are at high risk of VTE; however, the problem is not well quantified. Patients’ understanding of cancer-associated thrombosis (CAT) early in their cancer pathway has hitherto been neglected. The aims of this study, ‘VTE-BC’, are to investigate the scope of VTE in patients with BC in the UK and explore patients’ understanding of CAT from their experience of having BC and treatments.

Methods:
A sequential mixed-methods study was applied: i) quantitative (Phase I) to explore the incidence and risk factors for VTE in BC, by cohort and case-control analysis, followed by ii) qualitative (Phase II) through semi-structured interviews among patients with BC and healthcare professionals (HCPs), utilising thematic analysis.

Results:
VTE incidence in patients with BC was around 6.0 per 1000 from national datasets, lower than previously published. Cystectomy and stage IV disease significantly increased the risk of VTE in BC patients; adjusted odds ratio (OR); OR 2.88 (95% CI 1.63-5.07), P < 0.001 and OR 4.41 (95%CI 1.85-10.50), P=0.002, respectively, while chemotherapy was found to have borderline significance as a risk factor; OR 2.56 (95% CI 1.03-6.32), P=0.041.

Patients had a lack of awareness of CAT; they received limited education on VTE. Three major themes emerged from the interviews: ‘all about the cancer’ (CAT was not a priority for patients with BC and HCPs), ‘a labyrinthine process’ (information about VTE was bewildering and compartmentalised) and ‘improving the poor deal’ (patients’ and HCPs offered suggestions to improve communication around CAT).

Conclusions:
VTE is an important clinical problem in patients with BC. HCPs can build on the findings of VTE-BC to improve individualised CAT care through multidisciplinary inclusion of CAT discussion inpatient encounters.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Library of Congress Subject Headings (LCSH):	Bladder -- Cancer -- Patients -- Great Britain, Thrombophlebitis, Thromboembolism
Official Date:	August 2021
Dates:	Date Event August 2021 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Young, Annie M. (Annie Miller), 1955- ; Parashar, Deepak ; Ignatowicz, Agnieszka
Format of File:	pdf
Extent:	xiv, 229 leaves : illustrations (some colour)
Language:	eng

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