title: FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence.
abstract: BACKGROUND
  Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines.
  
  
  METHODS
  Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis.
  
  
  RESULTS
  Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy.
  
  
  CONCLUSIONS
  Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.
authors.affiliation: Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. palucaji@hotmail.com.
authors.forename: P
authors.identifier: http://orcid.org/0000-0003-4592-3813
authors.initials: P
authors.lastname: Jimenez-Fonseca
authors.affiliation: Hematology and Medical Oncology Department, UMU, IMIB, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Clinical Psychology and Psychobiology Department, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Calderon
authors.affiliation: Unitat d'Hemostàsia i Trombosi, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fontcuberta Boj
authors.affiliation: Medical Oncology Department, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Universitari Clínic, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Font
authors.affiliation: Hemaotology Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Lecumberri
authors.affiliation: Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Monreal
authors.affiliation: Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Muñoz Martín
authors.affiliation: Medical-Surgical Unit for Respiratory Disease, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Sevilla, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Otero
authors.affiliation: Pharmacy Department, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rubio
authors.affiliation: Emergency Department, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ruiz-Artacho
authors.affiliation: Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Suarez Fernández
authors.affiliation: Scientific Affairs, LEO Pharma, Barcelona, S.A, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Colome
authors.affiliation: Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Pérez Segura
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000150:complications*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D018570:Risk Assessment; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Cancer-associated thrombosis; Delphi consensus; Low-molecular weight heparin; Prophylaxis; Recommendations; Treatment; Venous thromboembolism