August 3, 2015

Doing More Is Not Always Better

An NEJM Editorial



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Alok Khorana, MD

How should a clinician respond when a patient presents with an unprovoked venous thromboembolism? Clots of indeterminant cause are common, and epidemiological studies have shown that some are associated with undiagnosed cancer. While an aggressive and extensive diagnostic workup might seem like a logical course, especially with a worried patient, does this “do-more” approach lead to earlier cancer detection and more effective treatment?


A recent trial involving nine Canadian medical centers compared the results of a limited screening strategy for unprovoked clot patients with the outcomes of a more extensive approach that added CT scans of the abdomen and pelvis. Cleveland Clinic oncologist Alok Khorana, MD, discusses the trial’s findings and their implications for clinical decisionmaking in a New England Journal of Medicine editorial.

Read Cancer Workup after Unprovoked Clot — Less Is More by Dr. Khorana of Cleveland Clinic’s Department of Hematology and Oncology.

Photo credit: ©Russell Lee


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