Unique Thrombosis Center Coordinates Better Care

Working from what is probably the only center of its kind in the U.S., a multidisciplinary team at Cleveland Clinic is answering the call for a more efficient and effective approach to the diagnosis, treatment and monitoring of cancer patients who develop potentially deadly thrombosis.

Thrombosis is the second leading cause of mortality in cancer patients and about 20 percent of cancer patients develop the condition. In the broader, non-cancer patient population, about 1 percent of initial thrombotic events are fatal. In cases of recurrent thrombosis, the mortality rate may be as high as 5 percent, according to Keith McCrae, MD, of Cleveland Clinic’s Department of Hematology and Oncology. These rates may be even higher in patients with cancer. Moreover, thrombosis often occurs in cancer patients whose underlying cancer is responding to therapy.

The Thrombosis Center is a strategic addition to the Cleveland Clinic campus, focusing on both better patient outcomes and the furthering of research, according to Dr. McCrae, Director of the Benign Hematology program, and Alok Khorana, MD, Director of the Gastrointestinal Malignancies Program at Cleveland Clinic’s Taussig Cancer Institute. The center is overseen by four physicians from various disciplines and staffed full-time by nurse clinicians and physician assistants.

Dr. Khorana, who previously developed a widely used scoring system (Khorana Score) to predict cancer patients’ risk of developing thrombosis, says the center is a next logical step toward making care of cancer patients at risk of thrombosis “more patient-centered, while avoiding the unnecessary use of hospital resources.”

Dr. McCrae also directs a research lab that conducts translational studies at the clinical and basic levels to find more clues about the cellular and molecular mechanisms that lead to thrombosis in cancer patients. He says the cancer patients who come to the Thrombosis Center — on average two to three per day now — not only receive more efficient care, but are forming the foundation of a biorepository that holds samples from patients with various types of cancer that will aid in further research.

The translational approach to medical science is being formally backed by the National Institutes of Health, in hopes of formulating clinical and basic research into a two-way pipeline that speeds new diagnostics, treatments, technologies and pharmacologic discoveries to the hospital bedside and into the general population. Ultimately, the Cancer Thrombosis Center may also serve as a foundation for NIH-supported clinical and translational research.

The ultimate goal of the center, Dr. McCrae says, is to “standardize the approach to cancer-associated thrombosis and treat patients more effectively and efficiently.” One part of the center’s approach includes educating cancer patients with thrombosis to better involve them in their own care.

The Cancer Thrombosis Center is a multidisciplinary effort. “Having the different disciplines involved (hematology, oncology and vascular medicine) in a coordinated center definitely makes (management of thrombosis) easier,” Dr. Khorana says. “And it gives oncologists the freedom to devote their time to treating cancer. We see ourselves as walking a line between being very patient-centered while bringing down the cost of health care. Admissions and readmissions are inconvenient for patients and incredibly expensive for our health system.”