Coagulation Case Challenges in Cancer

Coagulation Case
Challenges in Cancer

This activity is supported by an educational grant from
sanofi-aventis US, Inc.

This activity is sponsored by The University of Wisconsin School of Medicine and Public Health
and by Educational Concepts Group, LLC.

Estimated time to complete activity: 2.0 hours \| Release Date: June 25, 2010 \| Expiration Date: June 24, 2011 \| Media: Webcast

Introduction

The National Comprehensive Cancer Network has stated in their most recent practice guideline that venous thromboembolism (VTE) prevention and treatment is a critical need. Thrombosis is the second-leading cause of death in patients with cancer. In a recent analysis of more than 1 million hospitalized patients with cancer, the rate of VTE had increased by 28% from 1995 to 2003. The Fundamental Research in Oncology and Thrombosis (FRONTLINE) survey noted that only 50% of surgical oncologists and 5% of medical oncologists routinely use recommended therapy to prevent VTE in their cancer patients. Similar deficiencies have been found in the multinational IMPROVE registry of hospitalized medically ill patients, where only 45% of cancer patients received any form of VTE prophylaxis. Patients who suffer a VTE have an increased risk of recurrent VTE, bleeding complications, morbidity, and utilization of healthcare resources. The consequence of these practice gaps can be seen in a recent autopsy review where approximately 80% of cases of fatal pulmonary embolism were found to have occurred in non-surgical patients (whereas surgical patients are historically considered to be at greatest risk).

Faculty

Michael B. Streiff, MD, FACP – Chair Associate Professor of Medicine Medical Director, Johns Hopkins Anticoagulation Management Service and Outpatient Clinics The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Johns Hopkins Medical Institutions Baltimore, Maryland Bio	Alok A. Khorana, MD, FACP Vice-Chief, Division of Hematology/Oncology Associate Professor of Medicine and Oncology James P. Wilmot Cancer Center University of Rochester Rochester, New York Bio
Paul G. Richardson, MD Associate Professor of Medicine Harvard Medical School Clinical Director, Jerome Lipper Center for Multiple Myeloma Dana-Farber Cancer Institute Boston, Massachusetts Bio	Richard A. Van Etten, MD, PhD Professor of Medicine, Tufts University School of Medicine Chief, Division of Hematology/Oncology, Tufts Medical Center Director, Tufts Medical Center Cancer Center Boston, Massachusetts Bio

Learning Objectives
Upon completion of this educational activity, participants should be better able to:

Describe recent developments in understanding of the pathophysiology, manifestations, and screening of VTE in patients with cancer
Explain the association of VTE with cancer therapy, including cytotoxic chemotherapy, thalidomide, lenalidomide, and bevacizumab
Identify the risk for VTE and recommend prophylactic therapy, if appropriate, when treating patients with pancreatic cancer, multiple myeloma, and other common malignancies in conjunction with co-morbidities
Evaluate clinical and laboratory data in patients with acute leukemia, including acute promyelocytic leukemia
Discuss the management of coagulopathy/bleeding and of thrombosis risk in the setting of thrombocytopenia

Target Audience
The intended audience for this activity is medical oncologists, hematologist-oncologists, radiation oncologists, surgical oncologists, oncology pharmacists, and oncology nurses caring for patients with cancer.

Elements of Competence
This CME activity has been designed to change learner competency and focuses on the American Board of Medical Specialties areas of patient care, medical knowledge, and practice-based learning and improvement.

Accreditation Information
Physician Continuing Education Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Wisconsin School of Medicine and Public Health and Educational Concepts Group, LLC. The University of Wisconsin School of Medicine and Public Health is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
The University of Wisconsin School of Medicine and Public Health designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

Title IX and ADA Statement
The University of Wisconsin School of Medicine and Public Health provides equal opportunities in employment and programming including Title IX requirements. The University of Wisconsin School of Medicine and Public Health fully complies with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please notify Jackie Falconer by phone at 1.866.933.1696 or by e-mail to jfalconer@educationalconcepts.net.

Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the period June 25, 2010 through June 24, 2011, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) complete the post-activity assessment.

CME Credits
A statement of credit will be issued only upon successful completion of the evaluation and post-test with a score of 70% or better. Your statement of credit will be available online at www.educationalconcepts.net.

Policy on Disclosure
It is the policy of the University of Wisconsin School of Medicine and Public Health that the faculty, authors, planners, and other persons who may influence content of this CME activity disclose all relevant financial relationships with commercial interests* in order to allow CME staff to identify and resolve any potential conflicts of interest. Faculty must also disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation(s).

For this educational activity all conflicts of interests have been resolved and detailed disclosures are listed below:

*Name*	*Financial Relationship Disclosures*	*Discussion of Unlabeled/Unapproved Uses of Drugs/Devices in Presentation?*
Jackie Falconer	No relationships to disclose	No
Maureen Haas, PharmD, BCOP	No relationships to disclose	Yes
Alok A. Khorana, MD, FACP	Consultant: Boehringer Ingelheim, sanofi-aventis US, Inc Advisory Committee: Centocor Ortho Biotech Speaker: Eisai Inc./Pfizer Inc, sanofi-aventis US, Inc	Yes
Amy Meyer, BA, MS	No relationships to disclose	No
Paul G. Richardson, MD	Advisory Committee: Celgene Corporation, Millennium Pharmaceuticals, Inc.	No
Suzanne Rimmer	No relationships to disclose	No
John Sheehan, MD	No relationships to disclose	No
Tina Stacy, PharmD, BCOP, CCMEP	No relationships to disclose	Yes
Michael B. Streiff, MD, FACP	PI: Bristol-Myers Squibb Company Speaker: Medical Communications Media, Inc.	No
Ryann Taylor	No relationships to disclose	No
Richard A. Van Etten, MD, PhD	No relationships to disclose	No
Liz VanderWyden	No relationships to disclose	No

*The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests.

Acknowledgement of Commercial Support
This activity is supported by an educational grant from sanofi-aventis US, Inc.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Please refer to the official prescribing information for each product or consult the Physicians’ Desk Reference for discussion of approved indications, contraindications, and warnings.

Continuing Medical Education
For further information, please contact: Educational Concepts Group, LLC | 1300 Parkwood Circle SE | Suite 325 | Atlanta, Georgia 30339 | Phone: 1.770.933.1681 | Fax: 1.770.933.1692
www.educationalconcepts.net

None of the contents may be reproduced in any form without prior written permission from the publisher. This activity may be accessed at www.educationalconcepts.net.