Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed and if such a care takes place early in the course of the disease, combining standard oncology care and palliative care. In these settings, venous thromboembolism (VTE) represents a difficult medical challenge, for the requirement of acute treatments and for the strong impact on anticancer therapies that might be delayed or, even, totally discontinued. Moreover, cancer patients not only display high rates of VTE occurrence/recurrence but are also more prone to bleeding and this forces clinicians to optimize treatment strategies, balancing between hemorrhages and thrombus formation. VTE prevention is, therefore, regarded as a double-edged sword. Indeed, while on one hand the appropriate use of antithrombotic agents can reduce VTE occurrence, on the other it significantly increases the bleeding risk, especially in the frail patients who present with multiple co-morbidities and poly-therapy that can interact with anticoagulant drugs. For these reasons, thromboprophylaxis should start while active cancer treatment is ongoing, according to a simultaneous care model in a patient-centered perspective.

译文

同时护理代表了积极抗肿瘤治疗下癌症患者早期支持和姑息治疗之间的理想整合。癌症患者需要一种综合的临床,社会和心理管理,只有在保证从医院到家庭的护理连续性以及在疾病早期进行这种护理时,将标准的肿瘤学护理和姑息治疗相结合,才能有效。在这些情况下,静脉血栓栓塞 (VTE) 代表了一项艰巨的医学挑战,对于急性治疗的需求以及对可能被延迟甚至完全终止的抗癌疗法的强烈影响。此外,癌症患者不仅显示出高VTE发生/复发率,而且更容易出血,这迫使临床医生优化治疗策略,平衡出血和血栓形成。因此,预防VTE被视为一把双刃剑。事实上,一方面,适当使用抗血栓药物可以减少VTE的发生,另一方面,它显著增加出血风险,特别是在出现多种合并症和多治疗的体弱患者中,这些患者可能与抗凝药物相互作用。由于这些原因,根据以患者为中心的同时护理模型,应在进行积极的癌症治疗时开始进行血栓预防。

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