1. Fundamental Research in Oncology & Thrombosis FRONTLINE 1 Survey

2. FRONTLINE 1 Survey – Rationale FRONTLINE (Fundamental Research in Oncology and Thrombosis) was the first comprehensive global survey of thrombosis and cancer Key objectives –To collect data on the perceived risk and patterns of practice with regard to VTE in cancer patients undergoing surgical and medical management –To provide information on international, and regional practice patterns, allowing for the design of research studies to answer the concerns of practising clinicians Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. 1.Trousseau A. Clinique médicale de l’hôtel Dieu de Paris, 2 nd ed. Paris:JB Ballere et Fils 1865.

3. FRONTLINE 1 Survey – Design The survey, developed under the guidance of an advisory board, included separate sections relating to: –Surgical patients –Medical patients –Thrombosis associated with vascular access devices Questionnaire (available in seven languages) was distributed between July and November 2001 and responses were elicited via paper-based questionnaire and a dedicated website Oncologists were recruited by a series of mailings, advertisements and congress activities 3891 completed responses were received from 74 countries Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

4. FRONTLINE 1 Survey demographics of respondents Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. Response breakdownParameter Number of responses3891 Survey type (% respondents)Paper-based87 Web-based 13 Survey breakdown (number) Surgical patients1882 Medical patients2640 Catheter use3714 Case study2541 Region (% respondents)Western Europe45 Eastern Europe/Russia10 North America19 Rest of the World22 Not stated4 Practice setting (% respondents) Academic/University53 Community/District46

5. Perceptions of risk by cancer type >20% risk of VTE without prophylaxis (surgical patients) VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

6. Perceptions of risk by cancer type >20% risk of VTE without prophylaxis (medical patients) VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

7. Patterns of thromboprophylaxis in surgical patients Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

8. Main reasons for not giving prophylaxis in surgical patients VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

9. Proportion of medical patients receiving prophylaxis (overall) Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents Percentage of patients

10. Proportion of medical patients receiving prophylaxis by cancer type Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

11. Approach to thromboprophylaxis in surgical and medical patients % Respondents AC: anticoagulant; LMWH: low molecular weight heparin; UFH: unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

12. Typical duration of thromboprophylaxis in surgical and medical patients % Respondents Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

13. Thromboprophylaxis by region (surgical patients) % Respondents LMWH: low molecular weight heparin; UFH: unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

14. Thromboprophylaxis by region (medical patients) Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

15. Diagnostic methods for VTE (surgical and medical patients) % Respondents CT: computed tomography; MRI: magnetic resonance imaging; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

16. Standard initial treatment for VTE (surgical and medical patients) % Respondents DVT: deep vein thrombosis; LMWH: low molecular weight heparin; PE: pulmonary embolism; UFH: unfractionated heparin; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

17. Standard initial treatment for VTE by region (surgical patients) % Respondents LMWH: low molecular weight heparin; UFH: unfractionated heparin; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

18. Standard initial treatment for DVT by region (medical patients) DVT: deep vein thrombosis; LMWH: low molecular weight heparin; UFH: unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

19. Standard initial treatment for PE by region (medical patients) % Respondents LMWH: low molecular weight heparin; PE: pulmonary embolism; UFH: unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

20. Factors that would justify hospitalization in surgical and medical patients % Respondents DVT: deep vein thrombosis; PE: pulmonary embolism; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

21. Standard long-term anticoagulant after VTE episode (surgical and medical patients) DVT: deep vein thrombosis; LMWH: low molecular weight heparin; PE: pulmonary embolism; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

22. Standard long-term anticoagulant treatment after VTE episode by region (surgical patients) % Respondents LMWH: low molecular weight heparin; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

23. Standard long-term anticoagulant treatment after DVT episode by region (medical patients) DVT: deep vein thrombosis; LMWH: low molecular weight heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

24. Standard long-term anticoagulant treatment after PE episode by region (medical patients) % Respondents LMWH: low molecular weight heparin; PE: pulmonary embolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

25. Duration of anticoagulation treatment after VTE episode (surgical and medical patients) DVT: deep vein thrombosis; PE: pulmonary embolism; VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

26. Perception of risk with central venous access devices Association between central venous access and increased risk of thrombosis Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

27. Perception of risk with central venous access devices Likelihood of patients developing thrombosis without prophylaxis by region Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents % Patients

28. Thromboprophylaxis use in patients with central venous access device by region % Respondents Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

29. Thromboprophylaxis in patients with a central venous line by region AC: anticoagulant; Adj: adjuvant; LMWH: low molecular weight heparin; sc UFH: subcutaneous unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

30. Treatment of thrombosis in patients with a central venous line Removal of line when thrombosis develops Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

31. Treatment of thrombosis in patientd with a central venous line Other therapy % Respondents LMWH: low molecular weight heparin; UFH: unfractionated heparin. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.

32. Duration of treatment after thrombosis in a patient with central venous line/device Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388. % Respondents

33. Conclusions FRONTLINE-1 survey demonstrated the wide variations in treatment patterns and practice FRONTLINE-1 survey identified a need for guidelines to direct clinical practice in line with evidence-based data concerning cancer and VTE FRONTLINE-1 survey identified a need for further research on strategies for VTE prevention and treatment in cancer patients, including: –Primary prophylaxis in medically managed patients –Optimum management of VTE in cancer patients –Prevention and treatment of VTE associated with central venous access devices VTE: venous thromboembolism. Kakkar AK, et al. Oncologist. 2003;8:381 ‒ 388.