Anticoagulating the subsegmental pulmonary embolism in cancer patients: a survey amongst different medical specialties

The clinical significance of isolated subsegmental pulmonary embolism (SSPE) remains an area of controversy. In cancer patients, venous thromboembolism (VTE) is common and is a major cause of morbidity and mortality. The management of overt VTE in cancer patients is well established, nevertheless the management of incidentally diagnosed PE and especially SSPE, an increasingly frequent finding with the ubiquity of thin-slice computed tomography is less well defined. We have surveyed current attitudes towards treating SSPE in cancer patients among oncologists, respiratory and palliative care physicians. The survey was conducted between September 2012 and May 2013. Physicians surveyed were asked to select their management plan from options available depending on the site, number, symptoms, and in the presence of previous VTE. 154 physicians responded. We observed differences in the attitudes towards treatment between different specialties. In the adjuvant setting, oncologists were more likely to immediately anticoagulate for a single SSPE than palliative care physicians or chest physicians (84 vs 46 vs 56 %, respectively, p = 0.001). In the metastatic setting the differences were smaller (89 vs 69 vs 76 %, respectively, p = 0.057) but palliative care physicians remained less likely to immediately anticoagulate even in the case of multiple-site SSPE (85 vs 96 %, p = 0.014). Despite the unknown clinical significance of SSPE, and the likelihood that even in cancer patients some of these SSPEs may have trivial effects on prognosis if left untreated, the majority of the physicians surveyed would opt for anticoagulation in patients with unsuspected SSPE regardless of its extent.