Thrombosis
Professor Simon Noble leads the Thrombosis theme. He is a leading figure in palliative and supportive oncology.
Within Cardiff University
Director of the Division of Population Medicine at Cardiff University and of the Marie Curie Research Centre.
External positions
UK Medical Director of Thrombosis UK and an honorary consultant at Aneurin Bevan University Health Board in Gwent.
Research based impact
Significant influence on both clinical practice and health policy in the UK and internationally.
Within our research centre, Professor Noble specialises in cancer-associated thrombosis (CAT), particularly in advanced cancer patients. He advocates for evidence-based management of conditions affecting palliative care patients, emphasising the need to challenge practices based on poor evidence. He is also instrumental in promoting meaningful Patient and Public Involvement (PPI) in research, ensuring that patient perspectives shape study design and implementation.
SERENITY Project
The SERENITY project (Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life) is a €6 million, five-year initiative funded by Horizon Europe. Co-led by Professor Simon Noble (Cardiff University) and Professor Erik Klok (Leiden University Medical Centre), the project aims to address the complex decision-making surrounding the use of antithrombotic therapy (ATT) in patients with advanced cancer nearing the end of life.
Project summary
Antithrombotic medications, including anticoagulants and antiplatelet agents, are commonly prescribed to cancer patients to prevent blood clots. However, their continued use in the final stages of life can lead to increased bleeding risks, reduced quality of life, and higher healthcare costs. Despite these concerns, ATT is often maintained until death, partly due to a lack of clear guidelines and insufficient discussions between healthcare providers and patients.
The SERENITY project seeks to develop and evaluate a web-based shared decision-making tool designed to facilitate informed conversations among patients, their companions, and healthcare professionals regarding the continuation or cessation of ATT near the end of life. This tool will consider individual patient factors such as gender and history of thrombosis or bleeding, aiming to empower patients to make choices aligned with their values and preferences.
PPI in Serenity
A European public involvement strategy aligned with the study is also in place across work packages in SERENITY and led by the Marie Curie Research Centre here at Cardiff University. The impact of public involvement in SERENITY has and will continue to be planned out and tracked using the recently developed Public Involvement in Research Impact Toolkit (PIRIT).
The advantages of patient and public involvement (PPI) in research are becoming more widely known; however, different research organisations have different rates of adoption. Comparably, some groups provide tokenistic participation in the research process, which is inconsistent with the extent to which PPI partners are truly involved.
Anticipated Impact
By facilitating individualised discussions about ATT at the end of life, the SERENITY project aims to enhance patient empowerment and autonomy in decision-making, to improve the quality of life and treatment satisfaction for patients and their caregivers, to reduce unnecessary medication use and associated complications and to inform clinical guidelines and policies across Europe.
HIDDen and HIDDen 2
The HIDDen (Hospice Inpatient Deep vein thrombosis Detection study) and HIDDen 2 studies were important research projects that investigated the prevalence and impact of deep vein thrombosis (DVT) in patients receiving hospice and palliative care, with a particular focus on the ethical considerations of involving terminally ill patients in clinical research, including issues of patient autonomy and consent.
HIDDen aims
The study aimed to determine how common femoral DVTs are in hospice inpatients, to assess whether DVTs contribute to symptoms such as pain or leg swelling, and to evaluate the clinical significance of DVTs in the last weeks of life.
Key findings
Thirty five percent of patients were ineligible since they had been admitted for end-of-life care. DVT was found in about just under 30% of eligible participants. The study found that despite the high prevalence %), DVTs were often asymptomatic, and despite being large-volume clots, conferred no survival disadvantage. The findings challenged the utility of primary thromboprophylaxis in the hospice setting since over 50% of all patients admitted to hospice would not benefit from thromboprophylaxis.
A round table discussion comprising patient groups, professional organisations and clinical researchers discussed the results and the implications for practice.
Key findings from HIDDen2
This pragmatic observational study recruited 207 palliative patients from 3 acute hospitals in South Wales. Patients underwent colour duplex ultrasonography on admission to establish the prevalence of acute VTE. Patients were followed up to see what the incidence of VTE was within 90 days of admission.
These results shall be presented at the ISTH in Washington in June 2025.
