Abstract 13145: Differences of Cancer Types in Hospital Mortality in Patients With Venous Thromboembolism

Introduction: We sought to evaluate the clinical characteristics and outcomes of patients with cancer-associated VTE, compared with the matched cohort without cancer using real-world big data of VTE. Background: Cancer is associated with a high incidence of Venous Thromboembolism (VTE) and there are many guidelines/recommendations about VTE. However, the prognosis of cancer-VTE patients is not well known because of a lack of big data. Moreover, there is also no knowledge on how cancer type is related to prognosis. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). We identified 28,247 patients who were first hospitalized with VTE from April 2012 to March 2017. 26.0% were cancer patients. Compared with national statistics of cancer incidence in 2015 from National Cancer Center of Japan, the proportion of gynecological cancer patients was higher, but other cancer types had similar prevalence rates. Propensity score (PS) was estimated with logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. Results: We included 24,576 patients after exclusion. The median age was 71years (range: 59-80 years), and 42.0% were male. On PS-matched analysis with 12,418 patients, patients with cancer had higher total in-hospital mortality (9.5% vs. 3.8%, P<0.001; OR, 2.72, 95% CI: 2.33-3.19) and in-hospital mortality within 30days (6.8% vs. 3.2%, P<0.001; OR, 2.20, 95% CI: 1.85-2.62). On analysis for each type of cancer, in-hospital mortality in 10 types of cancer was significantly high, especially pancreas (OR: 9.65, 95%CI: 4.31-21.64), biliary tract (OR: 8.36, 95%CI: 2.42-28.89) and liver (OR: 7.33, 95%CI: 1.92-28.02). Conclusions: Patients with cancer had a higher in-hospital mortality for VTE than those without cancer, especially in pancreatic, biliary tract and liver cancers.

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Acute Hospital Mortality of Venous Thromboembolism in Patients With Cancer From Registry Data

Journal of the American Heart Association ◽

10.1161/jaha.120.019373 ◽

2021 ◽

Author(s):

Yuichiro Okushi ◽

Kenya Kusunose ◽

Yoshihiro Okayama ◽

Robert Zheng ◽

Michikazu Nakai ◽

...

Keyword(s):

Venous Thromboembolism ◽

Propensity Score ◽

Hospital Mortality ◽

Biliary Tract ◽

Vascular Diseases ◽

Registry Data ◽

Diagnosis Procedure Combination ◽

Patients With Cancer ◽

Liver Cancers ◽

Propensity Matching

Background The prognosis of patients with cancer‐venous thromboembolism (VTE) is not well known because of a lack of registry data. Moreover, there is also no knowledge on how specific types are related to prognosis. We sought to evaluate the clinical characteristics and outcomes of patients with cancer‐associated VTE, compared with a matched cohort without cancer using real‐world registry data of VTE. Methods and Results This study was based on the Diagnosis Procedure Combination database in the JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Of 5 106 151 total patients included in JROAD‐DPC, we identified 49 580 patients who were first hospitalized with VTE from April 2012 to March 2017. Propensity score was estimated with a logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. After propensity matching, there were 25 148 patients with VTE with or without cancer. On propensity score‐matched analysis with 25 148 patients with VTE, patients with cancer had higher total in‐hospital mortality within 7 days (1.3% versus 1.1%, odds ratio [OR], 1.66; 95% CI, 1.31–2.11; P <0.0001), 14 days (2.5% versus 1.5%, OR, 2.07; 95% CI, 1.72–2.49; P <0.0001), and 30 days (4.8% versus 2.0%, OR, 2.85; 95% CI, 2.45–3.31; P <0.0001). On analysis for each type of cancer, in‐hospital mortality in 11 types of cancer was significantly high, especially pancreas (OR, 12.96; 95% CI, 6.41–26.20), biliary tract (OR, 8.67; 95% CI, 3.00–25.03), and liver (OR, 7.31; 95% CI, 3.05–17.50). Conclusions Patients with cancer had a higher in‐hospital acute mortality for VTE than those without cancer, especially in pancreatic, biliary tract, and liver cancers.

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Comparison and impact of COVID-19 for patients with cancer: a survival analysis of fatality rate controlling for age, sex and cancer type

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2021-100341 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100341

Author(s):

Haiquan Li ◽

Edwin Baldwin ◽

Xiang Zhang ◽

Colleen Kenost ◽

Wenting Luo ◽

...

Keyword(s):

Cancer Patients ◽

Uterine Cancer ◽

Fold Increase ◽

Distant Metastases ◽

Cancer Type ◽

Fatality Rate ◽

Patients With Cancer ◽

Increased Risk ◽

Cancer Types ◽

Stratified Analysis

ObjectivesPrior research has reported an increased risk of fatality for patients with cancer, but most studies investigated the risk by comparing cancer to non-cancer patients among COVID-19 infections, where cancer might have contributed to the increased risk. This study is to understand COVID-19’s imposed HR of fatality while controlling for covariates, such as age, sex, metastasis status and cancer type.MethodsWe conducted survival analyses of 4606 cancer patients with COVID-19 test results from 16 March to 11 October 2020 in UK Biobank and estimated the overall HR of fatality with and without COVID-19 infection. We also examined the HRs of 13 specific cancer types with at least 100 patients using a stratified analysis.ResultsCOVID-19 resulted in an overall HR of 7.76 (95% CI 5.78 to 10.40, p<10−10) by following 4606 patients with cancer for 21 days after the tests. The HR varied among cancer type, with over a 10-fold increase in fatality rate (false discovery rate ≤0.02) for melanoma, haematological malignancies, uterine cancer and kidney cancer. Although COVID-19 imposed a higher risk for localised versus distant metastasis cancers, those of distant metastases yielded higher overall fatality rates due to their multiplicative effects.DiscussionThe results confirmed prior reports for the increased risk of fatality for patients with COVID-19 plus hematological malignancies and demonstrated similar findings of COVID-19 on melanoma, uterine, and kidney cancers.ConclusionThe results highlight the heightened risk that COVID-19 imposes on localised and haematological cancer patients and the necessity to vaccinate uninfected patients with cancer promptly, particularly for the cancer types most influenced by COVID-19. Results also suggest the importance of timely care for patients with localised cancer, whether they are infected by COVID-19 or not.

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Morbidity, Mortality and Costs Associated with Venous Thromboembolism in Hospitalized Patients with Cancer

Blood ◽

10.1182/blood.v128.22.4751.4751 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4751-4751

Author(s):

Gary H. Lyman ◽

Eva Culakova ◽

Marek S. Poniewierski ◽

Nicole M. Kuderer

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Cancer Patients ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Hospitalized Patients ◽

Annual Rate ◽

Patients With Cancer ◽

Time Period

Background: Venous thromboembolism (VTE) represents a leading cause of morbidity and mortality among hospitalized patients with cancer. Methods: Hospitalization data reported on adult cancer patients at US academic medical centers and affiliated hospitals between 1995 and 2012 were analyzed. Cancer diagnosis, presence of VTE, comorbidities and complications were based on ICD-9-CM codes. Major comorbidities considered were diabetes, and cerebrovascular, peripheral-vascular, heart, liver, and lung renal disease. In patients with multiple hospitalizations during the time period, a randomly selected hospitalization was utilized in the analysis. Hospitalization cost estimates were inflation adjusted to 2015 US dollars. Results: Nearly 6 million hospitalizations of 3,146,388 individual patients with cancer from more than 200 institutions were evaluated. VTE was reported in 8.4% of patients when all admissions are considered during the time period. When a single selected hospitalization is considered for each patient, VTE was reported in 166,547 (5.3%) of individual patients including 56,125 (1.8%) with pulmonary embolism (PE). The annual rate of VTE increased progressively from 3.5% in 1995 to over 6.5% in 2012 with the rate of PE nearly tripling from 0.8% in 1995 to 2.3% in 2012. For hospitalized patients receiving cancer chemotherapy, the annual rate of VTE more than doubled from 3.6% in 1995 to 8.3% in 2012. VTE was reported in 5.2%, 5.8% and 5.4% of patients with solid tumors, lymphoma, and leukemia, respectively (Table). Rates of VTE were greatest among patients with pancreatic (10.2%), gastric (7.1%) or other abdominal malignancies except colorectal cancer (9.2%) as well as those with ovarian (7.1%), lung (6.8%) and esophageal cancers (6.3%). The risk of VTE increased progressively from 2.3% in those with no comorbidities to over 11% for patients with 4 or more comorbid conditions. The strongest risk factors for VTE were infectious complications including sepsis (14%), invasive candidiasis (16%), pneumonia (11%) and IV line infections (14%).During this same time period, imaging related to VTE actually decreased with significantly lower rates of CT, vascular ultrasound and ventilation perfusion lung scans reported. In-hospital mortality was reported in 5.5% of cancer patients without VTE and in 15.0% of those with VTE including 19.4% of those with pulmonary embolism. In-hospital mortality during this time period decreased by approximately one-third in cancer patients both with and without VTE. While reported rates of VTE increased, the length of hospital stay shortened for patients with as well as without VTE during this period. Average costs per hospitalization adjusted to 2015 dollars for patients with and without VTE were $37,352 and $19,994, respectively. The estimated average inflation adjusted daily cost of hospitalization for patients with cancer and VTE increased nearly 50% between 1995 ($2,256) and 2012 ($3,297). Conclusions: VTE reported among hospitalized patients with cancer has increased significantly during the period of observation along with the cost of hospitalization while in-hospital mortality and imaging rates have decreased. However, patients with additional major medical comorbidities are at exceptionally high risk of serious complications including in-hospital mortality. Disclosures Lyman: Amgen: Research Funding. Kuderer:Janssen Scientific Affairs, LLC: Consultancy, Honoraria.

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Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics

Thrombosis and Haemostasis ◽

10.1160/th09-06-0397 ◽

2010 ◽

Vol 103 (02) ◽

pp. 338-343 ◽

Cited By ~ 42

Author(s):

Shankaranarayana Paneesha ◽

Aidan McManus ◽

Roopen Arya ◽

Nicholas Scriven ◽

Timothy Farren ◽

...

Keyword(s):

Cancer Patients ◽

Similar Rate ◽

Cancer Type ◽

Tumour Site ◽

Vein Thrombosis ◽

Patients With Cancer ◽

Skin Cancers ◽

Cancer Types ◽

Cancer Associated Thrombosis ◽

Deep Vein

SummaryVenous thromboembolism (VTE) is a clinically important complication for both hospitalised and ambulatory cancer patients. In the current study, the frequency, demographics and risk (according to tumour site) of VTE were examined among patients seen at outpatient DVT (deep-vein thrombosis) clinics. Of 10,015 VTE cases, 1,361 were diagnosed with cancer, for an overall rate of cancer-associated VTE of 13.6% in this outpatient population. Patients with cancer-associated VTE were significantly older than cancer-free VTE cases (66.4 ± 12.7 vs. 58.8 ± 18.5 years; p<0.0001). The frequency of cancer-associated VTE peaked earlier among females than males, occurring in the sixth (137/639, 21.4% vs. 98/851, 11.3%; p<0.001) and seventh decades (213/980, 21.7% vs. 197/1096, 18%; p=0.036). VTE was described most frequently in common cancers – breast, prostate, colorectal and lung (56.1% of cases). The risk of VTE varied widely across 17 cancer types. Calculating odds ratios (OR) to assess the effect size of cancer type on VTE risk, the highest odds were observed for patients with pancreatic cancer (OR 9.65, 95% confidence interval [CI] (5.51–16.91). Tumours of the head and neck had higher odds than previously reported (OR 8.24, 95% CI 5.06–13.42). Reduced risk estimates were observed for skin cancers (melanoma and non-melanoma: OR 0.89, 95% CI 0.42–1.87; OR 0.74, 95% CI, 0.32–1.69, respectively). We conclude that outpatients have a similar rate of cancer-associated VTE as VTE patient populations previously reported, that cancer-associated VTE occurs in an older age group and earlier in females and that outpatients exhibit distinct tumour site-specific risk from that described among hospitalised cancer patients.

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Risk factors for in-hospital mortality and prolonged length of stay in older patients with solid tumors

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9550 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9550-9550

Author(s):

M. Shayne ◽

E. Culakova ◽

M. S. Poniewierski ◽

D. A. Wolff ◽

G. H. Lyman

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Length Of Stay ◽

Hospital Mortality ◽

Cancer Patients ◽

Solid Tumors ◽

Older Patients ◽

Cancer Type ◽

Additional Risk ◽

Factors Associated

9550 Background: Little is known about risk factors that contribute to prolonged hospitalization and mortality in older patients with cancer. Methods: Cancer patients ≥65 years of age hospitalized between 1995 and 2003 at 133 academic medical centers were evaluated using the University Health System Consortium discharge database. This study identified 386,377 older hospitalized patients with various solid tumors. Multivariate analyses were performed to determine variables independently associated with the primary endpoints: length of stay (LOS) ≥10 days and in-hospital mortality (IHM). Results: Average LOS was 7.5 days with 23% hospitalized ≥10 days. A significant improvement in LOS was observed over the study timeframe (p<.0001). Patients with gastric cancer had the greatest risk of prolonged LOS while those with breast cancer had the lowest risk. Additional risk factors for prolonged LOS included infection, venous thromboembolism and red blood cell transfusion (RBCT). The overall rate of IHM was 7.3% with a significant improvement in risk over the study timeframe (p<.0001). IHM was strongly associated with prolonged LOS (p<.0001). Older patients with primary central nervous system malignancies had the highest rates of IHM (OR=1.81; 95% CI: 1.59–2.07), followed by esophageal and lung cancer. Male gender was a risk factor for both IHM and prolonged LOS (p<.0001). Older African American cancer patients were more likely to experience prolonged LOS and IHM compared with Caucasian patients (p<.0001) after adjustment for cancer type and comorbidities. Additional risk factors associated with IHM included metastatic disease, active infection, neutropenia, renal disease, lung disease, arterial and venous thromboembolism, congestive heart failure, hepatic disease, and RBCT. Conclusions: Improving trends in LOS and IHM for older patients with solid tumors were observed over time in this study. Risk factors associated with IHM such as infection, neutropenia and RBCT, when modified, could potentially further reduce rates of prolonged LOS and IHM in older cancer patients. [Table: see text]

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Predictors Of Vena Cava Filter Use For Venous Thromboembolism In Cancer Patients

Blood ◽

10.1182/blood.v122.21.935.935 ◽

2013 ◽

Vol 122 (21) ◽

pp. 935-935

Author(s):

Gwendolyn Ho ◽

Ann Brunson ◽

Richard H. White ◽

Ted Wun

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Brain Cancer ◽

Vena Cava ◽

Severity Of Illness ◽

Bleeding Risk ◽

Factors Associated ◽

Patients With Cancer ◽

Cancer Types

Abstract Background The use of vena cava filters (VCF) in the treatment of venous thromboembolism (VTE) is controversial. Few studies have evaluated the use of VCFs in cancer patients with acute thrombosis. Aims To determine frequency of VCF placement and factors associated with VCF use in patients with cancer hospitalized for acute VTE, and to compare these findings to patients without cancer hospitalized for acute VTE. Methods Using a retrospective observational study design, we analyzed hospital discharge records in California from 2005-2009 of cases presenting with acute VTE. Patients with cancer were identified by specific ICD-9-CM codes for the index VTE admission or a cancer diagnosis within 6 months prior to the index VTE. Bivariate and multivariable logistic regression analyses were used to determine predictive factors for placement of a VCF in cancer patients. Candidate risk factors included basic demographic parameters, cancer type, severity-of-illness (SOI) on admission, undergoing surgery, bleeding, and hospital characteristics. Results A VCF was placed in 19.6% of 14,000 cancer cases admitted with a principal diagnosis of acute VTE, versus 10.8% of 70,472 non-cancer cases admitted during the same time period. Among cancer cases, there was little variation in percentage that received a VCF based on age, and no significant variation across race or insurance type, except that self pay cancer patients had a lower rate of VCF placement. Variation across hospitals in the percentage of cancer cases that received a VCF was striking, ranging from 0% to 52% among hospitals that admitted a minimum of 15 acute VTE cases. There was a strong correlation (r=0.72, R2=0.52) in the frequency of VCF placement in cancer and non-cancer cases within individual hospitals. Among cancer types, the frequency of VCF placement was highest in cases with brain cancer (43%), with the observed frequency of VCF use among other cancer types ranging from 8%-23%. Patients with brain cancers, which has a high perceived bleeding risk were over 4 fold more likely to have a VCF placed compared to those cancers with low bleeding risk. Having acute leukemia did not predict for VCF placement. Only 8.2% of cancer patients had a strict contraindication to anticoagulation (acute bleeding or recent/imminent surgery), which are the only guideline-based indications for VCF placement. Active bleeding and undergoing surgery were each strongly associated with VCF use: 47% of cases that bled and 58% of cases who underwent surgery had a VCF placed. Results of the multivariable logistic model are shown in the table. In addition to bleeding and undergoing surgery, factors associated with VCF insertion included: larger hospital, urban location, private hospital and greater SOI at the time of admission. Conclusions The frequency of VCF use in cancer patients admitted for acute VTE is much higher than in non-cancer patients. Major risk factors for VCF use include bleeding, undergoing recent surgery, having brain cancer, urban location, and greater severity of illness. The frequency of VCF placement among cancer patients varied widely across hospitals. Given the extraordinary variation in the frequency of use of VCFs between hospitals, more research is needed to better define outcomes of VCF placement in cancer patients. Disclosures: Ho: American Society of Hematology: ASH HONORS trainee research award Other.

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National Epidemiology of Venous Thromboembolism in Patients with Malignancy in United States from 1993 to 2012

Blood ◽

10.1182/blood.v126.23.2060.2060 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2060-2060 ◽

Cited By ~ 1

Author(s):

Kathan Dilipbhai Mehta ◽

Leonard Appleman ◽

Hong Wang ◽

Roy E. Smith ◽

Rahul Atul Parikh

Keyword(s):

United States ◽

Venous Thromboembolism ◽

Bile Duct ◽

Head And Neck ◽

Cancer Patients ◽

Intrahepatic Bile Duct ◽

Cancer Type ◽

Patients With Cancer ◽

Co Morbidity ◽

National Estimates

Abstract Background: Venous thromboembolism (VTE) is an important cause of morbidity and mortality in cancer patients. National burden of inpatient VTE in patients with cancer is not known. Methods: We used the National Inpatient Sample (NIS), one of the largest publicly-available inpatient dataset in United States (U.S.), which represents a 20% stratified random sample of discharges from all hospitals, excluding rehabilitation and long-term acute care hospitals. The NIS is drawn from all States participating in Healthcare Cost and Utilization Project, representing more than 95 percent of the U.S. population. Discharge weights are used to generate national estimates. Patients with cancer were identified using ICD9 codes published by NIS. VTE was defined by ICD9 codes 451 - 453 and 415.1. Annual rates of inpatient VTE were calculated from 1993 to 2012 by cancer type. Multivariate odds of inpatient VTE was determined by logistic regression controlling for confounders (Age, sex, Charlson co-morbidity index, metastatic disease, chemotherapy, blood transfusion, major therapeutic operating room procedure, primary hypercoaguable state, disseminated intravascular coagulation, heparin induced thrombocytopenia, anti-phospholipid antibody syndrome, obesity and calendar year). Incidence of VTE in population was calculated by using prevalence published by CDC as our denominator from 2001 to 2011. Results: 69.1 million hospitalized patients (weighted number) with cancer were identified, and 2.6 million had VTE (3.8%). Rates of inpatient VTE increased for all cancers from 1993 and 2012 (Table 1). The cancers with sharpest rise in inpatient VTE rate were liver and bile duct (LBD), pancreas and esophagus (Slope: 0.33, 0.31 and 0.22 percent per year). The cancers with highest odds of inpatient VTE were pancreas, brain and LBD (OR: 2.49, 2.41, and 2.23). The cancers with highest incidence of VTE in population were pancreas, LBD and esophagus (182, 116, and 67 per 1000 person-year). The cancers with lowest odds of inpatient VTE were thyroid, head and neck and prostate (OR: 0.5, 0.67, and 0.87). The cancers with lowest incidence of VTE in population were thyroid, melanoma and testis (2, 2.5, and 4.8 per 1000 person-year). Conclusions: Our study provides national estimates of VTE, which are increasing across all cancer types. Certain cancers have higher incidence and odds of VTE as compared to others. Identification of these trends provides valuable information for the use of prophylaxis in cancers with high risk of VTE. Table 1. Incidence, Multivariate Odds and Rates of In-patient VTE in Cancer Patients in US. Cancer Type Incidence of VTE in Population (per 1000 person-year) Multivariate OR (95% CI) for Inpatient VTE Compared to All Other Cancers Inpatient VTE Rate (%) 1993 vs. 2012 (p<0.01) Slope of Change in VTE Rates from 1993 to 2012 Pancreas 182.4 2.49 (2.39 - 2.6) 5.7 12.0 + 0.31 Brain and nervous system 34.6 2.41 (2.29 - 2.54) 4.3 6.3 + 0.08 Liver and intrahepatic bile duct 115.8 2.23 (2.13 - 2.34) 3.5 9.9 + 0.33 Multiple myeloma 55.0 1.72 (1.62 - 1.81) 2.7 5.3 + 0.16 Non-Hodgkin`s lymphoma 19.7 1.69 (1.61 - 1.76) 3.2 5.7 + 0.10 Hodgkin`s disease 8.1 1.6 (1.51 - 1.7) 3.0 5.2 + 0.08 Ovary 30.8 1.59 (1.52 - 1.67) 2.6 6.6 + 0.20 Testis 4.8 1.5 (1.41 - 1.6) 2.4 5.6 + 0.16 Bronchus, lung 59.4 1.43 (1.37 - 1.49) 2.6 6.6 + 0.21 Stomach 40.1 1.39 (1.33 - 1.47) 3.0 6.8 + 0.20 Esophagus 66.6 1.38 (1.31 - 1.45) 2.2 6.1 + 0.22 Cervix 14.7 1.34 (1.27 - 1.42) 3.0 4.5 + 0.07 Uterus and Other female genital organs 8.6 1.32 (1.26 - 1.38) 2.9 5.3 + 0.09 Kidney and renal pelvis 16.0 1.2 (1.14 - 1.26) 2.9 5.0 + 0.10 Leukemias 24.4 1.15 (1.1 - 1.2) 1.8 4.3 + 0.11 Urinary bladder 7.7 1.09 (1.04 - 1.14) 2.1 4.4 + 0.12 Colon, Rectum and Anus 15.3 1.08 (1.04 - 1.13) 2.7 4.6 + 0.09 Breast 7.2 1 (0.96 - 1.04) 2.5 3.9 + 0.05 Bone and connective tissue n/a 1 (0.95 - 1.07) 1.4 4.1 + 0.15 Melanomas of skin 2.5 0.91 (0.87 - 0.96) 1.9 3.7 + 0.08 Prostate 5.4 0.87 (0.83 - 0.9) 2.3 3.5 + 0.06 Head and neck 7.0 0.67 (0.64 - 0.7) 0.9 3.3 + 0.12 Thyroid 2.0 0.5 (0.47 - 0.53) 0.7 2.4 + 0.07 Disclosures No relevant conflicts of interest to declare.

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Morbidity, Mortality and Costs Associated with Venous Thromboembolism in Hospitalized Patients with Cancer

Blood ◽

10.1182/blood.v124.21.2613.2613 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2613-2613

Author(s):

Gary H. Lyman ◽

Eva Culakova ◽

Marek S. Poniewierski ◽

Nicole M. Kuderer

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Venous Thromboembolism ◽

Length Of Stay ◽

Hospital Mortality ◽

Cancer Patients ◽

Infectious Complications ◽

Hospitalized Patients ◽

Patients With Cancer ◽

Risk Of Mortality

Background: Venous thromboembolism (VTE) occurs commonly in patients with cancer and is associated with considerable morbidity and mortality. While the risk of VTE is greater in hospitalized patients and those undergoing active treatment, less is known about factors associated with increased risk of mortality and costs in this setting. The study presented here evaluates the risk of mortality among hospitalized cancer patients with VTE and the association of patient comorbidities and infectious complications on duration of hospitalization, in-hospital mortality and costs. Methods: Data on hospitalization of adult patients (age≥18) with cancer between 2004 and 2012 from 239 US academic medical centers reporting to the University Health Consortium were analyzed. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary outcomes consisted of length of stay, in-hospital mortality and estimated cost of hospitalization. Stratified analyses were performed based on patient characteristics, year of hospitalization, cancer type, major comorbidities and infectious complications. Costs were adjusted to 2014 dollars. Results: Among more than 3.8 million admissions of adult patients with cancer, 246,653 included a diagnostic code for VTE representing 198,173 individual patients with both cancer and VTE. Overall, 41% of patients with cancer and VTE were hospitalized for 10 days or longer with an in-hospital mortality rate of 11.3% and estimated average costs per hospitalization of $37,039. While length of stay and mortality rates remained relatively stable over the 9 years of observation, 2014-adjusted costs per day hospitalization increased from $2,600 in 2004 to $3,200 in 2012. In-hospital mortality was greatest in patients with lung (15.8%) and gastric (14.1%) cancers and leukemia (14.2%). Medical comorbidities associated with the highest rates of mortality included congestive heart failure (19.8%), cerebrovascular disease (20.4%), and major disorders of the lung (20.6%), liver (20.0%), and kidney (21.4%) with mortality increasing in direct proportion to the number of comorbidities. Likewise, comorbidities associated with the greatest average costs per hospitalization included congestive heart failure ($51,885), cerebrovascular disease ($55,815), and major disorders of the lung ($53,899), liver ($51,332), and kidney ($55,774) with estimated costs increasing from $22,622 with no medical comorbidity to over $70,000 with four or more. Alternatively, infectious complications associated with the highest rates of mortality and greatest average costs were sepsis (38.1%; $90,529) and pneumonia (26.0%; $69,024). Conclusions: Hospitalized patients with cancer and VTE are at considerable risk for prolonged hospitalization and in-patient mortality accompanied by considerable hospital costs. Patients with additional major comorbidities and infectious complications are at even greater risk of in-hospital mortality and substantially greater costs. Additional efforts to identify cancer patients at greater risk for VTE and its complications including prolonged hospitalization and in-hospital mortality are needed as well as better strategies and agents for reducing the risk and consequences of VTE. Disclosures Lyman: Amgen: Research Funding.

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Treatment and secondary prevention of venous thromboembolism in cancer patients

Onkologische Welt ◽

10.1055/s-0038-1630173 ◽

2012 ◽

Vol 03 (03) ◽

pp. 121-125

Author(s):

I. Pabinger ◽

C. Ay

Keyword(s):

Clinical Trials ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Oral Anticoagulants ◽

Factor Xa ◽

New Oral Anticoagulants ◽

Phase Iii ◽

Patients With Cancer ◽

Potential Use

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.

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