Thromboprophylaxis in active cancer patients: Is it a controversial clinical issue or not? Preliminary results of ACT4CAT study.

e18803 Background: Cancer Associated Thrombosis (CAT) is an increasing challenge for oncology patients since oncologists sometimes are reluctant to mitigate the risk with thromboprophylaxis. Active cancer patients while receiving chemotherapy have a 7fold risk of thrombosis compared with no cancer patients. Anticoagulation holds a prominent place in prevention of CAT usually with Low Molecular Weight Heparins (LMWHs). Methods: ACT4CAT is prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high thrombotic risk, active cancer patients who received thromboprophylaxis enrolled after signing informed consent. Results: Preliminary results collected from 18 oncology departments. From 431 enrolled patients 322 (65.4%) had completed the study. Tumor types included: lung 28.8%, gastrointestinal 39.8%, gynecological 7.0%, breast 4.4%, urological 7.0% and others 20%. Majority of patients (88.2%) received High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as platinum agents (55.9%), antimetabolites (44.7%) and immunotherapy (12.6%). In 1st line were 62.1%, 2nd line 18.4%, adjuvant 8.9% and neoadjuvant 2.4%. The following table depicts: age, gender, metastatic disease, Khorana score ≥2 and HRTCAs. All patients received thromboprophylaxis for 5.3±3.6 months with: tinzaparin 90.8%, fondaparinux 5.5%, bemiparin 1.5%, enoxaparin 1.2%, apixaban 0.5% and rivaroxaban 0.5%. Intermediate doses received 70.9% of patients regardless clinical setting (1st, 2nd, adjuvant & neoadjuvant: 70.2%, 79.2%, 51.3% and 70.0% respectively, p = 0.0254), although intermediate doses were used more in metastatic stages (OR:2.4 95%CI: 1.4-4.2, p = 0.0028). Nine thrombotic events reported (2.1%, 95%CI: 1.1-3.9%), irrespective of clinical setting but with a trend towards prophylactic doses. Eleven grade 1 bleedings reported (2.6%, 95%CI: 1.4-4.5%), despite clinical setting or dose used. Conclusions: Thromboprophylaxis in ambulatory active cancer patients with high thrombotic risk is safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs and drug-drug interactions influence the clinical decision of thromboprophylaxis in active cancer patients mainly with LMWHs and quite often with intermediate doses regardless clinical setting. Clinical trial information: NCT03909399. [Table: see text]

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Real-World Data on Thromboprophylaxis in Active Cancer Patients: Where Are We? Are We Getting There?

Cancers ◽

10.3390/cancers12071907 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1907

Author(s):

Nikolaos Tsoukalas ◽

Pavlos Papakotoulas ◽

Athina Christopoulou ◽

Alexandros Ardavanis ◽

Georgios Koumakis ◽

...

Keyword(s):

Cancer Patients ◽

Low Molecular Weight Heparins ◽

Bleeding Events ◽

Real World Data ◽

Thrombotic Risk ◽

Cancer Associated Thrombosis ◽

Tumor Types ◽

Chemotherapy Agents ◽

Higher Doses ◽

Active Cancer

Background: Cancer patients are at high risk for cancer-associated thrombosis (CAT). CAT is the second leading cause of death in these patients but it can be preventable with thromboprophylaxis. Patients and Methods: An observational, prospective, multicenter study aiming to record CAT management in clinical practice was conducted by the Hellenic Society of Medical Oncology (HeSMO). Results: A total of 426 active cancer patients (mean age 65.3 years, mean BMI: 26.1 kg/m2) who received thromboprophylaxis, were included from 18 oncology units. Tumor types were lung 25.1%, pancreas 13.9%, breast 8.7%, stomach 8.5%, ovarian 7.8%, and others 36%, while 69% had metastases. A total of 71% had a Khorana score ≤2 and 61% received High Thrombotic Risk Chemotherapy Agents (HTRCAs, e.g., platinum). For thromboprophylaxis patients received mainly Low Molecular Weight Heparins (LMWHs), on higher than prophylactic doses in 50% of cases. Overall, 16 (3.8%) thrombotic events and 6 (1.4%) bleeding events were recorded. Notably, patients on higher doses of LMWHs compared to patients who received standard prophylactic doses had 70% lower odds to develop thrombotic events (OR: 0.3, 95% CI: 0.10–1.0, p = 0.04). Conclusion: CAT is an important issue in oncology. Along with the Khorana score, factors as metastases and use of HTRCAs should also be taken into consideration. Thromboprophylaxis for active cancer patients with LMWHs, even on higher doses is safe and efficient.

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ACT for prevention and prophylaxis of cancer-associated thrombosis (CAT).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14135 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14135-e14135

Author(s):

Nikolaos Tsoukalas ◽

Athina Christopoulou ◽

Christos N Papandreou ◽

Nikolaos Kapodistrias ◽

Anna Koumarianou ◽

...

Keyword(s):

High Risk ◽

Cancer Patients ◽

Bleeding Events ◽

History Of ◽

Anticancer Treatment ◽

Cancer Associated Thrombosis ◽

Risk For Thrombosis ◽

Chemotherapy Agents ◽

Clinical Trial Information ◽

Active Cancer

e14135 Background: CAT is the 2nd leading cause of death in oncology patients and there is need for thrombosis management across the natural history of cancer because of its dynamic nature. Anticoagulant therapy is the cornerstone of prevention and treatment, since thrombosis interferes with cancer treatment, increases health care resource utilization, imposes emotional and economic burden. Methods: A prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high risk for thrombosis, active cancer patients who received thromboprophylaxis are enrolled after signing informed consent. Results: Preliminary results are collected from 17 oncology departments. From the 272 enrolled patients, 176 (64.7%) have completed second visit (3-4 cycles of anticancer treatment). Primary cancers included: lung 31.3%, pancreas 26.1%, colorectal 13.6%, gynecological cancers 10.2%, stomach 7.8%, bladder 6.3%, and others.75.6% of the patients had metastatic disease. 1/3 of the patients were smokers or ex-smokers, and 33% underwent surgery. Most of patients (65.9%) were at 1st line treatment and 17.6% at 2nd line. The vast majority (90.3%) were treated with High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as cisplatin etc. Regarding Khorana score, 65.1% had ≥2. In particular, 86.7% of patients with Khorana score ≤1 received HRTCAs while 95.4% of patients with score = 2.All patients received thromboprophylaxis, specifically: 93.0% tinzaparin, 5.2% fondaparinux and 1.8% other (enoxaparin, bemiparin) with average duration 5.3±3.1 months. 67.1% of the patients received higher than standard prophylactic doses. 3 patients (1.7%) experienced thrombotic events (2 DVT and 1 PE). These 3 patients had metastases and were treated with HRTCAs. Five grade 1 bleeding events were reported (2.8%). Conclusions: Thromboprophylaxis of CAT is both safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs along with drug-drug interactions, increase the LMWHs usage often in higher than prophylactic doses in CAT management. Clinical trial information: NCT03909399.

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Evaluation of Rivaroxaban and Dalteparin in Cancer Associated Thrombosis

Blood ◽

10.1182/blood.v126.23.432.432 ◽

2015 ◽

Vol 126 (23) ◽

pp. 432-432

Author(s):

Ateefa Chaudhury ◽

Asha Balakrishnan ◽

Christy Thai ◽

Bjorn Holmstrom ◽

Michael V. Jaglal

Keyword(s):

Cancer Patients ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Cancer Center ◽

Minor Bleeding ◽

Efficacy And Safety ◽

Recurrent Vte ◽

Chi Square Analysis ◽

Cancer Associated Thrombosis ◽

Active Cancer

Abstract Introduction: Venous thromboembolism (VTE) in the form of deep venous thrombosis (DVT) or pulmonary embolism (PE) is a complication of malignancy. Several studies have demonstrated the superiority of dalteparin (Fragmin®), a low molecular weight heparin (LMWH), in comparison to oral vitamin K antagonists in preventing VTE recurrence in the setting of active cancer. LMWH is the preferred treatment of cancer associated thrombosis. However, the cost of LMWH can be prohibitive and the need for daily subcutaneous injections can decrease patients' quality of life. While rivaroxaban (Xarelto®), a Factor Xa inhibitor, has been approved for the treatment and secondary prevention of DVT and PE, there is limited data regarding its use in cancer patients. The objective of our study is to determine the efficacy and safety of rivaroxaban compared to dalteparin in cancer associated thrombosis. Methods: This is a retrospective chart review of cancer patients greater than age 18 treated at H. Lee Moffitt Cancer Center between May 3, 2010 and June 30, 2015 on anticoagulation with rivaroxaban or dalteparin. Patients were excluded if the length of anticoagulant therapy was < 30 days, anticoagulant therapy was initiated > 6 months after VTE diagnosis, the indication for treatment was not DVT/PE, if patients had contraindications to either LMWH or rivaroxaban, or patients were not on treatment doses of therapy. Out of 459 patients identified, 226 patients (107 in the rivaroxaban group, and 119 in the dalteparin group) were eligible for analysis based on our exclusion criteria. Efficacy was determined by the incidence of recurrent VTE, such as recurrent DVT, new fatal or non-fatal PE within 30 days. The secondary endpoint of the study was to determine the safety of rivaroxaban compared to dalteparin in cancer patients for the treatment of VTE. Safety was determined by the incidence and severity of bleeding. Major bleeding was defined as clinically overt if it was associated with a fall in hemoglobin of 2 g/dL or more, required transfusions of ≥ 2 units of packed red blood cells, involved retroperitoneal, intracranial, or critical site bleeding, or if it contributed to death. Minor bleeding was defined as overt bleeding not meeting the criteria for major bleeding but associated with medical intervention, unscheduled contact with a physician, interruption or discontinuation of anticoagulation treatment, or associated with any other discomfort such as pain or impairment of activities of daily life. Descriptive statistical analyses were utilized. Chi square analysis and t- test were performed to compare categorical and continuous variables. All data was analyzed using SPSS version 21.0 statistical software. Results: Rivaroxaban had a similar rate of DVT and PE failure with 1 event versus 2 with dalteparin (p = 0.625). The rivaroxaban group had 0 major and 8 minor bleeds compared to 3 major and 8 minor bleeds in the dalteparin group with p values of 0.09 and 0.86 respectively. Comorbidities and risk factors for thrombosis were similar in both groups as summarized in Table 1. Table. Rivaroxaban vs. Dalteparin: No Significant Differences in the Efficacy and Safety Profile in Cancer Associated Thrombosis RivaroxabanN = 107 DalteparinN =119 P value DVT Failure within 30 days 1 (0.93%) 2 (1.68%) 0.625 PE Failure within 30 days 1 (0.93%) 1 (0.84%) 0.94 Major Bleeding 0 (0 %) 3 (2.5%) 0.09 Minor Bleeding 8 (7.5%) 8 (6.7%) 0.864 Median Age (Yrs) 61 65 0.93 MaleFemale 58 (54.2%) 49 (45.8%) 60 (50.4%) 59 (49.6%) 0.596 Active Cancer 96 (86.5%) 111 (93.2%) 0.350 Surgery within 30 Days 14 (13.1%) 13 (10.9%) 0.684 Hypertension 58 (54.2%) 61 (51.3%) 0.69 Diabetes 14 (13.1%) 14 (11.8%) 0.84 Coronary Artery Disease 6 (5.61%) 11 (9.2%) 0.326 History of Previous DVT 12 (11.2%) 5 (4.2%) 0.074 BMI >30 39 (36.4%) 48 (40.3%) 0.585 Creatinine Clearance (Cr Cl) 30 - 50 Cr Cl 50 - 70 7 (6.5%) 100 (93.3%) 7 (5.9%) 112 (94.1%) 0.837 Conclusions: Our study evaluated the safety and efficacy of rivaroxaban compared to dalteparin in patients with predominantly active cancer treated at a large comprehensive cancer center and found rivaroxaban to be comparable to dalteparin in this cohort. There were no significant differences in regards to recurrent VTE or major/minor bleeding with patients on rivaroxaban or dalteparin in our cohort of patients. Large randomized trials evaluating the efficacy and safety of rivaroxaban in the oncology population are needed to further validate our findings. Disclosures No relevant conflicts of interest to declare.

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A community-based program for personalized cancer care using next-generation sequencing (NGS).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.11102 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 11102-11102

Author(s):

Shile Liang ◽

Pranil Chandra ◽

Zeqiang Ma ◽

Debbie Haynes ◽

James Prescott ◽

...

Keyword(s):

Clinical Trials ◽

Cancer Patients ◽

Clinical Decision Making ◽

Clinical Decision ◽

Molecular Profiling ◽

Targeted Agents ◽

Community Based ◽

Off Label ◽

Molecular Abnormalities ◽

Tumor Types

11102 Background: Despite growing interest and need, molecular profiling of tumor samples is largely unavailable in community cancer centers, where nearly 80% of cancer patients (pts) are treated. In 10/12, Sarah Cannon Research Institute (SCRI) launched a community-based molecular profiling program to: 1) better understand the molecular constituency of cancer patients, 2) identify appropriate pts for phase I and II clinical trials of targeted agents, and 3) identify pts with molecular abnormalities responsive to FDA-approved agents. Methods: Eligible pts consented to testing of available biospecimens, which were interrogated for alterations in 35 cancer-related genes using NGS (1000X average coverage) in a CLIA/CAP laboratory. Results were reported to the treating physician within 14 days and stored in a database to enable correlation with clinical outcomes. Results: As of 1/13, 209 pts had been enrolled with 84% having sufficient material for assay. At least 1 mutation was detected in 46% of tumors. Results in the 3 most commonly assayed tumor types are summarized (Table). Mutations for which there are FDA-approved targeted agents were found in 14 off-label tumors (EGFR 4, KIT 3, SMO 3, BRAF 2, HER2 2). 40 pts (27%) were subsequently enrolled in clinical trials; in 19 of these, assay results influenced clinical trial selection. Conclusions: This program provides molecular profiling data to community oncologists for clinical decision making. Experience to date indicates this information can be provided in a timely manner for incorporation into clinical practice. Profiling results will enable: 1) selection of pts with appropriate tumor targets for investigational targeted agents, 2) enhanced study enrollment, 3) evaluation of FDA approved targeted agents in off-label tumor types, and 4) correlation of treatment outcomes with patterns of tumor molecular abnormalities. [Table: see text]

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Prevention and treatment of venous thromboembolism in cancer patients: project of clinical guidelines

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2020.3.7588 ◽

2020 ◽

Vol 27 (3) ◽

pp. 75-88

Author(s):

S. M. Kozhukhov ◽

N. V. Dovganich ◽

I. I. Smolanka ◽

I. A. Kryachok ◽

O. F. Ligirda

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Cancer Progression ◽

Bleeding Risk ◽

Treatment Modalities ◽

Bleeding Events ◽

Related Factors ◽

Management Algorithm ◽

Cancer Associated Thrombosis ◽

Active Cancer

Cancer-associated thrombosis is an actual issue in the intersection of cardiology and oncology. Active cancer counts for approximately 20 % of the total number of cases of venous thromboembolism (VTE), and VTE is one of the leading cause of death in cancer patients, second only to cancer progression. VTE in cancer has some features that distinguish it from other VTE cases. The combination of cancer-related, treatment-related and patient-related factors increases their overall risk of VTE. The experts of the Cardio-Oncology working group have created a practical approach guideline for the management of VTE in cancer patients based on a multi-disciplinary strategy, ESMO, ASCO recommendations. This document has collected information on VTE, bleeding events and treatment modalities in cancer patients that may be beneficial for clinicians in determining strategies of anticoagulant therapies in these patients. Clinicians of various specialties using these recommendations will be able to determine the most appropriate VTE management algorithm, taking into account the bleeding risk, the type of cancer with its treatment, and drug interactions.

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Impact of Tumor Genomic Mutations on Thrombotic Risk in Cancer Patients

Cancers ◽

10.3390/cancers12071958 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1958 ◽

Cited By ~ 1

Author(s):

Orly Leiva ◽

Jean M. Connors ◽

Hanny Al-Samkari

Keyword(s):

Risk Stratification ◽

Cancer Patients ◽

Patient Characteristics ◽

Tumor Location ◽

Thrombotic Risk ◽

Increased Risk ◽

Prevention Of Cancer ◽

Cancer Associated Thrombosis ◽

Molecular Aberrations ◽

The Impact

Venous thromboembolism (VTE) is common in patients with cancer and is an important contributor to morbidity and mortality in these patients. Early thromboprophylaxis initiated only in those cancer patients at highest risk for VTE would be optimal. Risk stratification scores incorporating tumor location, laboratory values and patient characteristics have attempted to identify those patients most likely to benefit from thromboprophylaxis but even well-validated scores are not able to reliably distinguish the highest-risk patients. Recognizing that tumor genetics affect the biology and behavior of malignancies, recent studies have explored the impact of specific molecular aberrations on the rate of VTE in cancer patients. The presence of certain molecular aberrations in a variety of different cancers, including lung, colon, brain and hematologic tumors, have been associated with an increased risk of VTE and arterial thrombotic events. This review examines the findings of these studies and discusses the implications of these findings on decisions relating to thromboprophylaxis use in the clinical setting. Ultimately, the integration of tumor molecular genomic information into clinical VTE risk stratification scores in cancer patients may prove to be a major advancement in the prevention of cancer-associated thrombosis.

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Effectiveness and Safety of Rivaroxaban in Treatment of Venous Thromboembolism in Cancer Patients

Blood ◽

10.1182/blood.v126.23.2319.2319 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2319-2319 ◽

Cited By ~ 3

Author(s):

Khine Z Win ◽

Nathan Wilson ◽

David D Stenehjem ◽

Natalee Tanner ◽

George M. Rodgers ◽

...

Keyword(s):

Platelet Count ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Median Time ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight ◽

Major Bleed ◽

Recurrent Vte ◽

Cancer Associated Thrombosis ◽

Active Cancer

Abstract Introduction Patients with active cancer have a high risk for venous thromboembolism (VTE). The current treatment of choice for cancer-associated thrombosis is low molecular weight heparin (LMWH). Evidence for the efficacy and safety of the target-specific oral anticoagulants in the prevention and treatment of cancer-associated thrombosis is limited. In the EINSTEIN trials, comparing rivaroxaban to LMWH plus a vitamin K antagonist, only a small number of patients with active cancer received treatment with rivaroxaban (6.8% [n=118] in EINSTEIN-DVT1 and 4.7% [n=114] in EINSTEIN-PE2). The use of rivaroxaban over LMWH for cancer-associated thrombosis is not recommended by the current guidelines.3 However, due to the parenteral route of administration and high cost burden of LMWH, some cancer patients at our institution have received rivaroxaban for cancer-associated thrombosis. Method An observational chart review was performed to determine the effectiveness and safety of rivaroxaban for the treatment of VTE in cancer patients by observing recurrent VTE and bleeding events. For the effectiveness endpoint, patients who received rivaroxaban for less than one month were excluded from the study. For the safety analysis, patients who received at least one dose of rivaroxaban were included in the study. Result A total of 92 cancer patients with VTE who received rivaroxaban at Huntsman Cancer Institute were selected for the study. Median age was 60 years old and 54% (n=50) were male. Average estimated creatinine clearance at the initiation of rivaroxaban was 96.2 mL/min (range 31.8-241 mL/min, Cockcroft-Gault). Thirty-eight patients (41%) were treated for DVT (deep venous thromboses), 32 patients (35%) had PE (pulmonary embolism), and 19 patients (21%) had both DVT and PE. A total of 20 patients (21.7%) had a bleeding event while on therapy (see table). Ten patients (10.8%) experienced a major bleed and the median time to major bleeding was 4.4 months (IQR 2.4-11.6 months). One patient had a fatal intracranial bleed. Four patients (4.3%) had critical bleeding and 5 patients (5.4%) had a clinically relevant bleeding with ≥ 2g/dL drop in hemoglobin level and/or required ≥2 units of red blood cell transfusion. Pharmacodynamic interactions may have contributed to 3 major bleeds, including one patient on aspirin, another on ibuprofen, and the third patient on both aspirin and clopidogrel at the time of bleeding. Seven patients were taking rivaroxaban 20 mg daily at the time of the major bleed. The median platelet count at the time of bleeding was 170k/µL (IQR 108-333k/µL). One patient had a platelet count of 17 k/µL and was admitted with sepsis at the time of bleed. Ten patients (10.8%) experienced minor symptomatic bleeds and the median time to bleeding was 2.5 months (IQR 0.73-4.8 months). Only 4 patients (4.3%) experienced recurrent VTE while on rivaroxaban. Two patients had recurrent DVT. Two patients developed recurrent PE and both were admitted to the hospital for parenteral anticoagulation. The median time to recurrent VTE was 5.7 months (IQR 2.5-11 months). The median platelet count at the time of recurrence was 120 k/µL (range 26-216k/µL). One patient had a known thrombophilia, Factor V Leiden mutation. Conclusion These data suggest that rivaroxaban may be a safe and acceptable alternative to LMWH for the treatment and secondary prevention of cancer-associated thrombosis. Table 1.Huntsman Cancer Institute (n=92)EINSTEIN-DVT1(Cancer sub-group, n=118)EINSTEIN-PE2(Cancer sub-group, n=114)CLOT trial4(n=336)Major bleeding10.8% (n=10)14.4% (n=17)12.3% (n=14)14% (n=47)Clinically relevant non-major bleeding10.8% (n=10)Recurrent DVT2.2% (n=2)3.4% (n=4)n/a4.2% (n=14)Recurrent PE2.2% (n=2)n/a1.8% (n=2)3.9% (n=13) References: 1. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N. Engl. J. Med. 2010;363(26):2499-2510. 2. Büller HR, Prins MH, Lensin AWA, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N. Engl. J. Med. 2012;366(14):1287-1297. 3. NCCN Clinical Practice Guidelines in Oncology. Cancer-Associated Venous Thromboembolic Disease, v2.2014. www.nccn.org. 4. Lee AYY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumadin for the prevention of recurrent venous thromboembolism in patients with cancer. N. Engl. J. Med. 2003;349(2):146-153. Disclosures No relevant conflicts of interest to declare.

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Different D-dimer algorithms to rule out pulmonary embolism in patients with cancer: a comparative study

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.198 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

BV Silva ◽

C Mendonca ◽

N Cunha ◽

P Silverio Antonio ◽

T Rodrigues ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cancer Patients ◽

Clinical Decision ◽

Pulmonary Angiography ◽

Lower Sensitivity ◽

Vein Thrombosis ◽

Patients With Cancer ◽

D Dimer ◽

Active Cancer ◽

Rule Out

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary embolism (PE) is more prevalent in patients with cancer. D-dimers are a less useful test in such patients due to less specificity. Several algorithms have been developed as an alternative to the fixed d-dimer cutoff, aiming to avoid the excessive use of computed tomography pulmonary angiography (CTPA), but it is not clear which is the most accurate algorithm in PE patients with cancer. Objective To compare the efficacy of 4 algorithms to rule out pulmonary embolism (fixed Ddimer cutoff, age-adjusted, YEARS and PEGed) in patients with active cancer. Methods Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied. In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if DDimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimer >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA. Results Of 409 patients with suspected PE, 87 patients (21,3%) had cancer. The prevalence of PE was 38% in cancer patients and 35% in patients without cancer (p > 0.05). Age-adjusted cut-off, compared to the conventional cutoff, had an AUC significantly higher (0.68 vs 0.61, p = 0.005). Despite both having 100% sensitivity, age-adjusted cutoff had a significant higher specificity compared to conventional cut-off (44% vs 35%, p < 0.05). Both YEARS and PEGED algorithms had significantly lower sensitivity (p = 0.003 and p = 0.002, respectively) and higher specificity (p < 0.001, for both) compared to conventional cutoff in patients with active cancer. The AUC of these two algorithms was not significantly different compared to conventional cutoff (p = 0.08 and p = 0.78, respectively). Conclusion Considering our results, age-adjusted cut-off seems to be the most accurate algorithm to rule out pulmonary embolism in active cancer patients. Sen(%)Spec(%)Conventional10022Age-adjusted10035YEARS9144PEGED9130Abstract Figure. AUC of four algorithms

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Tackling Cancer Associated Thrombosis: A Multi-Professional Approach

Blood ◽

10.1182/blood-2018-99-112538 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4691-4691

Author(s):

Sumantha Gabriel ◽

Kate Musgrave

Keyword(s):

Cancer Patients ◽

Patient Treatment ◽

P Value ◽

Chi Square ◽

Thrombotic Risk ◽

New Strategy ◽

Chi Square Test ◽

New Guidelines ◽

Knowledge Of Cancer ◽

Cancer Associated Thrombosis

Abstract Introduction Thromboembolism is a leading cause of death in people with cancer; second only to the cancer itself. There is an urgent need to raise the profile of cancer associated thrombosis amongst not only patients but staff treating people with cancer. Aims This project aimed to educate cancer patients about their thrombotic risk and to improve both the prevention and treatment of cancer associated thrombosis. Methods A review of attitudes and use of thromboprophylaxis was performed in a large, UK-based, teaching hospital; prior to and following the introduction of a new strategy to improve knowledge of cancer associated thrombosis. The study was performed between March and July 2018, with the strategy fully implemented by May 2018. This strategy included a three pronged approach: the introduction of a regular teaching programme for nurses, pharmacists and doctors; the implementation of new guidelines relating to cancer associated thrombosis; and the use of educational videos and posters within patient areas. The knowledge of clots/thrombosis of people with cancer, discussions with staff concerning thrombotic risk and use of tinzaparin thromboprophylaxis at a high risk dose (4500 units) were all investigated. Cancer patients admitted to the hospital were eligible for the study only if they had been admitted for at least 24 hours, this allowed staff the opportunity to discuss the risk of thrombosis with them. A typical one week period was chosen to complete each part of the study, the second week occurred two months after the introduction of the new strategy. A p value of <0.05 was considered significant and was calculated using a Chi-square test. Results A total of 91 patients were included in the study (42 prior to the intervention and 49 following). They included a mix of both out-patients (32/42, 74% prior to intervention and 25/49, 51% following) and in-patients (10/42, 26% prior to and 24/49, 49% following). Median age was 65 years (range 21 - 87 years) prior to intervention and 67 years (range 21 - 86 years) following. For those admitted to hospital, the median length of admission was 3 days (range 1-84 days) prior to intervention and 4 days (range 2-33 days) following. Overall there was a slight male preponderance (55% both prior to intervention and following). People with a range of cancer types were interviewed. In the cohort prior to intervention the most common cancer sites were: lung (8/42), bowel (8/42) and skin (7/42). Following the intervention the most common were: breast (6/49), skin (5/49) and lung (4/49). A higher proportion of people questioned before the intervention had known metastases (29/42, 69% prior to and 22/49, 45% following; p<0.05). Generally people with cancer had a good knowledge of venous thromboembolism and this remained high following the intervention (39/42, 93% to 41/49, 84%; p=0.18). There was a significant increase in the number of people who had discussed thrombotic risk with a healthcare professional during their hospital admission or out-patient treatment (12/42, 24% to 24/49, 51%; p<0.05). The use of tinzaparin thromboprophylaxis in those eligible to receive it, remained high following the intervention (13/16, 81% to 16/17, 91%, p=0.26) and the appropriate use of a higher risk dose (4500 units) rose significantly (1/13, 8% to 12/16, 75%, p<0.001). Conclusion The use of a multi-professional approach to preventing and treating cancer associated thrombosis increased discussion between staff and patients regarding thrombosis and improved accuracy of thromboprophylaxis dosing. Our results strongly support the use of a strategy based on regular training and patient education. Disclosures Gabriel: Leo Pharma: Other: Travel and accommodation sponsorship. Musgrave:Leo Pharma: Other: Travel and accomodation sponsorship.

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Increased Hospitalization and Mortality from COVID-19 in Prostate Cancer Patients

Cancers ◽

10.3390/cancers13071630 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1630

Author(s):

Dimple Chakravarty ◽

Parita Ratnani ◽

Stanislaw Sobotka ◽

Dara Lundon ◽

Peter Wiklund ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Mortality Rates ◽

Mount Sinai Hospital ◽

Solid Cancer ◽

Continuous Variables ◽

Breast Cancer Patients ◽

Chi Square ◽

Hospital System ◽

Tumor Types

Background: Cancer patients with COVID-19 have a poor disease course. Among tumor types, prostate cancer and COVID-19 share several risk factors, and the interaction of prostate cancer and COVID-19 is purported to have an adverse outcome. Methods: This was a single-institution retrospective study on 286,609 patients who underwent the COVID-19 test at Mount Sinai Hospital system from March 2020 to December 2020. Chi-square/Fisher’s exact tests were used to summarize baseline characteristics of categorical data, and Mann–Whitney U test was used for continuous variables. Univariable logistic regression analysis to compare the hospitalization and mortality rates and the strength of association was obtained by the odds ratio and confidence interval. Results: This study aimed to compare hospitalization and mortality rates between men with COVID-19 and prostate cancer and those who were COVID-19-positive with non-prostate genitourinary malignancy or any solid cancer, and with breast cancer patients. We also compared our studies to others that reported the incidence and severity of COVID-19 in prostate cancer patients. Our studies highlight that patients with prostate cancer had higher susceptibility to COVID-19-related pathogenesis, resulting in higher mortality and hospitalization rates. Hospitalization and mortality rates were higher in prostate cancer patients with COVID-19 when compared with COVID-19 patients with non-prostate genitourinary (GU) malignancies.

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