Patients with cancer and deep vein thrombosis (DVT) experience higher rates of hospitalization and mortality, are less frequently treated with thrombolysis, and experience gastrointestinal (GI) bleeds more frequently compared with patients with DVT in the absence of underlying malignancy, according to a study presented by lead author Sheeba Habeeb Ba Aqeel, MD, of the John H. Stroger, Jr. Hospital of Cook County in Chicago as part of the ASCO20 Virtual Scientific Program.
According to Dr. Ba Aqeel and colleagues, pulmonary embolism represents is an important cause of increased mortality in patients with cancer. Few large studies have compared the risk of mortality and health-care burden from DVT and pulmonary embolism in patients with cancer compared to patients without cancer.
The study included 404,121 adults from the Nationwide Emergency Department Sample (NEDS) database who received a diagnosis of acute DVT between January 2016 and December 2017. The risk of admission from the ED as well as the risk of inpatient mortality was compared between patients with cancer and DVT versus patients with DVT but without cancer in univariate and multivariate logistic regression analyses. Secondary outcomes in this study included hospital length of stay (LOS), inpatient hospital charges, GI bleed risk, and rates of inferior vena cava (IVC) filter placement and thrombolysis.
Approximately 8% (n=32,330) of patients in the overall cohort had an underlying malignancy, most commonly cancers of the GI tract (20.1%), hematologic malignancies (16.5%), and lung cancers (13.5%). Patients with any form of cancer were older on average (66.4 vs. 59.8 years) and more likely to be men (51.8% vs 47.5%) compared with patients with DVT but no cancer.
Patients with cancer and DVT were significantly more likely to be admitted from the ED compared with those without cancer (70.5% vs 39.1%; odds ratio [OR] 3.71; 95% CI 3.41-4.04; p<0.001). Patients with cancer and DVT also demonstrated a significantly higher mortality even after adjustment for age and comorbidities (OR=3.09; 95% CI 2.42-3.94; p<0.001) as well as higher GI bleed rates (OR=1.75; 95% CI 1.45-2.12; p<0.001).
In addition, patients with cancer and DVT had higher rates of IVC filter placement (15.2% vs. 9.4%) and lower rates of treatment with thrombolysis (4.5% vs. 7.4%), which the investigators explained might have been attributable to the higher rates of concomitant GI bleeding in this population.
The investigators noted that while primary prophylaxis for venous thromboembolism in patients with cancer remains controversial, the high morbidity, mortality, and health-care burden from thrombosis in this population indicates a need for additional research.
Aqeel SHB, Lingamaneni P, Farooq MZ, et al. Nationwide analysis of healthcare burden and risk of mortality in cancer patients with deep venous thrombosis. J Clin Oncol 38: 2020 (suppl; abstr e19093). Presented as part of the 2020 ASCO Virtual Scientific Program, May 29-31, 2020.