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Chemotherapy increased risk for VTE in patients with cancer
Patients with cancer who underwent chemotherapy as outpatients demonstrated an increased risk for venous thromboembolism and major bleeding complications, according to results of a large-scale retrospective analysis.
The risk for VTE was highest in the year following treatment initiation, as well as in patients with pancreatic, stomach and lung cancers.
Gary H. Lyman, MD, MPH, professor of medicine in the division of medical oncology at Duke University School of Medicine and the Duke Cancer Institute, and colleagues used the US IMPACT health care claims database to identify 27,500 patients with solid tumors who initiated chemotherapy between 2005 and 2008.
Patients with cancers at increased risk for VTE — lung, pancreas, stomach, colon/rectum, bladder or ovarian cancers — were included in the study.
The overall incidence of VTE among patients at 3.5 months after treatment initiation was 7.3% (range, 4.6-11.6). The incidence increased to 13.5% (range, 9.8-21.3) at 12 months.
The risk for other major bleeding complications was higher in patients with VTE than those without at 3.5 months (11% vs. 3.8%) and 12 months (19.8% vs. 9.6%).
Researchers also assessed health care costs a year before the start of chemotherapy and a year after initiation. They found that health care costs were significantly higher in patients who developed VTE ($110,719 vs. $76,804), a difference primarily attributed to additional VTE-related inpatient, outpatient and emergency room costs.
“Importantly, this observational study suggests that the observed rate for symptomatic VTE in real-world practice are considerably greater than reported in patients eligible for randomized clinical trials,” Lyman said in a press release. “Clinical oncologists need to be aware of the increased risk for this serious complication of cancer and cancer treatment, and when the risk is sufficiently great and the balance of benefits and harms acceptable, oncologists should consider prophylactic anticoagulation.”
Disclosure: The researchers report consultant or advisory roles with, research funding and honoraria from, employment relationships with or ownership interests in Bayer, BMS, Daiichi Sankyo, Janssen Pharmaceuticals, Pfizer, Portola, Sanofi, Sanofi R&D and XOD.
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The title of this article suggests that chemotherapy aggravates the already-increased DVT propensity of patients with solid tumors. Possibly, but not rigorously demonstrated by this study. It does seem likely that exuberant tumor cell lysis, if accompanied by microparticle release, would enhance thrombophilia and provide rationale for anticoagulant prophylaxis. For now, this remains a reasonable hypothesis worth investigating.