Incidence of cancer-associated thrombosis remains high over time, varies with therapy
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Key takeaways:
- Patients with cancer who received first-line chemotherapy had higher risk for VTE than patients who received targeted or endocrine therapy.
- Black patients appeared at greater risk than white patients.
Incidence of venous thromboembolism remained high among patients with cancer even as the treatment landscape has evolved over the past 16 years, according to data published in JAMA Network Open.
Cancer type, staging and systemic treatment regimen appeared significantly associated with risk for cancer-associated VTE, according to researchers.
“These results suggest that patient-specific and treatment-specific factors, accounting for changes in the treatment landscape over time, play a critical role in assessing the risk [for cancer-associated thrombosis], and ongoing efforts to identify these patterns are of utmost importance for risk stratification and prognostic assessment,” Kylee L. Martens, MD, hematology and oncology fellow at Oregon Health & Science University, and colleagues wrote.
Background and methodology
The retrospective cohort study aimed to assess incidence of cancer-associated VTE over time and determine patient-, cancer- and treatment-specific factors associated with its risk.
Researchers analyzed U.S. Department of Veterans Affairs health care system data of 434,203 patients (median age, 67 years; 96.8% men; 72.1% white) with newly diagnosed invasive solid tumors and hematologic neoplasms between 2006 and 2021.
They evaluated incidence of VTE using a combination of several processing confirmed outcomes.
Pertinent patient variables included demographics, region, rurality, area deprivation index, NCI comorbidity index, cancer type, staging, first-line systemic treatment within 3 months, and other factors potentially associated with risk for VTE, researchers wrote.
Duration of follow-up consisted of date of diagnosis until first VTE event, death, loss of follow-up or administrative censoring on April 1, 2022.
Results, next steps
Researchers reported an overall incidence of cancer-associated VTE at 12 months of 4.5%, with yearly trends ranging from 4.2% to 4.7%. They noted a higher risk for VTE among patients with aggressive lymphoid neoplasms when compared with patients with indolent lymphoid or myeloid hematologic neoplasms, adding that the trend partially may be associated with catheter-related events.
Compared with patients who did not receive treatment, patients who received first-line chemotherapy (HR = 1.44; 95% CI, 1.4-1.49) or immune checkpoint inhibitors (HR = 1.49; 95% CI, 1.22-1.82) demonstrated a higher adjusted relative risk than patients receiving targeted therapy (HR = 1.21; 95% CI, 1.13-1.3) or endocrine therapy (HR = 1.2; 95% CI, 1.12-1.28).
Adjusted VTE risk appeared significantly higher among non-Hispanic Black patients (HR = 1.23; 95% CI, 1.19-1.27) and lower among Asian or Pacific Islander patients (HR = 0.84; 95% CI, 0.76-0.93) when compared with non-Hispanic white patients.
These data further research into how the complexities of the varying characteristics of each individual patient can alter VTE risk factors, according to researchers.
“Taken together, these findings highlight several additional epidemiologic factors that warrant consideration for future [VTE] risk stratification models,” they wrote.
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