Outcomes in stroke patients with malignancy vary with cancer type, stroke treatment

In-hospital outcomes for acute ischemic stroke patients with solid organ malignancy varied depending on the type of cancer and use of stroke interventions, according to a study published in Neurology.

“Solid organ malignancy is associated with an increased incidence of acute ischemic stroke (AIS),” Aayushi Garg, MD, of the department of neurology at the University of Iowa Hospitals and Clinics, and colleagues wrote. “There is further evidence to support that patients with malignancy also have a higher risk of early complications, disability, recurrent thromboembolic events and mortality after stroke.”

Garg and fellow researchers sought to evaluate whether solid organ malignancies influenced in-hospital outcomes and recurrent strokes in hospitalized AIS patients by using the Nationwide Readmissions Database to find 1,385,840 AIS hospitalizations (mean age, 70.4 years; 50.2% women) from 2016 to 2018.

Researchers compared differences in the use of acute stroke interventions and clinical outcomes in patients with and without malignancy, and measured stroke severity with the Stroke Administrative Severity Index.

The primary outcome was in-hospital mortality and secondary outcomes included cerebral edema, length of hospital stay, non-routine discharge, subarachnoid hemorrhage and intraparenchymal hemorrhage (IPH). Researchers used survival analysis to evaluate the risk of readmission as a result of recurrent stroke after discharge.

Researchers found that 3.7% (n = 50,553) of hospitalizations had a concurrent diagnosis of solid organ malignancy, with the five most common being lung cancer (24.6%), prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%) and colorectal cancer (6.2%). Patients with malignancy had an elevated risk for readmission — specifically driven by lung and pancreatic cancers — as a result of recurrent AIS within 1 year of discharge (HR = 1.18; 95% CI, 1.11-1.25).

After adjusting for baseline differences, researchers reported that patients with malignancy also were more likely to have IPH (OR = 1.11; 95% CI, 1.04-1.19), in-hospital mortality (OR = 2.15; 95% CI, 2.04-2.28) and discharge disposition other than to home (OR = 1.7; 95% CI, 1.64-1.75).

Further, data showed patients with malignancy were less likely to receive IV thrombolysis and more likely to undergo mechanical thrombectomy. Among these treatment subgroups, outcomes were comparable between patients with and without malignancy, except for patients with lung cancer, who remained at a higher risk for mortality and adverse disposition despite acute stroke interventions.

“While patients with malignancy generally have worse in-hospital outcomes compared to those without, there is considerable variation in these outcomes according to the different cancer types and the use of acute stroke interventions,” Garg and colleagues wrote.