Review articleVenous thromboembolism and prognosis in cancer
Section snippets
VTE as a Proximate Cause of Death in the Cancer Patient
PE can directly lead to death in patients with cancer, as can arterial events. There are a lack of recent data identifying causes of death in patients with cancer. We were able to clarify this issue in a recent analysis of causes of death in cancer patients receiving chemotherapy in a prospective observational study [12]. Of 4,466 patients enrolled in this study, 141 (3.2%) patients died during the period of observation (median, 75 days). As might be expected, a majority of patients died of
VTE and Its Effect on Short-Term Prognosis
A recent prospective observational cohort study of cancer patients initiating a new chemotherapy regimen has shed light on the association of VTE and early mortality during chemotherapy [14]. The study evaluated 4,458 adult cancer patients with solid tumors or malignant lymphoma between 2002 and 2006 at 115 United States sites. VTE occurred in 93 (2.1%) patients at a median of 38 days following initiation of chemotherapy. One hundred and thirty-seven patients died during the period of
VTE and Its Effect on Long-Term Prognosis
Data regarding the effect of VTE on long-term prognosis in patients with cancer come primarily from large population-based databases. In an analysis of the Danish Cancer Registry, 668 cancer patients with DVT were compared to 5,371 matched control cancer patients [17]. In the group with cancer at the time of VTE, the one-year survival rate was 12%, as compared with 36% in the control group (P < 0.001), and the mortality ratio for the entire follow-up period was 2.2 (95%CI, 2.05 to 2.40). These
Conclusions
VTE is a frequent complication of the natural history of cancer and anti-cancer therapies. VTE itself may be directly responsible for death in patients with cancer; in the most recent available data, thrombosis is believed to account for 9% of cancer-related deaths. Even more importantly, the development of VTE serves as a harbinger of poor outcomes for patients with cancer. Cancer patients with VTE have an elevated risk of early mortality during chemotherapy, as well as increased risk of tumor
Conflict of interest
There are no conflicts of interest for this paper.
Acknowledgements
Dr. Khorana is supported by grants from the National Cancer Institute K23 CA120587, the National Heart, Lung and Blood Institute 1R01HL095109-01 and the V Foundation.
References (28)
Malignancy, thrombosis and Trousseau: the case for an eponym
J Thromb Haemost
(2003)- et al.
Deep-vein thrombosis in patients with multiple myeloma receiving first-line thalidomide-dexamethasone therapy
Blood
(2002) - et al.
The hemostatic system as a regulator of angiogenesis
J Biol Chem
(2000) - et al.
Tissue factor, thrombin, and cancer
Chest
(2003) - et al.
Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy
J Thromb Haemost
(2007) - et al.
Development and validation of a predictive model for chemotherapy-associated thrombosis
Blood
(2008) - et al.
The incidence of venous thromboembolism among patients with primary lung cancer
J Thromb Haemost
(2008) - et al.
Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival
Blood
(2009) - et al.
Thalidomide and deep vein thrombosis in multiple myeloma: risk factors and effect on survival
Clin Lymphoma
(2003) - et al.
Thromboembolism in hospitalized neutropenic cancer patients
J Clin Oncol
(2006)
The hypercoagulable state of malignancy: pathogenesis and current debate
Neoplasia
Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study
Arch Intern Med
Potential role of platelets in endothelial damage observed during treatment with cisplatin, gemcitabine, and the angiogenesis inhibitor SU5416
J Clin Oncol
Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer
J Clin Oncol
Cited by (302)
Does the diagnostic timing of cancer-associated thromboembolism influence the survival outcome in ovarian cancer patients?
2024, Journal of the Formosan Medical AssociationEffect of blood type on mortality among patients with brain metastases
2023, Clinical Neurology and NeurosurgerySystemic coagulopathy promotes host lethality in a new Drosophila tumor model
2023, Current BiologyPostoperative venous thromboembolism risk stratification in patients with uterine cancer
2023, American Journal of Obstetrics and Gynecology