Epidem Stein 4

Incidence of venous thromboembolism in patients hospitalized with cancer Reported by: Stein PD et al. Am J Med. 2006;119:60-68.

0.5

1.6

Colon

1.9

0.6

1.4

Ovary

1.9

0.5

1.6

Liver, gallbladder, intra- & extrahepatic ducts

1.8

0.9

1.1

Leukemia

1.7

0.4

1.4

Breast (female)

1.7

0.4

1.3

Cervix

1.6

*

1.4

Bladder

1.0

0.3

0.8

Lip, oral cavity, pharynx

<0.6

*

*

Average

2.0

0.6

1.6

No cancer

1.0

0.3

0.8

The incidence of VTE in hospitalized patients with cancer began to increase sharply beginning in 1989 (Figure 1). The relative increase for cancer vs noncancer patients was statistically significant (P<.0001)

89

91

93

95

97

99

Figure 6. The relative risk of DVT ranged from 1.07 to 4.65

The incidence of DVT among patients with cancer increased significantly between 1989 and 1999 (P<.0001) (Figure 3)

4 3.5 3 2.5 2 1.5 1 0.5 0

3 2

Noncancer patients

79

81

83

85

87

89

91

93

95

97

99

!

The relative risk for VTE, PE and DVT in patients with malignancies compared with patients without malignancies is shown in Figures 4 to 6

Figure 4. The relative risk of VTE ranged from 1.02 to 4.34

!

Among cancer patients aged 40 to 59 years, the incidence of VTE, PE, and DVT was 46% to 80% higher than in patients without cancer within the same age group

!

Among cancer patients aged 60 to 79 years, the incidence of VTE, PE, and DVT was only 18% to 42% higher than in patients without cancer within the same age group

CONCLUSIONS ! The incidence of VTE, PE, and DVT was 2-fold higher in patients with cancer than in noncancer patients

4.5

!

4

Cancer patients

4

0

Year

Figure 1. Changes in the incidence of VTE in patients with and without cancer, 1979 to 1999

3.5

In the late 1980s, rates of VTE, PE, and DVT increased. This increase may be attributable, in part, to improvements in diagnostic capabilities and greater awareness

3 2.5 2 1.5 1

91

93

95

97

99

Bladder

89

Cervix

87

Breast

85

Leukemia

83

Liver

81

Ovary

79

0.5 Colon

Noncancer patients

Kidney

4 3.5 3 2.5 2 1.5 1 0.5 0

5

Cancer patients

Rectal

Table 1 summarizes the incidences of VTE, PE, and DVT for cancer overall, by site, and for noncancer patients

87

Prostate

!

85

1

Patients with pancreatic cancer had the highest incidence of VTE (4.3%); the lowest incidence was in patients with bladder cancer (1.0%) The incidence of both PE and VTE in patients with cancer were twice those of patients without cancer (0.6% vs 0.3% and 1.6% vs 0.8%), respectively

83

Esophagus

!

81

Figure 3. Changes in the incidence of DVT in patients with and without cancer, 1979 to 1999

*Insufficient data

!

79

Year

!

Bladder

2.0

Bladder

Kidney

Cervix

1.4

Cervix

0.7

Breast

2.1

Noncancer patients

Breast

Rectum, rectosigmoid junction, anus

Leukemia

1.6

Leukemia

0.6

Liver

2.0

Liver

Prostate

Ovary

1.3

Ovary

*

Colon

2.0

Colon

Esophagus

Cancer patients

Kidney

1.6

Kidney

0.6

Rectal

2.1

Rectal

Trachea, bronchus and lung

0.5 Prostate

1.8

Prostate

0.5

1 Esophagus

2.2

1.5

Esophagus

Uterus

2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0

Lung

2.0

Lung

0.6

Uterus

2.5

Uterus

Lymphoma, lymphosarcoma, reticulosarcoma

2

Lymphoma

2.3

Lymphoma

0.7

Stomach

2.7

2.5

Stomach

Stomach

3

Myeloprol

2.5

Myeloprol

*

Brain

2.9

3.5

Brain

Myeloproliferative, other lympathic/hematopoeitic

Figure 2. Changes in the incidence of PE in patients with and without cancer, 1979 to 1999

Pancreas

2.8

4

Pancreas

1.0

4.5

Relative risk of PE in cancer patients

3.5

Figure 5. The relative risk of PE ranged from 0.77 to 3.66

Relative risk of DVT in cancer patients

Brain

Data were obtained from the National Hospital Discharge Registry, which samples ~8% of short term hospital stays and ~1% of discharges in the United States

RESULTS Patients ! Among 40,787,000 patients hospitalized with any of the 19 malignancies, 827,000 (2%) had VTE; of 662,309,000 patients who did not have malignancies, 6,854,000 had VTE (1%) !

3.5

Lung

!

1.2

Uterus

METHODS ! All patients discharged with the diagnostic code for 1 of 19 malignancies between 1979 and 1999 were included in the study

4.3

Lymphoma

This study examined the risk for VTE in patients with cancer using data from the National Hospital Discharge Survey

Pancreas

Stomach

!

Possible factors that may contribute to an increased risk for thromboembolic events in patients with cancer include: ! Tumor-cell procoagulants and/or cytokines ! Tumor-associated inflammatory cell procoagulants and/or cytokines ! Mediators of platelet adhesion or aggregation generated by tumor cells and/or tumor-associated inflammatory cells

DVT

Myeloprol

!

Previous data suggest that the risk for VTE varies according to type of cancer ! Pancreatic cancer is associated with the highest risk for incidence of VTE ! Lung, ovary, brain, pancreatic, stomach, kidney, and colon cancer are also associated with an increased risk of VTE ! The extent of cancer and use of chemotherapy and/or radiation influence risk for VTE

PE

VTE in hospitalized cancer and noncancer patients (%)

!

VTE

Brain

INTRODUCTION ! VTE is a common complication of cancer; patients are at greatest risk during the first few months after diagnosis

Cancers

Pancreas

Conclusions: The incidence of VTE, PE, and DVT was 2-fold higher in patients with cancer compared with noncancer patients. The incidence differed according to cancer type. The rate of VTE in patients with cancer increased in the late 1980s and 1990s.

Diagnoses/100 hospitalizations

The incidence of PE among patients with cancer increased significantly between 1989 and 1999 (P<.001) (Figure 2). This increase was of substantially smaller magnitude than that observed for VTE

PE in hospitalized cancer and noncancer patients (%)

Results: Two percent of patients with any of the studied malignancies had VTE which was twice the rate of VTE in patients without cancer. Venous thromboembolism was most common in patients with pancreatic cancer, and was least frequent in patients with bladder, lip, oral cavity, or pharyngeal cancer. The rates of PE and DVT individually were also twice the rates seen in patients without cancer. The incidence of VTE began to increase in the late 1980s for patients with cancer.

!

DVT in hospitalized cancer and noncancer patients (%)

Methods: Men and women of all ages discharged with a diagnostic code for 19 types of malignancies, PE, or DVT from 1979 through 1999. Data were obtained from the National Hospital Discharge Survey.

Table 1. VTE, PE, and DVT in patients with cancer (all ages)

Relative risk of VTE in cancer patients

ABSTRACT Background: While venous thromboembolism (VTE) is a common complication of cancer, little is known regarding the frequency of VTE in various malignancies. This study assesses the incidence and risk of VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT) in patients with cancer.

Year

For educational purposes only. These were not prepared or reviewed by the primary author.