title: Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics.
abstract: Venous thromboembolism (VTE) is a clinically important complication for both hospitalised and ambulatory cancer patients. In the current study, the frequency, demographics and risk (according to tumour site) of VTE were examined among patients seen at outpatient DVT (deep-vein thrombosis) clinics. Of 10,015 VTE cases, 1,361 were diagnosed with cancer, for an overall rate of cancer-associated VTE of 13.6% in this outpatient population. Patients with cancer-associated VTE were significantly older than cancer-free VTE cases (66.4 +/- 12.7 vs. 58.8 +/- 18.5 years; p<0.0001). The frequency of cancer-associated VTE peaked earlier among females than males, occurring in the sixth (137/639, 21.4% vs. 98/851, 11.3%; p<0.001) and seventh decades (213/980, 21.7% vs. 197/1096, 18%; p=0.036). VTE was described most frequently in common cancers - breast, prostate, colorectal and lung (56.1% of cases). The risk of VTE varied widely across 17 cancer types. Calculating odds ratios (OR) to assess the effect size of cancer type on VTE risk, the highest odds were observed for patients with pancreatic cancer (OR 9.65, 95% confidence interval [CI] (5.51-16.91). Tumours of the head and neck had higher odds than previously reported (OR 8.24, 95% CI 5.06-13.42). Reduced risk estimates were observed for skin cancers (melanoma and non-melanoma: OR 0.89, 95% CI 0.42-1.87; OR 0.74, 95% CI, 0.32-1.69, respectively). We conclude that outpatients have a similar rate of cancer-associated VTE as VTE patient populations previously reported, that cancer-associated VTE occurs in an older age group and earlier in females and that outpatients exhibit distinct tumour site-specific risk from that described among hospitalised cancer patients.
authors.affiliation: Consultant Haematologist, Department of Haematology, Warwick Hospital, Warwick, CV34 5BW, UK.
authors.forename: S
authors.initials: S
authors.lastname: Paneesha
authors.forename: A
authors.initials: A
authors.lastname: McManus
authors.forename: R
authors.initials: R
authors.lastname: Arya
authors.forename: N
authors.initials: N
authors.lastname: Scriven
authors.forename: T
authors.initials: T
authors.lastname: Farren
authors.forename: T
authors.initials: T
authors.lastname: Nokes
authors.forename: S
authors.initials: S
authors.lastname: Bacon
authors.forename: A
authors.initials: A
authors.lastname: Nieland
authors.forename: D
authors.initials: D
authors.lastname: Cooper
authors.forename: H
authors.initials: H
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: O'Shaughnessy
authors.forename: P
authors.initials: P
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis; D055815:Young Adult