Predictors of venous thromboembolism in patients with advanced common solid cancers.
There is uncertainty about risk heterogeneity for venous thromboembolism (VTE) in older patients with advanced cancer and whether patients can be stratified according to VTE risk. We performed a retrospective cohort study of the linked Medicare-Surveillance, Epidemiology, and End Results cancer registry in older patients with advanced cancer of lung, breast, colon, prostate, or pancreas diagnosed between 1995-1999. We used survival analysis with demographics, comorbidities, and tumor characteristics/treatment as independent variables. Outcome was VTE diagnosed at least one month after cancer diagnosis. VTE rate was highest in the first year (3.4%). Compared to prostate cancer (1.4 VTEs/100 person-years), there was marked variability in VTE risk (hazard ratio (HR) for male-colon cancer 3.73 (95% CI 2.1-6.62), female-colon cancer HR 6.6 (3.83-11.38), up to female-pancreas cancer HR 21.57 (12.21-38.09). Stage IV cancer and chemotherapy resulted in higher risk (HRs 1.75 (1.44-2.12) and 1.31 (1.0-1.57), resp.). Stratifying the cohort by cancer type and stage using recursive partitioning analysis yielded five groups of VTE rates (nonlocalized prostate cancer 1.4 VTEs/100 person-years, to nonlocalized pancreatic cancer 17.4 VTEs/100 patient-years). In a high-risk population with advanced cancer, substantial variability in VTE risk exists, with notable differences according to cancer type and stage.
Hall
Isaac E
IE
Sections of General Internal Medicine, Primary Care Center, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208025, New Haven, CT 06520, USA.
Andersen
Martin S
MS
Krumholz
Harlan M
HM
Gross
Cary P
CP
Med Care. 1993 Aug;31(8):732-48
8336512
Lancet. 1994 Apr 9;343(8902):886-9
7908358
Arch Intern Med. 1998 Sep 14;158(16):1809-12
9738611
Cancer. 2007 Nov 15;110(10):2339-46
17918266
J Thromb Haemost. 2008 Apr;6(4):601-8
18208538
N Engl J Med. 1996 Mar 14;334(11):677-81
8594425
Thromb Haemost. 2003 Mar;89(3):493-8
12624633
Chest. 1999 Apr;115(4):972-9
10208194
N Engl J Med. 1997 Sep 4;337(10):663-9
9278462
N Engl J Med. 1988 Feb 11;318(6):352-5
3123929
J Clin Pathol. 2004 Dec;57(12):1254-7
15563663
Circulation. 1999 Mar 16;99(10):1325-30
10077516
Eur Heart J. 2006 Aug;27(16):1954-64
16847008
Health Econ. 1994 Nov-Dec;3(6):385-93
9435921
Arch Intern Med. 2002 Jun 10;162(11):1245-8
12038942
Thromb Haemost. 2005 Feb;93(2):284-8
15711744
Cancer. 2007 Nov 15;110(10):2119-52
17939129
Blood. 2008 May 15;111(10):4902-7
18216292
Ann Oncol. 2006 Feb;17(2):297-303
16282243
Am J Med. 2004 Jul 1;117(1):19-25
15210384
Thromb Haemost. 2002 Nov;88(5):745-9
12428088
Chest. 2004 Sep;126(3 Suppl):338S-400S
15383478
N Engl J Med. 2000 Dec 21;343(25):1846-50
11117976
J Clin Oncol. 2007 Jan 1;25(1):70-6
17194906
J Gen Intern Med. 2007 Mar;22(3):321-6
17356962
Ann Intern Med. 1996 Jul 1;125(1):1-7
8644983
J Clin Oncol. 2006 Mar 1;24(7):1112-8
16505431
J Clin Oncol. 2002 Oct 1;20(19):4015-21
12351599
N Engl J Med. 1999 Sep 9;341(11):793-800
10477777
Medicine (Baltimore). 1999 Sep;78(5):285-91
10499070
Thromb Haemost. 2005 Jan;93(1):76-9
15630494
N Engl J Med. 2003 Apr 10;348(15):1425-34
12601075
J Thromb Haemost. 2003 Dec;1(12):2463-5
14675077
Arch Intern Med. 2006 Feb 27;166(4):458-64
16505267
J Clin Epidemiol. 2000 Dec;53(12):1258-67
11146273
Thromb Res. 2003;112(4):203-7
14987912
Crit Rev Oncol Hematol. 2006 Sep;59(3):211-7
16806961
N Engl J Med. 1996 Mar 14;334(11):682-7
8594426
Ann Oncol. 2006 Feb;17(2):289-96
16317012
Semin Thromb Hemost. 2003 Jun;29(3):247-58
12888929
J Clin Oncol. 2001 Sep 1;19(17):3712-8
11533092
Thromb Haemost. 2002 Jun;87(6):1076-7
12083490
JAMA. 2005 Feb 9;293(6):715-22
15701913
Am J Hematol. 1996 Apr;51(4):319-23
8602634
Med Care. 2002 Mar;40(3):201-11
11880793
Curr Opin Pulm Med. 2001 Sep;7(5):360-4
11584190
Thromb Haemost. 2002 Apr;87(4):575-9
12008937
Circulation. 2004 Aug 17;110(7):874-9
15289368
Arch Intern Med. 2003 Mar 24;163(6):688-92
12639201
Ann Intern Med. 2000 Mar 21;132(6):425-34
10733441
J Clin Oncol. 2004 May 15;22(10):1944-8
15143088