title: Thromboembolism in lung cancer - an area of urgent unmet need.
abstract: BACKGROUND
  Thromboembolism is common in lung cancer. Current thromboprophylaxis guidelines lack specific recommendations for appropriate strategies in this high thrombotic risk patient cohort. We profiled lung cancer patients receiving anti-cancer therapy. Thromboembolism incidence and thromboembolism-related mortality rates are reported and we explored patient, disease, and treatment-related risk factors associated with higher thrombotic rates.
  
  
  METHODS
  Retrospective review of lung cancer patients referred to a Comprehensive Cancer Centre between 01/07/2011 and 30/06/2012 for anti-cancer therapy. Data were collected from medical, pharmacy, pathology and diagnostic imaging electronic records.
  
  
  RESULTS
  After a median follow up of 10 months (range: 0.03-32 months), 24/222 patients (10.8%) had developed radiologically confirmed thromboembolism; 131 events per 1000 person-years (95%CI 87-195). Thromboembolism occurred equally in patients with non-small cell and small cell lung cancer (10.8% and 10.5% respectively), and more frequently among patients with adenocarcinoma compared to squamous cell carcinoma (14.7% and 5.3% respectively). Chemotherapy-treated patients experienced thromboembolism more often than patients who did not receive chemotherapy (HR 5.7 95%CI 2.2-14.8). Radiotherapy was also associated with more frequent thromboembolism (HR 5.2 95%CI 2.0-13.2). New lung cancer diagnosis, presence of metastatic disease, second primary malignancy and Charlson Index ≥ 5 were also associated with higher rates of thromboembolism. Importantly, pharmacological thromboprophylaxis (P-TP) was not routinely or systematically prescribed for ambulant lung cancer patients during any treatment phase, at this institution. The majority (83%) of thromboembolic events occurred in the ambulatory care setting.
  
  
  CONCLUSIONS
  Morbidity and mortality from thromboembolism occurs frequently in lung cancer. Thromboprophylaxis guidelines should be developed for the ambulatory care setting.
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: Marliese.Alexander@petermac.org.
authors.forename: M
authors.initials: M
authors.lastname: Alexander
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kirsa
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: MacManus
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Ball
authors.affiliation: Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Solomon
authors.affiliation: Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Burbury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000150:complications*; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology
keywords: Lung cancer; Thromboembolism; Thromboprophylaxis