title: Impact of thrombosis on standard treatment in solid tumors.
abstract: BACKGROUND
  Malignancy leading to a hypercoagulable state is a well established concept. The reported frequency of venous thrombotic events in cancer patients is 5-8%. There is limited data on the influence of thrombosis on treatment decisions in solid tumors.
  
  
  METHODS
  A retrospective audit of all cases of thrombosis developing in newly diagnosed solid tumors from 1st January 2011 to 31st December 2014 was performed. Changes in treatment decisions for malignancy (deferral of surgery/chemotherapy, changes in the planned course of chemotherapy or changes in the planned dates of chemotherapy) after the documentation of thrombosis were noted.
  
  
  RESULTS
  A total of 11,796 solid tumor cases were registered. 61 patients with thrombosis (0.52%) were identified. In 14 patients(23%), treatment decisions for malignancy had to be changed after the occurrence of thrombosis. 2 patients were deferred surgery, 9 could not undergo chemotherapy according to planned schedules, and 3 were deferred chemotherapy. In survival analysis by multivariate model, stage (p=0.01) and ECOG performance status (p=0.01) significantly predicted survival whereas thrombus location (p=0.09), symptomatic thrombosis (p=0.06), and age (p=0.19) did not.
  
  
  CONCLUSIONS
  Frequency of thrombosis in solid tumors in our centre was less compared to previous reports. There was a significant deviation (nearly one fourth patients) from standard of treatment for malignancy after the development of thrombosis. Survival of patients who developed thrombosis did not significantly vary depending on location of thrombosis or whether it is symptomatic or not.
authors.affiliation: Department of Clinical Hematology & Medical Oncology, Malabar Cancer Centre, Thalassery, Kannur, Kerala 670103, India. Electronic address: cknair09@gmail.com.
authors.forename: Chandran K
authors.initials: CK
authors.lastname: Nair
authors.affiliation: Division of Clinical Research and Biostatistics, Malabar Cancer Centre, Thalassery, Kannur, Kerala 670103, India.
authors.forename: Atanu
authors.initials: A
authors.lastname: Bhattacharjee
authors.affiliation: Department of Clinical Hematology & Medical Oncology, Malabar Cancer Centre, Thalassery, Kannur, Kerala 670103, India.
authors.forename: Vineetha
authors.initials: V
authors.lastname: Raghavan
authors.affiliation: Department of Imageology, Malabar Cancer Centre, Thalassery, Kannur, Kerala 670103, India.
authors.forename: Satheesh
authors.initials: S
authors.lastname: Babu
authors.affiliation: Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kannur, Kerala 670103, India.
authors.forename: Satheesan
authors.initials: S
authors.lastname: Balasubramanian
mesh_terms: D000328:Adult; D000368:Aged; D003133:Commission on Professional and Hospital Activities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology*
keywords: Solid tumors; Standard treatment; Survival; Thrombosis