Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics

Shankaranarayana Paneesha; Aidan McManus; Roopen Arya; Nicholas Scriven; Timothy Farren; Tim Nokes; Sue Bacon; Anthea Nieland; Derek Cooper; Harry Smith; Denise O‘Shaughnessy; Peter Rose; for the VERITY Investigators

doi:10.1160/TH09-06-0397

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 103(02): 338-343
DOI: 10.1160/TH09-06-0397

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics

Shankaranarayana Paneesha

¹Consultant, Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, UK

,

Aidan McManus

²Director, MMRx Consulting, Cheam, Surrey, UK

,

Roopen Arya

³Consultant, Department of Haematology, King‘s College Hospital, London, UK

,

Nicholas Scriven

⁴Consultant, Medical Assessment Unit, The Calderdale Royal Hospital, Halifax, UK

,

Timothy Farren

⁵Clinical Scientist, Department of Haematology, Barts and The London School of Medicine and Dentistry, London, UK

,

Tim Nokes

⁶Consultant, Department of Haematology, Derriford Hospital, Plymouth, UK

,

Sue Bacon

⁷Thrombosis Nurse Specialist, Scarborough Hospital, Scarborough, UK

,

Anthea Nieland

⁸Thrombosis Nurse Specialist, Northampton General Hospital NHS Trust, Northampton, UK

,

Derek Cooper

⁹Statistical Consultant, London, UK

,

Harry Smith^*

¹⁰Harry Smith, Medical Advisor, Sanofi Aventis UK

,

Denise O‘Shaughnessy

¹¹Special Advisor, Blood Policy Unit, Department of Health, London, UK

,

Peter Rose

¹²Consultant, Department of Haematology, Warwick Hospital, Warwick, UK

,

for the VERITY Investigators

› Author Affiliations

Abstract

Summary

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.

Keywords

Clinical studies - cancer - venous thrombosis

Full Text

References

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