Cancer‐associated venous thromboembolism in Israel: Incidence, risk factors, treatment, and health care utilization in a population based cohort study

Abstract

Background Recent international guidelines recommend thromboprophylaxis in patients with cancer at intermediate‐high venous thromboembolism (VTE) risk. Objectives We aimed to assess the current incidence, risk factors and management of cancer‐associated VTE and associated health care resource utilization in a 2.5‐million‐member state‐mandated health service in Israel. Methods Patients aged ≥18 years with newly diagnosed cancer, initiating systemic anticancer treatment from 2010 through 2018 were identified from the Israel National Cancer Registry. The index date was fixed as the first day of systemic anticancer treatment. The cumulative VTE incidence from the first day of systemic anticancer treatment and the respective hazard ratios for VTE risk factors were calculated at 12 months of follow‐up. Health care resource utilization (primary care physician, emergency room, and hospital visits) during the study period was compared between patients with and without VTE. Results A total of 15 388 patients were included, and 338 had VTE with a 12‐month cumulative incidence of 2.2% (95% confidence interval, 1.96%‐2.43%). In a multivariable model, older age, higher comorbidity index, intermediate‐high‐risk Khorana score, certain malignancy types, and chemotherapy were significantly associated with an increased VTE risk in the year after initiating anticancer treatment. Compared with matched controls, the VTE subcohort were more likely to be hospitalized (81.4% vs 35.2%), have longer hospital stays (20.1 days vs 13.1 days), have an emergency room visit (41.5% vs 19.3%), and have a larger number of primary care physician visits (17.6 vs 12.5). Conclusion Several risk factors, including the Khorana score, were associated with VTE incidence. VTE was associated with long‐term use of anticoagulation. Health care utilization was higher in patients with VTE.

Real-world Data on Treatment Patterns and Bleeding in Cancer-associated Thrombosis: Data from the TROLL Registry

“…Several other studies have reported similar findings. 5 21 22 However, some studies have reported prescription frequencies of DOACs of up to 50% as initial treatment in patients with CAT. 23 24 25 A lower proportion of patients with gastrointestinal or genitourinary malignancies and defining active cancer as cancer diagnosed up to 5 years preceding the thrombosis may be possible explanations for the higher DOAC prescription rate in these studies.…”

“…One study reported similar findings regarding increased DOAC prescription. 5 However, no data were presented for treatment patterns according to cancer sites.…”

“… 1 Patients with cancer-associated thrombosis (CAT) are at a higher risk of mortality and morbidity and tend to consume more health care resources than cancer patients without VTE. 2 3 4 5 Moreover, patients with CAT have an increased risk of recurrent VTE, yet at the same time they have an increased risk of bleeding compared to VTE patients without cancer. 6 In this context, the care of CAT patients is a particularly vexing clinical problem.…”

Trends and updates on the epidemiology of cancer-associated thrombosis: a systematic review

“…Accounting for differences in study design, CAT occurrence appeared to have geographic variations. Among representative studies at the time of initial cancer diagnosis, the 12-month cumulative incidence of CAT was 4.5% in 1 study (USA), 9 2.3% in 2 studies (Denmark, Israel), 10,12 and 0.5% in 2 studies (Taiwan, Japan). 6,13 One additional cohort study from Harris County, USA reported a higher incidence of 8.1% PE/LE-DVT at 12 months, 8 though the patient population was diverse (50% Hispanic, 28% Black), young (mean age 54), uninsured (74%) and living in disadvantaged neighborhoods (84%), and with more aggressive cancer and advanced stage (48%).…”

Management of venous thromboembolism in patients with active cancer

“…1 A recent large registry study showed higher rates of mortality, recurrent VTE, and bleeding in patients with active cancer when compared with patients with a history of cancer or no cancer. 2 Sharman Moser et al 3 compared patients with cancer with and without VTE and found those with VTE were more likely to be hospitalized (81.4% vs 35.2%), had longer hospital stays (20.1 days vs 13.1 days), and were more likely to visit the emergency room (41.5% vs 19.3%). Studies have shown a 39.5% increase in total healthcare costs in ambulatory patients with lung cancer and VTE, 4 as well as increased healthcare utilization, a 3-fold increase in the rate of hospitalization, and an annual increase in per-patient cost of approximately $29,000 for recurrent VTE.…”