Effect of testing for cancer on cancer- or venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE

Robertson, Lindsay; Broderick, Cathryn; Yeoh, Su Ern; Stansby, Gerard

doi:10.1002/14651858.cd010837.pub5

Cited by 13 publications

(14 citation statements)

References 38 publications

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“…Although cancer is a relevant risk factor, a Cochrane meta-analysis found no evidence for additional PET/CT testing after a first unprovoked VTE because there was no benefit in any outcomes: cancer and all-cause mortality ( P =0.25 and P =0.66, respectively), VTE-related morbidity ( P =0.96), time to cancer diagnosis ( P =0.88), and malignancy diagnosis in the early or advanced stage ( P =0.36 and P =1.00, respectively). 72…”

Section: Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary E...mentioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

3,308

702

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BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year’s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary E...mentioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

3,308

702

View full text Add to dashboard Cite

show abstract

“…However, a meta-analysis of four randomized controlled trials has concluded that extensive cancer screening following VTE, including CT scans or combined positron emission tomography/CT scans, results in detection of cancers at an earlier stage, but does not reduce cancer-related mortality compared with routine screening (i.e., current guidelines). 41 Consequently, no current evidence proposes extensive cancer screening following a VTE diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Increased Cancer Risk in Patients with Kidney Disease and Venous Thromboembolism: A Population-Based Cohort Study

et al. 2022

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Background Venous thromboembolism (VTE) may be a harbinger of cancer in the general population. Patients with kidney disease have an a priori increased VTE risk. However, it remains unknown how a VTE affects subsequent cancer risk in these patients. Objectives To examine the cancer risk in patients with kidney disease following a VTE. Methods We conducted a nationwide population-based cohort study in Denmark (1996–2017), including all VTE patients with a diagnosis of kidney disease. We calculated absolute risks of cancer (accounting for competing risk of death) and age-, sex-, and calendar-period standardized incidence ratios (SIRs) comparing the observed cancer incidence with national cancer incidence rates and cancer incidence rates of VTE patients without kidney disease. Results We followed 3,362 VTE patients with kidney disease (45.9% females) for a median follow-up time of 2.4 years (interquartile range: 0.6–5.4). During follow-up, 464 patients were diagnosed with cancer, of whom 169 (36.4%) were diagnosed within the first year. The 1-year absolute risk of any cancer was 5.0% (95% confidence interval [CI]: 4.3–5.8), with a SIR of 2.9 (95% CI: 2.5–3.4) when compared with the general population, and 2.0 (95% CI: 1.8–2.4) when compared with VTE patients without kidney disease. During subsequent years of follow-up, the SIRs declined to 1.5 (95% CI: 1.3–1.6) when compared with the general population, and 1.1 (95% CI: 0.9–1.2) compared with VTE patients without kidney disease. Conclusions Patients with hospital-diagnosed kidney disease have increased cancer risk after VTE, especially within the first year following the VTE diagnosis.

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“…The large heterogeneity of solid and hematologic cancer distribution after acute VTE accounts for difficulties in targeting organ-specific cancers in current screening strategies. However, most studies have failed to show any benefit for overall morbidity and mortality despite a higher number of initially detected cancers, possibly at an earlier stage [ 11 ]. As such, current guidelines recommend limited assessment (medical history, physical examination, laboratory tests, chest X-ray) associated with age- and sex-specific procedures (mammography between 50 and 75 years old, cervical Pap test in women aged 21–65 years, FOBT in individuals aged 50–75 years, PSA or prostate examination in men aged 55 to 70 years and low-dose thoracic CT for smokers aged more than 55 years old).…”

Section: Discussionmentioning

confidence: 99%

“…However, the SOME trial, comparing a limited screening to an extensive approach, including an abdominal CT associated with a virtual colonoscopy and gastroscopy, did not improve cancer detection or prognosis [ 10 ]. To date, although extensive screening procedures have been associated with a higher number of detected cancers, their impact on survival seems uncertain [ 11 ]. As such, all recent guidelines favor limited screening, but current real-life clinical practices are mainly based on individual screening strategies according to the physician’s choice [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry

et al. 2022

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(1) Background and Objectives: Venous thromboembolism (VTE) is strongly associated with cancer, and may be the first event revealing occult neoplasia. Nonetheless, the reasonable extent of the etiological assessment after an unprovoked VTE event remains debated. The main objective of this study was to evaluate the incidence of occult neoplasia one year after an episode of VTE, in consecutively hospitalized patients for VTE from the REMOTEV registry. The secondary objectives were to assess the performance of the various tests used for occult cancer screening in a real-life setting and analyze the risk factors associated with the discovery of cancer and the 1-year prognosis. (2) Methods: REMOTEV is a prospective, non-interventional cohort study of patients with acute VTE. Patients included in the registry from 23 October 2013 to 28 July 2018 were analyzed after a follow-up of 12 months. Cancer detection was performed according to local practices and consisted of a limited strategy to which an abdominal ultrasound was added. In the presence of suggestive clinical manifestations, further examinations were performed on an individual basis. (3) Results: A total of 993 patients were included in the study. At 1 year, the incidence of newly diagnosed cancer was low (5.3%). Half of the detected cancers were metastatic at discovery (51%) and had a poor global prognosis (32% of mortality at 1 year). Admission pulmonary CT scans as well as (thoracic)-abdomino-pelvic CT scans (when performed) were responsible for the majority of detected cancers. Age over 65 years and the concomitant presence of an unusual site and lower-limb deep vein thrombosis were the only factors associated with occult neoplasia in this cohort. After 1-year FU, mortality was higher in cancer patients (HR 6.0 (CI 95% 3.5–10.3, p < 0.0001)), and cancer evolution was the leading cause of death in the cancer group. (4) Conclusions: In REMOTEV, VTE-revealed occult cancer prevalence was low, but similar to recent reports and associated with higher age, multiple thrombotic sites and worse prognosis.

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Effect of testing for cancer on cancer- or venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE

Abstract: This is a repository copy of Effect of testing for cancer on cancer-or venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE.

Cited by 13 publications

References 38 publications

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Increased Cancer Risk in Patients with Kidney Disease and Venous Thromboembolism: A Population-Based Cohort Study

The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry

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