Incidence of venous thromboembolism among chemotherapy-treated patients with lung cancer and its association with mortality: a retrospective database study

Abstract

Cancer patients, especially those with lung cancer and undergoing chemotherapy, have an elevated risk for venous thromboembolism (VTE). This study assessed incidence, timing, and risk factors for VTE (specifically receipt of chemotherapy), along with the association between VTE and survival among lung cancer patients receiving chemotherapy. Using Florida Medicaid administrative claims data (2000-2008), patients with any diagnosis of primary lung cancer were selected. Patients with recent prior VTE and those enrolled in Medicare or an HMO were excluded. Crude rates of VTE per 100 person years were estimated, and Cox proportional hazards models were developed to assess risk factors for VTE in the lung cancer population, and the association between VTE and survival among patients undergoing chemotherapy. Of 15,749 lung cancer patients, 7,052 (2,242 receiving chemotherapy and 4,810 not receiving chemotherapy) met cohort selection criteria. The incidence of VTE was 10.8 per 100 person-years (PYs) in the chemotherapy cohort and 6.8 per 100 PYs in the non-chemotherapy cohort. Among patients on chemotherapy developing VTE, median time to occurrence was 109 days, with 61 and 82 % of patients experiencing an event within six and 12 months, respectively. In multivariate analyses, the adjusted risk of VTE was 30 % higher among patients undergoing chemotherapy. Comorbidity and the presence of a central venous catheter also were significantly associated with a greater risk of developing VTE. Moreover, patients in the chemotherapy cohort who developed VTE had a significantly faster time-to-death (adjusted hazard ratio [HR] = 1.97; 95 % CI 1.69-2.29).VTE was common among lung cancer patients, especially among patients receiving chemotherapy, with the majority of VTE events occurring within 6 months of initiation of chemotherapy. The presence of a VTE event was significantly associated with an increased risk of mortality.

Efficacy and safety of adjunctive anticoagulation in patients with lung cancer without indication for anticoagulants: a systematic review and meta-analysis

“…On one hand, our data—which are consistent with a previous analysis26—suggest that adjunctive anticoagulation treatment can reduce the occurrence of VTE, which has been proved to be a risk factor for mortality 3 5 9. On the other hand, an accumulating number of in vitro and in vivo studies indicate that anticoagulants have an anticancer effect in non-antithrombotic pathways 27–30.…”

“…Danish registry data indicate that 1-year survival in cancer patients with VTE is three times less than in those without VTE 9. A more recent study by Huang et al 5 reported that lung cancer patients with VTE had a twofold shorter time to death.…”

“…The incidence of VTE in patients with cancer has been reported to be increased by >20-fold compared with the general population,2 3 and this risk seems to increase further by 20–30% in patients with advanced cancer who receive chemotherapy 4 5. Lung cancer is among the malignant diseases showing the highest incidence of VTE 1 6.…”

Apoptotic vesicles: deathly players in cancer‐associated coagulation

“…Cancer patients have an approximately four‐fold increased risk of developing VTE . Multiple mechanisms for the prothrombotic effects of tumors have been suggested from both in vitro and clinical studies (Figure ) . For example, enhanced TF expression by monocytes and subendothelial vascular cells may be increased following the secretion of tumor‐derived vascular endothelial cell growth factor .…”

“…Venous thromboembolism (VTE) represents the second highest cause of death in 10–57% of cancer patients, with only 12% of affected individuals surviving beyond 1 year . Of greater concern, the four‐fold risk of VTE in cancer patients is increased to six‐ to seven‐fold with chemotherapy . Moreover, tumor‐induced coagulation enhances cancer progression through the protease‐activated receptor 2 G‐protein coupled receptor pathway …”