Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations

Mahé, Isabelle; Mayeur, Didier; Krakowski, I.

doi:10.1007/s00520-016-3224-0

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…Notably, among patients with cancer, the risk of VTE is estimated to be four- to seven-fold that of the general population ( 4–6 ). Furthermore, in cancer patients, VTE is associated with worse prognosis ( 7–10 ) and increased medical costs ( 11 , 12 ). Among 4466 cancer patients in the United States, VTE was observed to be the second most common cause of death ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry

Ohashi

Ikeda

Kunitoh

et al. 2020

Japanese Journal of Clinical Oncology

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Background The Cancer-VTE Registry evaluates the occurrence and management of venous thromboembolism in Japanese participants with major solid tumors. Using Registry data, we evaluated the frequency of concurrent venous thromboembolism in cancer patients prior to treatment initiation by cancer type. Methods The Cancer-VTE Registry is an ongoing (March 2017–September 2020) prospective cohort study using a nationwide, multicentre clinical registry. Participants aged ≥20 years with colorectal, lung, stomach, pancreatic, breast or gynecologic cancer, confirmed staging, ≥6 months life expectancy post-registration and who had undergone venous thromboembolism screening were managed with routine clinical care. Venous thromboembolism frequency at registration was evaluated. Results Of 9735 participants, 571 (5.9%) had venous thromboembolism at baseline, including asymptomatic [5.5% (n = 540)] and symptomatic venous thromboembolism [0.3% (n = 31)]. Most participants with venous thromboembolism (n = 506, 5.2%) had deep vein thrombosis only; 65 (0.7%) had pulmonary embolism with/without deep vein thrombosis. The prevalence of distal and proximal deep vein thrombosis was 4.8% (n = 466) and 0.9% (n = 83), respectively. The highest prevalence of venous thromboembolism was for pancreatic cancer (8.5%) and the lowest for breast cancer (2.0%). Venous thromboembolism prevalence increased as cancer stage advanced. Conclusions Although there was a marked difference in venous thromboembolism by cancer type, the data suggest that cancer stage is an important risk factor for venous thromboembolism. Thus, metastasis seems a critical risk factor for venous thromboembolism. This is the first demonstration of venous thromboembolism prevalence and risk factors in Japanese cancer patients prior to treatment. Trial registration UMIN000024942.

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Section: Introductionmentioning

confidence: 99%

Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry

Ohashi

Ikeda

Kunitoh

et al. 2020

Japanese Journal of Clinical Oncology

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“…VTE is a complication commonly linked to active cancers and is furthermore exacerbated by associated treatments 20 . In a population-based study, cancer was associated with a 4.1-fold greater risk of thrombosis, whereas the use of chemotherapy increased the risk 6.5-fold 21 , 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the known increased risk of an initial VTE and recurrences in cancer patients, along with the associated costs, few analyses have been performed on the economic impact of VTE in this patient population 29 . Improving the implementation guidelines in patients with VTE and cancer is of utmost importance to reduce the risk of recurrence, as well as hospital stay durations 20 and their associated costs. VTE is an independent prognostic factor and is a largely preventable disease when thromboprophylaxis is appropriately used, as recommended worldwide by International Clinical Practice 22 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score

Hase¹,

Barros²,

Igai³

et al. 2018

Clinics

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OBJECTIVES:Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality.METHODS:A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score ≥3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation.RESULTS:Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization.CONCLUSIONS:Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.

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“…Because breast cancer is the most common cancer worldwide, it contributes to a large number of cancer-related VTE cases and associated health care costs (Mahe et al, 2016). Up to 80% of breast cancer patients with VTE will suffer from long-term symptoms of post-thrombotic syndrome, including pain, oedema and ulceration (Khan et al, 2017;Nishimoto et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Deep venous thrombosis (DVT) and pulmonary embolism (PE), together described as venous thromboembolism (VTE), continue to be common complication in cancer inpatients (Ay et al., 2017). Because breast cancer is the most common cancer worldwide, it contributes to a large number of cancer‐related VTE cases and associated health care costs (Mahe et al., 2016). Up to 80% of breast cancer patients with VTE will suffer from long‐term symptoms of post‐thrombotic syndrome, including pain, oedema and ulceration (Khan et al., 2017; Nishimoto et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients

Qiang

Wang

et al. 2020

Journal of Advanced Nursing

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Aim The purpose of this study was to develop and validate an individualized nomogram to predict venous thromboembolism (VTE) risk in hospitalized postoperative breast cancer patients. Design A single‐central retrospective and non‐interventional trial. Methods For model development, we used data from 4,755 breast cancer patients between 1 November 2016–30 June 2018 (3,310 patients in the development group and 1,445 in the validation group). Overall, 216 patients developed VTE (150 in development group and 66 in validation group). The model was validated by receiver operating characteristic curves and the calibration plot. The clinical utility of the model was determined through decision curve analysis. Results The individualized nomogram consisted of six clinical factors: age, body mass index, number of cardiovascular comorbidities, neoadjuvant chemotherapy, surgical treatment, hospital length of stay and two pre‐operative biomarkers of Homocysteine and D‐dimer. The model at the 3.9% optimal cut‐off had the area under the curve of 0.854 (95% CI, 0.824–0.884) and 0.805 (95% CI, 0.740–0.870) in the development and validation groups. A p = 0.570 of the calibration test showed that the model was well‐calibrated. The net benefit of the model was better between threshold probabilities of 5%–30% in decision curve analysis. Conclusion The nomogram of VTE risk assessment, is applicable to hospitalized postoperative breast cancer patients. However, multi‐central prospective studies are needed to improve and validate the model. Effectiveness and safety of thromboprophylaxis in high‐risk patients are needed to demonstrate in interventional trials. Impact This nomogram can be used in clinical to inform practice of physicians and nurses to predict the VTE probability and maybe direct personalized decision making for thromboprophylaxis in hospitalized postoperative breast cancer patients.

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Management of venous thromboembolism in cancer patients: the economic burden of hospitalizations

Abstract: As discussed in the article, the current costs are high. Better physician adherence to clinical practice guidelines could potentially reduce these costs by lowering the number of recurrent VTE in patients with cancer.

Cited by 6 publications

References 25 publications

Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry

Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry

Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score

Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients

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