The incidence and risk factors for venous thromboembolism in adolescent and young adult oncology patients

Abstract

Background Venous thromboembolism (VTE) is a known complication among pediatric and adult cancer patients. Adolescent and young adult oncology (AYAO) patients have unique biological and physiological characteristics that make them distinct from other populations. Our objective was to study the VTE incidence, risk factors, and outcomes, which have been understudied in this population. Procedure A retrospective case–control study was conducted on AYAO participants with new or relapsed cancer and an imaging confirmed VTE from January 2011 to November 2016 at our institution. Eligible AYAO participants without a history of VTE were designated as controls and were randomly selected from our institution's tumor registry. Demographics, medical history, surgeries, central venous catheter (CVC) data, VTE diagnosis and treatment, relapses, and deaths were abstracted. Results Thirty‐five VTE cases and 70 controls were included in this analysis. Eighty percent of cases had leukemia or lymphoma (vs. a solid tumor) compared to 58% of controls. The majority of VTEs (57%) were CVC associated, and more than 70% of cases had more than one CVC placed during their cancer treatment versus 34% of controls. Infection was associated with increased VTE risk (OR = 6.35, 95% CI = 2.30, 17.55, p < .0001). VTE cases had increased cancer relapse (23% vs. 10%) and mortality rates (29% vs. 16%) than controls. Conclusion AYAO participants with a VTE were more likely to have leukemia or lymphoma, more than one CVC or infection. Further studies are needed to identify patients who would benefit from modifiable prevention measures, such as limiting to one CVC, preventing infections, or considering prophylactic anticoagulation for those with a liquid tumor.

Central venous catheter–associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice

“…Since the risk of some complications might be higher during treatment (i.e., intensive use of CVC), the IRs per 1000 CVC-treatment days were also calculated, which still showed that the insertion of a SL PICC is associated with a significantly higher risk of (severe) complications and local infections in particular compared to a TIVAP. The high rate of complications associated with PICCs was also reported previously in adult patients with HL and pediatric oncology patients in general [1,[9][10][11][12][13]. Three studies did investigate risk factors for CVT (CVC and non-CVCrelated) specifically in pediatric patients with lymphoma.…”

“…This incidence falls within the wide range reported for children with cancer in general of 2–50% [ 27 – 29 ]. The risk of CVC-related CVTs has been described to be higher in patients with HL compared to other oncology patients, presumably caused by the frequent presence of risk factors for CVT (e.g., vein compression in the upper body, high-dose corticosteroid treatment), as also described in the “Introduction” section [ 1 , 3 , 9 , 11 – 14 , 28 ]. However, the difference between HL and non-HL patients might also be explained by the CVC types included in the previously performed studies, i.e., only 0–3% PICCs [ 28 , 29 ].…”

“…In total 98 patients were included with a median age at diagnosis of 15 years (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Most patients (96%) were diagnosed with classic HL.…”

“…However, general anesthesia is needed for insertion, sedation for removal, percutaneous punctures to access the port, and a larger scar will remain visible after removal, whereas these disadvantages do not apply to PICCs. On the other hand, higher incidence rates of mechanical failure, CVC-related infections, and CVC-related central venous thrombosis (CVT) have been associated with PICCs when compared to other CVC-types in a variety of adult and pediatric patients (i.e., oncology, intensive care unit, total parenteral nutrition) [1][2][3][4][5][6][7][8][9][10]. However, the incidence of all CVC-related complications for patients with HL specifically has not been described previously.…”

“…Based on studies in adults and children, the risk of CVCrelated CVTs has been described to be higher in patients with HL, compared to other oncology patients [3,9]. Suggested risk factors that may contribute to this difference are tumor-associated inflammation and compression of veins typically occurring in the upper body, the older age of patients, and frequent high-dose corticosteroid treatment, which are all known risk factors for thrombosis [1,3,[11][12][13][14][15].…”