The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

Maraveyas, Anthony; Kraaijpoel, Noémie; Bozas, George; Huang, Chao; Mahé, Isabelle; Bertoletti, Laurent; Bartels‐Rutten, Annemarieke; Beyer‐Westendorf, Jan; Constans, J.; Iosub, Diana Irina; Couturaud, Francis; Muñoz, Andrés; Biosca, Mercedes; Lerede, Teresa; Es, Nick van; Nisio, Marcello Di

doi:10.1111/jth.15489

Cited by 10 publications

(11 citation statements)

References 29 publications

(69 reference statements)

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“…This finding supports recent calls for the same sensitive approach needed for any breaking bad news scenario [13,30], and the need for person-centred information to redress uncertainty-related anxiety [21]. In our study, those with symptoms were more distressed and fearful consistent with post-traumatic distress from cancer-associated PE being related to perceived seriousness of the health threat [16,32] this in the absence of the knowledge that their symptoms may also have adverse prognostic significance [33].…”

Section: Discussionsupporting

confidence: 87%

Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Benelhaj

Hutchinson²,

Maraveyas³

et al. 2022

PLoS ONE

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Background The diagnosis of symptomatic cancer-associated thrombosis often causes distress and alarm for patients, especially for those unaware of the risk, or the signs and symptoms to look out for. There are few data about cancer patients’ experiences of incidentally diagnosed pulmonary embolism (IPE), where lack of warning (recognised signs, symptoms) may cause delayed diagnosis and aggravate distress. Objectives To explore cancer patients’ experience of the diagnosis of and living with incidental pulmonary embolism treated with anticoagulation. Methods A qualitative study using modified grounded theory approach. Semi-structured interviews were conducted as part of a mixed- methods prospective observational survey study of consenting patients with IPE. Data were subjected to thematic analysis. The qualitative findings are presented. Findings Eleven participants were interviewed (mean age 68.3 years, range 38–82 years; various forms of cancer and stages). Three major themes and one cross-cutting theme were generated. Theme (1): IPE is experienced in the context of cancer and concomitant comorbidities. Issues are understood in the shadow of–and often overshadowed by—current serious illness. Theme (2): Being diagnosed with IPE. Misattribution to cancer or other comorbidities caused delay in help-seeking and diagnosis. Theme (3): Coping with anticoagulation. Participants’ incorporated anticoagulation treatment and its effects into their daily routine with acceptance and stoicism. Finally, the cross-cutting theme relates to a lack of information and uncertainty, contributing to distress throughout the experience. Conclusion The diagnosis of IPE was upsetting and unexpected. Expert and timely information was valued by those with IPE. Education called for about the increased risk of cancer-associated thrombosis and the signs and symptoms to be aware of.

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Section: Discussionsupporting

confidence: 87%

Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Benelhaj

Hutchinson²,

Maraveyas³

et al. 2022

PLoS ONE

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“…A prognostic score incorporating performance status and the presence of new or worsening symptoms at the time of IPE diagnosis, with and without considering the presence of incurable malignancy, correlated with overall survival and early mortality in patients with IPE [ 42 ]. Analysis of a registry of 695 IPE patients found that respiratory symptoms within 14 days of the presentation and the ECOG performance status were the most consistent predictors of mortality [ 43 ].…”

Section: Risk Stratification In Patients With Ipementioning

confidence: 99%

Emergency management of incidental pulmonary embolism (IPE)

et al. 2022

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Venous thrombo-embolic (VTE) disease is a common cause of complications in patients with cancer and is the second most common cause of death in oncology patients other than the malignant disease. Whilst symptomatic VTE comprises the majority of such presentations to an emergency department (ED), incidental pulmonary embolism (IPE) is an increasingly frequent reason for attendance.Many studies report that the consequences of IPE do not differ significantly from those with symptomatic presentations and thus most guidelines recommend using the same approach. The complexity of treatment in cancer patients due to increased prevalence of co-morbidities, higher risk of bleeding, abnormal platelet and renal function, greater risk of VTE recurrence, and medications with the risk of anticoagulant interaction are consistent across patients with symptomatic and IPE.One of the initial challenges of the management of IPE is the design of a pathway that provides both patients and clinicians with a seamless journey from the radiological diagnosis of IPE to their initial clinical workup and management. Increased access to ambulatory care has successfully reduced ED utilisation and improved clinical outcomes in high-risk non-oncological populations, such as those with IPE.In this clinical review, we consider IPE management, its workup, the conundrums it may present for emergency physicians and the need to consider emergency ambulatory care for this growing cohort of patients.

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“…Another study by O'Connell et al [15,16] revealed that in patients with cancer and unsuspected VTE, survival was significantly reduced in those with symptomatic events compared to those who were truly asymptomatic (P = 0.002). In the above-mentioned prospective cohort study of 695 ambulatory cancer patients with unsuspected PE, respiratory symptoms within 14 days prior to the diagnosis of PE and ECOG performance status were the two most important predictors for overall survival in this population [17]. These data suggest the importance of carefully assessing symptoms in cancer patients, including those that might not typically be thought of as related to PE (such as fatigue).…”

Section: Symptomatic Vs Asymptomaticmentioning

confidence: 86%

How to treat incidental pulmonary embolism in cancer patients? Recent advances

Delluc

Wang

2021

Kardiol Pol

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Patients with cancer have an increased risk of venous thromboembolism (VTE). In addition, due to the growing use of computed tomography scans in these patients and the improved scanners and imaging qualities, many cases of VTE are diagnosed incidentally on images obtained for reasons other than suspicion of VTE. Studies have shown that as many as half of all cancer-related pulmonary embolism (PE) cases could be incidental. Despite the common occurrence, the optimal management of incidental PE in patients with cancer remains unclear. This review will summarize pertinent literature related to incidental PE in the cancer population and discuss their outcomes and recommended treatments.

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The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

Abstract: Background: Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE

Cited by 10 publications

References 29 publications

Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Emergency management of incidental pulmonary embolism (IPE)

How to treat incidental pulmonary embolism in cancer patients? Recent advances

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