The following is a summary of “Epidemiology of Cancer-Associated Venous Thromboembolism in Patients With Solid and Hematologic Neoplasms in the Veterans Affairs Health Care System,” published in the June 2023 issue of Nephrology by Martens et al.
Cancer-associated thrombosis (CAT) is a leading cause of morbidity and mortality for cancer patients. For a study, researchers aimed to evaluate the occurrence of CAT and to identify the risk associated with different factors, which are patient-specific, cancer-specific, and treatment specific. The study was conducted within the US Department of Veterans Affairs’ national health care system from 2006 to 2021. The follow-up duration was from the diagnosis date to the first venous thromboembolism (VTE) occurrence, death, loss of follow-up (defined as a 90-day gap without clinical encounters), or administrative censoring on April 1, 2022. Study included patients recently diagnosed with an invasive solid tumor and hematologic neoplasms. The reported data were examined from December 2022 to February 2023.
Investigators analyzed the incidence of VTE with the combination of the International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification, and natural language processing confirmed outcomes. CAT incidence was estimated with a cumulative incidence of competing risk functions. Multivariable Cox regression models were developed to assess the association of baseline variables with CAT.
The relevant patient factors included demographics, region, rurality, area deprivation index, National Cancer Institute comorbidity index, cancer type, staging, first-line systemic treatment within three months (time-varying covariate), and others correlated with the VTE risk. The inclusion criteria met with a total of 434,203 patients (420,244 men [96.8%]; median [IQR] age, 67 [62-74] years; 7,414 Asian or Pacific Islander patients [1.7%]; 20,193 Hispanic patients [4.7%]; 89 371 non-Hispanic Black patients [20.6%]; 313 157 non-Hispanic White patients [72.1%]). At 12 months, the incidence rate was 4.5% overall, with annual patterns ranging between 4.2% to 4.7%. The cancer stage and type affected the VTE risk rate.
Investigators confirmed the well-known risk distribution among the patients. Patients with highly active lymphoid neoplasms were more prone to VTE risk than those with less active or myeloid hematologic neoplasms.
Study reported patients with first-line chemotherapy prone (hazard ratio [HR], 1.44; 95% CI, 1.40-1.49) and immune checkpoint inhibitors (HR, 1.49; 95% CI, 1.22-1.82) had a higher associated risk than patients who received the targeted therapy (HR, 1.21; 95% CI, 1.13-1.30) or endocrine therapy (HR, 1.20; 95% CI, 1.12-1.28). Study suggested that the VTE risk was relatively higher in the Non-Hispanic Black patients (HR, 1.23; 95% CI, 1.19-1.27) and relatively lower in Asian or Pacific Islander patients (HR, 0.84; 95% CI, 0.76-0.93) compared with Non-Hispanic White patients.
Study concluded that VTE incidence was high in cancer patients; novel and existing CAT risks were identified to give helpful insight into treatment.