Venous thromboembolism in cancer patients receiving specialized palliative care
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Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221081121. doi: 10.1177/10760296221081121.
BACKGROUND: The prevalence of venous thromboembolism (VTE) in cancer patients is particularly high during disease progression and during relapses. Patients cared for in specialized palliative care units (SPCU) are rarely included in VTE studies. Objective: We sought to study the prevalence, clinical characteristics and survival of people with VTE in the context of SPCU.
Methods: We retrospectively included 2707 consecutive people with active cancer treated in an SPCU. Data were summarized using descriptive statistics and frequency of categorical variables. Overall survival was estimated by Kaplan-Meier and compared by the log-rank test. Thrombotic events were confirmed by imaging.
RESULTS: We studied 1984 (73.3%) women and 723 (26.7%) men. The overall prevalence of thrombosis was 22.2% with only 6.2% occurring after the start of SPCU care, and was higher in women (24.6% versus 15.8%), particularly with tumors gynecological (cervical: 30.5%, ovarian: 29.2%). Median survival was slightly longer for patients without VTE (80 days [IQR21-334] and 69 days [IQR 25-235]; p = 0.03).
CONCLUSIONS: The prevalence of VTE was high and varied by tumor origin. VTE can impact survival. Although the median survival is short, some patients are followed for months, suggesting that in the absence of a high bleeding risk, treatment of thrombosis aimed at decreasing the morbidity of re-thrombosis should be considered. On the other hand, few patients developed symptomatic VTE during SPCU care, making widespread primary prophylaxis likely unwarranted. The personalization of anticoagulation according to the hemorrhagic risk and physical performance is essential.