Increasing Incidence and Declining Mortality After Cancer-Associated Venous Thromboembolism: A Nationwide Cohort Study - 25/06/21
, Flemming Skjøth, PhD b, c, Mette Søgaard, PhD a, c, Anette Arbjerg Højen, PhD a, Thure Filskov Overvad, PhD a, d, Simon Noble, MD e, Samuel Zachary Goldhaber, MD f, Torben Bjerregaard Larsen, MD a, cAbstract |
Purpose |
The incidence of cancer-associated venous thromboembolism has increased, but whether short-term mortality after cancer-associated venous thromboembolism has changed remains uncertain. We investigated whether the increasing incidence of venous thromboembolism in cancer patients is associated with a change in mortality.
Methods |
We used administrative medical registries to identify a cohort of all Danish patients diagnosed with a first primary cancer from 2006 to 2017. We examined temporal changes in 1-year risks of venous thromboembolism and in mortality risks at 30 days and 1 year after venous thromboembolism. Cox regression was used to assess changes in mortality rate ratios over time.
Results |
We included 350,272 cancer patients (median age 68 years, 49.1% female), of whom 8167 developed venous thromboembolism within 1 year after cancer diagnosis. The cumulative 1-year risk of venous thromboembolism was 1.8% in 2006-2008, increasing to 2.8% for patients diagnosed in 2015-2017. The 30-day mortality after venous thromboembolism decreased from 15.1% in 2006-2008 to 12.7% in 2015-2017, and the 1-year mortality decreased from 52.4% to 45.8%, equivalent to a hazard ratio (HR) of 0.83 (95% confidence interval [CI], 0.75-0.90). This pattern of declining 1-year mortality was consistent for patients with pulmonary embolism, HR 0.79 (95% CI, 0.69-0.90), and deep venous thrombosis, HR 0.76 (95% CI, 0.67-0.87). Lower mortality over time was evident across all strata of cancer stage, cancer type, and cancer treatment.
Conclusions |
The 1-year risk of venous thromboembolism after a first primary cancer diagnosis in Denmark increased during 2006-2017. This increase was accompanied by declining mortality.
El texto completo de este artículo está disponible en PDF.Keywords : Cancer, Epidemiology, Neoplasms, Pulmonary embolism, Trends, Venous thromboembolism
Esquema
| Funding: This study was supported by an unrestricted research grant from the Obel Family Foundation. The funding source had no role in study design; in the collection, analysis, and interpretation of data; in writing the report; or in the decision to submit the article for publication. |
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| Conflicts of Interest: All authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest. TBL has served as an investigator for Janssen Scientific Affairs, LLC, and Boehringer Ingelheim and received speaking fees from Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, MSD, and AstraZeneca. SN has received speakers’ bureau fees for Leo Pharma, Pfizer, and Bristol Myers Squib, and been on the advisory board for Daichi Sankyo and Bristol Myers Squib. SZG reports grants from Bayer, Boehringer-Ingelheim, BMS, Boston Scientific BTG EKOS, Janssen, the National Heart, Lung, and Blood Institute, and Pfizer; personal fees from Agile, Bayer, Boehringer-Ingelheim, and Pfizer, outside the submitted work. AAH has received speaking fees from Bayer, Bristol-Myers Squibb/Pfizer and, MSD, and served on advisory boards for Bayer and Bristol-Myers Squibb/Pfizer. FS and MS have received consulting fees from Bayer. The other authors declare no conflicts of interest. |
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| Authorship: AO: conceptualization, methodology, investigation, writing – original draft preparation, review, & editing, project administration; FS: methodology, investigation, data curation, resources, formal analysis, software, validation, visualization, writing – original draft preparation, writing – review & editing; MS: conceptualization, methodology, investigation, writing – original draft preparation, writing – review & editing; AH: conceptualization, writing – review & editing; TO: conceptualization, investigation, writing – original draft preparation, writing – review & editing; SN: conceptualization, writing – review & editing; SG: conceptualization, writing – review & editing; TBL: conceptualization, methodology, investigation, supervision, funding acquisition, resources, writing – original draft preparation, writing – review & editing. |
Vol 134 - N° 7
P. 868 - juillet 2021 Regresar al número
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