Abstract
Background: Previous data has shown that cancer-related VTE is associated with reduced two-year survival for patients with several tumor types. The reason for the survival difference is not clear.
Methods: Using the California cancer registry and hospital discharge data, we identified all cases diagnosed with colon, breast and lung cancer over a 6-year period. Patients with local or regional stage cancer who developed incident VTE within 2 years after the diagnosis of cancer were identified. The cause of death was determined using a master death registry. Each VTE case was compared to 4 case-controls without VTE after matching for age, race, sex, stage and number of medical co-morbidities. The odds ratio (OR) for dying from any cause and dying due to the underlying cancer in the subsequent 2 years was calculated.
Results (Table): Approximately 40% of all deaths occurred < 30 days of the VTE diagnosis for all cancers. The longer the time interval between cancer diagnosis and VTE, the greater the relative risk of dying of cancer.
Conclusions: Patients with lung, breast and colon cancer who developed VTE < 2 years after cancer diagnosis were significantly more likely to die, and death was attributed to the underlying cancer in a sizable percentage of these cases. This indicates that among patients initially diagnosed with local or regional stage cancer of the breast, colon or lung, VTE is frequently a harbinger or consequence of metastatic stage.
Odds Ratio (OR) for Death and Death Due to Cancer
| VTE Cases < 2 Years From Cancer Dx . | N . | Died < 2 Years From Date of VTE (%) . | OR (CI) For Death in VTE Cases < 2 Years . | Cancer As the Cause of Death N (%) . | OR (CI) for VTE Cases to Die of Cancer . | % Deaths Due to Cancer . |
|---|---|---|---|---|---|---|
| CI = Confidence Interval | ||||||
| Local Stage | ||||||
| Breast | 545 | 85 (16) | 4.1 (3.0 – 5.6) | 30 (6) | 4.5 (2.7 – 7.7) | 53 |
| Colon | 377 | 130 (35) | 3.9 (3.0 – 5.1) | 58 (15) | 5.0 (3.3 – 7.5) | 45 |
| Lung | 234 | 150 (64) | 3.7 (2.6 – 5.5) | 110 (45) | 3.0 (2.0 – 4.4) | 73 |
| Regional Disease | ||||||
| Breast | 493 | 116 (24) | 3.4 (2.6 – 4.4) | 73 (15) | 2.8 (2.1 – 3.9) | 63 |
| Colon | 887 | 375 (42) | 2.1 (1.9 – 2.6) | 273 (31) | 2.1 (1.8 – 2.5) | 73 |
| Lung | 485 | 386 (80) | 3.7 (2.8 – 5.0) | 320 (66) | 2.5 (2.0 – 3.3) | 66 |
| VTE Cases < 2 Years From Cancer Dx . | N . | Died < 2 Years From Date of VTE (%) . | OR (CI) For Death in VTE Cases < 2 Years . | Cancer As the Cause of Death N (%) . | OR (CI) for VTE Cases to Die of Cancer . | % Deaths Due to Cancer . |
|---|---|---|---|---|---|---|
| CI = Confidence Interval | ||||||
| Local Stage | ||||||
| Breast | 545 | 85 (16) | 4.1 (3.0 – 5.6) | 30 (6) | 4.5 (2.7 – 7.7) | 53 |
| Colon | 377 | 130 (35) | 3.9 (3.0 – 5.1) | 58 (15) | 5.0 (3.3 – 7.5) | 45 |
| Lung | 234 | 150 (64) | 3.7 (2.6 – 5.5) | 110 (45) | 3.0 (2.0 – 4.4) | 73 |
| Regional Disease | ||||||
| Breast | 493 | 116 (24) | 3.4 (2.6 – 4.4) | 73 (15) | 2.8 (2.1 – 3.9) | 63 |
| Colon | 887 | 375 (42) | 2.1 (1.9 – 2.6) | 273 (31) | 2.1 (1.8 – 2.5) | 73 |
| Lung | 485 | 386 (80) | 3.7 (2.8 – 5.0) | 320 (66) | 2.5 (2.0 – 3.3) | 66 |
Disclosures: Expert witness for Pacficare.; GSK Speaker’s Bureau.
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