Does an incident cancer diagnosis increase the risk of arterial thromboembolism in Medicare enrollees?
Patients with incident cancer have a substantially increased short-term risk of arterial thromboembolism, including myocardial infarction and ischemic stroke, which correlates with cancer stage and generally resolves by 1 year.
Background The risk of arterial thromboembolism in patients with cancer is incompletely understood. Objectives The authors aimed to better define this epidemiological relationship, including the effects of cancer stage. Methods Using the Surveillance Epidemiology and End Results-Medicare linked database, we identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 through 2011. They were individually matched by demographics and comorbidities to a Medicare enrollee without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics. Cox hazards analysis was used to compare rates between groups at discrete time points. Results We identified 279,719 pairs of patients with cancer and matched controls. The 6-month cumulative incidence of arterial thromboembolism was 4.7% (95% confidence interval CI: 4.6% to 4.8%) in patients with cancer compared to 2.2% (95% CI: 2.1% to 2.2%) in controls (HR: 2.2; 95% CI: 2.1 to 2.3). The 6-month cumulative incidence of myocardial infarction was 2.0% (95% CI: 1.9% to 2.0%) in patients with cancer compared with 0.7% (95% CI: 0.6% to 0.7%) in controls (HR: 2.9; 95% CI: 2.8 to 3.1). The 6-month cumulative incidence of ischemic stroke was 3.0% (95% CI: 2.9% to 3.1%) in patients with cancer compared to 1.6% (95% CI: 1.6% to 1.7%) in controls (HR: 1.9; 95% CI: 1.8 to 2.0). Excess risk varied by cancer type (greatest for lung), correlated with cancer stage, and generally had resolved by 1 year. Conclusions Patients with incident cancer face a substantially increased short-term risk of arterial thromboembolism.
“Compared to an age and sex matched control group they found a cumulative incidence of arterial thromboembolism of 4.7% in all cancer patients vs. 2.2% at 6 months. The risk is higher in some types of tumours such as lung, gastric, and pancreatic. Advance stage was associated with increased ATEs risk, with stage IV patients having a >10-fold increase in ATE in the first month after diagnosis of cancer.”
Navi et al. (Tue,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: