Case-Control Analysis of the Impact of Anemia on Quality of Life in Patients with Cancer: A Qca Study Analysis

Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ–5D–3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively; mean difference: −12.4, p < 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically

Case-Control Analysis of the Impact of Anemia on Quality of Life in Patients with Cancer: A Qca Study Analysis

The impact of anemia on the quality of life (QoL) in cancer patients has been studied previously; however, the cut-off point used to define anemia differed among studies, thus providing inconsistent results. Therefore, we analysed the clinical impact of anemia on QoL using the same cut-off point for hemoglobin level to define anemia as that used in ESMO clinical practice guidelines. This post-hoc analysis aimed to determine the impact of anemia on QoL in cancer patients through the European Organization for Research and Treatment of Cancer Quality of life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ-5D-3L) questionnaire. We found that cancer patients with anemia had significantly worse QoL in clinical terms. In addition, anemic patients had more pronounced symptoms than those in non-anemic patients. Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ-5D-3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively; mean difference: -12.4, p < 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically

Enfermedad tromboembólica venosa en el paciente oncológico: manejo terapéutico y complicaciones

La relación entre la enfermedad tromboembólica venosa (ETV) y el cáncer representa un desafío en la práctica clínica. La trombosis venosa profunda (TVP) y la tromboembolia pulmonar (TEP) se asocian con un incremento en la mortalidad en pacientes oncológicos. Este compendio de publicaciones tiene como objetivo abordar situaciones controvertidas en la trombosis asociada al cáncer (TAC) para guiar a los clínicos en la toma de decisiones. El aumento de la incidencia de ETV incidental en pacientes con cáncer plantea interrogantes sobre el pronóstico, especialmente en aquellos con TEP incidental. Se realizó un estudio retrospectivo en el que evaluamos el efecto de la TVP incidental en la mortalidad en pacientes con TEP incidental. Entre 2010 y 2018, se incluyeron 200 pacientes, de los cuales el 31% tenía TVP incidental concomitante y el 40,1% falleció durante el seguimiento. La mortalidad no aumentó en los pacientes con TVP (cociente de riesgo [CR] 1,01; IC del 95%: 0,43-2,75; p=0,855). En el análisis multivariante, el peso (CR ajustado: 0,96; IC del 95%: 0,92-0,99; p=0,032) y la metástasis (CR ajustado: 10,26; IC del 95%: 2,33-44,9; p=0,002) fueron factores predictivos de la mortalidad. En conclusión, el bajo peso y la presencia de metástasis se asociaron con la mortalidad, mientras que la presencia de TVP concomitante no se relacionó con una peor supervivencia. Las guías de práctica clínica recomiendan que los pacientes con ETV incidental reciban el mismo tratamiento anticoagulante que aquellos con ETV sintomática, no obstante, existe una falta de datos sobre las complicaciones a largo plazo en estos pacientes. Se realizó un análisis post hoc de estudios prospectivos en pacientes con TAC entre 2008 y 2019, siendo el resultado principal las tasas de ETV recurrente y hemorragia clínicamente relevante (HCR) en grupos de ETV incidental y sintomática. Se incluyeron 796 pacientes con TAC, de los cuales el 42,8% presentaba una ETV incidental. No se observaron diferencias significativas en las tasas de ETV recurrente (0,4 por 100 pacientes/mes vs 0,5 por 100 pacientes/mes; p=0,313) ni en las tasas de HCR (0,6 por 100 pacientes/mes vs 0,5 por 100 pacientes/mes; p=0,128) entre pacientes con ETV incidental y sintomática, respectivamente. A los seis meses de seguimiento, la incidencia acumulada de HCR fue significativamente mayor en pacientes con ETV incidental en comparación con aquellos con ETV sintomática (7,9% vs 4,4%, respectivamente; RP:1,8; IC del 95%: 1,01-3,2). En conclusión, los pacientes con cáncer y ETV incidental presentan tasas similares de HCR y ETV recurrente en el seguimiento a largo plazo en comparación con aquellos con ETV sintomática. Sin embargo, a los seis meses, los pacientes con ETV incidental tienen una mayor incidencia acumulada de HCR. Las guías clínicas recomiendan la anticoagulación durante al menos 6 meses en los pacientes con TAC, sin embargo, no existe evidencia concluyente acerca del tratamiento más allá de los 6 meses. Se realizó un estudio retrospectivo de pacientes con TAC reclutados entre 2008 y 2019. Los resultados primarios y secundarios fueron ETV recurrente a los 6 y 12 meses, respectivamente. Se incluyeron 311 pacientes, de los cuales el 33,4% tenía metástasis. A los 6 y 12 meses, la incidencia de ETV recurrente fue del 6,1% y del 8,7%, respectivamente. La ETV recurrente fue más frecuente en pacientes con metástasis a los 6 (subdistribución del cociente de riesgo [sCR] 3,83; IC del 95%, 1,54-9,52) y 12 meses (sCR 5; IC del 95%, 2,2-11,5). Los pacientes con ETV incidental tuvieron menos eventos recurrentes a los 6 (sCR0,3; IC del 95%, 0,1-0,8) y 12 meses (sCRS 0,0,3; IC del 95%, 0,1-0,6) tras la suspensión de la anticoagulación. En conclusión, la incidencia de ETV recurrente a los 6 y 12 meses tras la suspensión de la anticoagulación es mayor en los pacientes con TAC. Aquellos con metástasis presentan un mayor riesgo, mientras que los pacientes con ETV incidental presentan un riesgo menor

Tromboembolia de pulmón

Resumen: La tromboembolia de pulmón (TEP), la forma más grave de presentación de la enfermedad tromboembólica venosa (ETV), constituye actualmente un problema sanitario de primer orden, por su elevado impacto en términos de morbimortalidad, costes y consumo de recursos. La mortalidad temprana asociada a la TEP se debe fundamentalmente a inestabilización hemodinámica, agravamiento de enfermedades previas o complicaciones asociadas al tratamiento de la TEP. Más allá de la mortalidad, existen complicaciones relevantes relacionadas con la TEP, como los sangrados asociados a la anticoagulación, las recurrencias ETV y la persistencia de síntomas respiratorios residuales; esta última complicación relacionada con la TEP está caracterizada principalmente por dos entidades, la hipertensión pulmonar tromboembólica crónica y la enfermedad tromboembólica crónica pulmonar. Los relevantes avances científicos realizados en los últimos años han permitido mejorar el manejo tanto diagnóstico como terapéutico de la enfermedad, tal y como se expone en el presente documento mediante una serie de preguntas relevantes sobre la TEP que son respondidas con la mejor evidencia científica actualmente disponible. Abstract: Pulmonary embolism (PE), the most severe form of presentation of venous thromboembolic disease (VTE), currently represents a foremost healthcare issue due to its high impact in terms of morbidity, mortality, costs, and resource consumption. Early mortality associated with PE is primarily due to hemodynamic instability, exacerbation of pre-existing conditions, or major complications of antithrombotic therapies. Beyond the risk of death, there are relevant complications related to PE, such as bleedings, VTE recurrences, and persistence of residual respiratory symptoms; the latter complication related to PE is mainly characterized by two entities, chronic thromboembolic pulmonary hypertension and chronic thromboembolic disease. Significant scientific advances made in recent years have allowed for the improvement of both diagnostic and therapeutic management of the disease, as outlined in this document through a series of relevant issues about PE that are answered with the most up-to-date scientific evidence

Prognostic significance of incidental deep vein thrombosis in patients with cancer presenting with incidental pulmonary embolism

In symptomatic acute pulmonary embolism (PE), the presence of deep vein thrombosis (DVT) is a risk factor for 30- and 90-day mortality. In patients with cancer and incidental PE, the prognostic effect of concomitant incidental DVT is unknown. In this retrospective study, we examined the effect of incidental DVT on all-cause mortality in such patients. Adjusted Cox multivariate regression analysis was used for relevant covariates. From January 2010 to March 2018, we included 200 patients (mean age, 65.3 ± 12.4 years) who were followed up for 12.5 months (interquartile range 7.4–19.4 months). Of these patients, 62% had metastases, 31% had concomitant incidental DVT, and 40.1% (n = 81) died during follow-up. All-cause mortality did not increase in patients with DVT (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.43–2.75, p = 0.855). On multivariate analysis, weight (adjusted HR 0.96, 95% CI 0.92–0.99, p = 0.032), and metastasis (adjusted HR 10.26, 95% CI 2.35–44.9, p = 0.002) were predictors of all-cause mortality. In conclusion, low weight and presence of metastases were associated with all-cause mortality, while presence of concomitant DVT was unrelated to poorer survival

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain