Incidence and predictors of venous thromboembolism (VTE) among ambulatory patients with lung cancer.

Abstract

7066 Background: The incidence of VTE among lung cancer patients reported in hospital-discharge database studies and single-institution studies is 2%-13%. The incidence and economic impact of lung cancer–associated VTE is unknown in the ambulatory setting, where most cancer care occurs. This retrospective cohort analysis examined incidence and risk factors for VTE in ambulatory patients with primary lung tumors who were starting chemotherapy. Methods: Data were extracted from the IMS Patient-Centric database, a large administrative database of US healthcare claims. Demographics/clinical characteristics and healthcare resource utilization of patients with solid tumors, including lung, and patients in a matched control cohort without cancer were evaluated. The incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and DVT+PE was recorded during 3- to 12-month follow-up after chemotherapy initiation in the lung cancer cohort. Results: Lung cancer (n=6,732) and control (n=17,284) cohorts had 51% women, with a mean age of 64 years. Respective mean Charlson Comorbidity Index (CCI) scores were 6.7 and 0.6. VTE occurred in 13.9% of the lung cancer cohort (odds ratio [OR], 3.15; 95% confidence interval [CI], 2.55, 3.89) and 1.4% of the control cohort (P<0.0001). The incidence of DVT, PE, and DVT+PE was 7.4%, 3.6%, and 2.9%, respectively, in the lung cancer cohort vs 1.0%, 0.2%, and 0.2% in the control cohort (P<0.0001 for all comparisons). The use of erythropoiesis-stimulating agents (ESAs; OR, 1.63; 95% CI, 1.40, 1.89; P<0.0001 vs no ESA), CCI ≥5 (OR, 2.56; 95% CI, 1.02, 6.39; P=0.045 vs CCI <5), and congestive heart failure (CHF; OR, 1.29; 95% CI, 1.01, 1.66; P=0.045 vs no CHF) were associated with VTE. Bleeding occurred in 22.1% of the lung cancer cohort and 7.0% of the control cohort (P<0.0001). Among lung cancer patients, VTE was associated with a 39.5% higher total medical cost than non-VTE (P<0.0001). Conclusions: VTE is highly prevalent among patients with lung cancer receiving chemotherapy and is associated with a significant increase in healthcare resource utilization. Disclosure: Study funding and editorial support provided by sanofi-aventis U.S.