Abstract
IntroductionCancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce.Materials and methodsWe conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data. From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We calculated VTE incidence rates in children with cancer vs. controls, and hazard ratios (HRs) using Cox regression.ResultsWe identified four VTE events in children with cancer compared with four events in the larger control population corresponding to absolute risks of 1.52 and 0.06 per 1000 person-years respectively. The four children with VTE and cancer were diagnosed with hematological, bone or non-specified cancer. Childhood cancer was hence associated with a highly increased risk of VTE (HR adjusted for age and sex: 28.3; 95%CI = 7.0-114.5).ConclusionsChildren with cancer are at increased relative risk of VTE compared to those without cancer. Physicians could consider thromboprophylaxis in children with cancer to reduce their excess risk of VTE however the absolute risk is extremely small and the benefit gained therefore would need to be balanced against the risk invoked of implementing such a strategy.Novelty & Impact StatementsWhile there is a reasonable level of knowledge about the risk of VTE in adult populations, it is not well known whether this risk is reflected in paediatric patients. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. While this finding is important, the absolute risk of VTE is still low and must be balanced with the risks of anticoagulation.
Highlights
Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce
In the last 30 years, the survival rate has improved dramatically, and today the 5-year-survival of both leukemia and Non Hodgkins Lymphoma in children exceeds 85% [1]. Health care in these children focuses more on the prevention of Abbreviations: CI, Confidence Interval; CVC, Central venous catheters; HR, Hazard ratio; PE, Pulmonary embolism; VTE, Venous thromboembolism. ☆☆ Details of ethics approval: This project was approved by the Clinical Practice Research Datalink (CPRD) Independent Scientific Advisory Committee (Protocol no. 10–091)
We selected children with cancer diagnosed between April 1997 and December 2006 as this was the period from which data linked to Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) were available
Summary
Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce. Materials and methods: We conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. As the treatment strategies for critically ill children have improved, the rate of VTE in children has increased both in the general population [9], and among patients with cancer [10]. Despite the identification of these risk factors, few studies have quantified the absolute and relative risks of VTE in cancer compared with general population controls. Guidelines for adults stipulate that thromboprophylaxis is advised for high-risk inpatients including those
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