Patterns of venous thromboembolism risk, treatment, and outcomes among patients with cancer from uninsured and vulnerable populations

Abstract

The epidemiology of cancer-associated thrombosis (CAT) among uninsured and vulnerable populations in the US is not well-characterized. We performed a retrospective cohort study for patients with newly diagnosed cancer from 2011 to 2020 at Harris Health System, which cares for uninsured residents in the Houston metropolitan area. Patient demographics, NCI comorbidity index, area of deprivation index (ADI), cancer histology, staging, and systemic therapy data were extracted.CAT included overall venous thromboembolism (VTE) or pulmonary embolism +/À lower extremity deep vein thrombosis (PE/LE-DVT) within 1 year of diagnosis. We used multivariable Fine-Gray models to assess the associations with CAT accounting for death as a competing risk. Among 15 342 patients, 74% were uninsured and 84% lived in socioeconomically disadvantaged neighborhoods. There were 16% Non-Hispanic White (NHW), 28% Non-Hispanic Black (NHB), 50% Hispanic (27% Mexican), and 6% Asian/Pacific Islanders (API). The 1-year CAT incidence rate was 14.6%.Overall VTE was lower for Hispanics versus NHW ) and API versus NHW ). PE/LE-DVT was higher for NHB versus NHW ). CAT was also associated with chemotherapy-based regimens (+/À immunotherapy), age, obesity, cancer type/staging, VTE history, and recent hospitalization. NCI comorbidity and ADI scores were associated with mortality but not CAT. In a large cohort of underserved patients with cancer, we identified an elevated incidence of CAT with known and novel risk predictors. Hispanics had lower adjusted rates of CAT and mortality. Our findings highlight the need to investigate and incorporate vulnerable populations in clinical trials.

Epidemiology of Cancer-Associated Venous Thromboembolism in Patients With Solid and Hematologic Neoplasms in the Veterans Affairs Health Care System

“…This discrepancy observed among patients of different races and ethnicities is not associated with worse outcomes, because Hispanic patients and Asian or Pacific Islander patients had improved survival outcomes compared with non-Hispanic White patients. These patterns have also been reported in other cancer registry analyses . For example, an observational analysis of more than 16 000 patients found an unadjusted incidence rate of CAT to be 3 times higher among non-Hispanic Black patients compared with non-Hispanic White patients.…”

“…These patterns have also been reported in other cancer registry analyses. 13,14,20,21 For example, an observational analysis 20 of more than 16 000 patients found an unadjusted incidence rate of CAT to be 3 times higher among non-Hispanic Black patients compared with non-Hispanic White patients. Similarly, another longitudinal cohort analysis 13 of 15 000 predominantly uninsured patients found a higher…”

Updates in the Incidence, Pathogenesis, and Management of Cancer and Venous Thromboembolism

“…12 For example, Hispanic and Asian patients with cancer have a lower 1-year incidence of VTE complication compared with White or Black patients. 20 Furthermore, concomitant prothrombotic genetic risk factors such as factor V Leiden and non-O blood types are also associated with CAT events. 21 Chemotherapy is also an important risk factor for CAT.…”

Venous thromboembolism risk in cancer patients receiving first‐line immune checkpoint inhibitor versus chemotherapy

“…6 Interpretation of the findings of these observational studies is complicated by the fact that ICI recipients often have progressive cancers refractory to multiple prior lines of therapy, and prior studies often do not distinguish first-line and subsequent lines of therapy. [7][8][9][10] Consequently, current hematology and oncology society risk stratification guidelines for pharmacologic thromboprophylaxis do not specify the inclusion of ICIs as systemic therapy type conferring elevated risk of thrombosis. 11,12 In the current study, we assessed the incidence of VTE associated with first-line ICI versus first-line chemo among comparable patients with matched cancer types, staging, and comorbidities.…”

“…In contrast, another recent systematic review found the incidence of VTE reported from observational cohort studies to be much higher at approximately 5–8% at 6 months 6 . Interpretation of the findings of these observational studies is complicated by the fact that ICI recipients often have progressive cancers refractory to multiple prior lines of therapy, and prior studies often do not distinguish first‐line and subsequent lines of therapy 7–10 . Consequently, current hematology and oncology society risk stratification guidelines for pharmacologic thromboprophylaxis do not specify the inclusion of ICIs as systemic therapy type conferring elevated risk of thrombosis 11,12 …”