Symptomatic Venous Thromboembolism in Cancer Patients Treated With Chemotherapy

Abstract

The relation between cancer and venous thromboembolism (VTE) has been known since at least 1865, and it is generally accepted that the incidence of VTE in cancer patients is high.¹ Nevertheless, the true incidence of VTE in cancer patients is unknown. One of the reasons for this lack of clarity is the presence of confounding factors. Most cancer patients need surgery for their malignancy, will be exposed to chemotherapy and/or intravenous catheters, and may become immobilized during their disease. The relation between VTE and (different kinds of) chemotherapy has been most extensively investigated in patients with breast cancer.^2-11 In patients with breast cancer stage I or II, the incidence of VTE seemed to increase from 0.2% to 2.0% in those receiving chemotherapy. In most of those studies, patients were also treated with tamoxifen citrate, which itself is thrombogenic.¹² In patients with high-grade glioma treated with chemotherapy, the incidence of VTE was 12% in a prospective study¹³ and 16% in a retrospective study.¹⁴ Finally, Grem et al¹⁵ reported an incidence of 17% in 36 patients with unresectable or metastatic colon carcinoma treated with a combination of fluorouracil and leucovorin calcium and granulocyte-macrophage colony-stimulating factor. These data suggest a significantly increased risk for VTE in patients with different kinds of malignancies who are receiving chemotherapy.