A recent study found that a coexisting cancer diagnosis in patients hospitalized for acute pulmonary embolism (PE) was associated with a 90% increase in all-cause inpatient mortality, longer lengths of stay, higher total charges per hospitalization, greater risk for readmission, and increased rates of home health services after discharge, compared with patients with PE without a cancer diagnosis. Study findings were published in BMC Pulmonary Medicine.
Prompted by a lack of recent data comparing the clinical and health care utilization outcomes of PE in the presence or absence of cancer, investigators conducted a cross-sectional analysis of the National Inpatient Sample (NIS) database of the Agency for Healthcare Research and Quality (AHRQ). The data set included 3,313,044 patients discharged from the hospital between 2002 and 2014 who had a primary or secondary diagnosis of acute PE. Among those patients, 84.2% did not have cancer, and 15.8% had coexisting cancer (56% metastatic cancer, 35% solid tumor without metastasis, and 9% lymphoma). The mean age of cancer patients was 66.2 years, whereas the mean age of cancer-free patients was 63.1 years (P <.0001). Female sex predominated in both groups.
The authors excluded patients with obstetrical pulmonary embolism and other diagnoses, including iatrogenic PE, septic PE, primary pulmonary hypertension, kyphoscoliotic heart disease, chronic PE, chronic pulmonary heart disease, pulmonary arteriovenous fistula, pulmonary artery aneurysm, pulmonary circulatory disease, pulmonary circulatory disease not otherwise specified, and history of PE .
The study population (n = 671,852) included patients with a concurrent diagnosis of cancer (n = 105,935; 5.8%) and those with no cancer diagnosis (n = 566,917; 84.2%). The researchers defined cancer as a comorbidity if lymphoma, metastatic cancer, or solid tumor without metastasis was present in the same hospitalization. The mean age of cancer patients was 66.2 years, whereas the mean age of patients without cancer was 63.1 years (P <.0001). Female sex predominated in both groups. All-cause in-hospital mortality was the primary outcome investigated. Study participants included patients with both a PE diagnosis on admission and hospital-acquired PE.
The retrospective cross-sectional analysis revealed that in-hospital all-cause mortality was significantly higher in patients with cancer than in those without (11.8% vs 6.6%, respectively; odds ratio, 1.79; 95% CI, 1.75-1.83; P <.0001). Of hospitalizations for acute PE, individuals with cancer had a significantly longer median length of stay (6 days; IQR, 3-10) than those not having cancer (5 days; IQR 3-9; P <.0001) and higher median total charges per hospitalization ($30,885; IQR, 16,308-61,113; P <.0001) compared with $27,273 (IQR, 15,271-53,340) in those without cancer. The assessed risk of readmission was also higher in patients with cancer, who had a median AHRQ Elixhauser Comorbidity Index risk of readmission score of 31 (IQR, 23-41) vs 12 (IQR, 4-22; P <.0001) in patients without cancer. More patients with cancer were discharged needing home health services, including home hospice.
“To the best of our knowledge, this is the largest cross-sectional analysis of patients with and without cancer admitted for acute PE utilizing the NIS database, which allowed the comparison of differences in outcomes between the 2 groups,” the authors note. “Early identification of oncology patients at the highest risk for [venous thromboembolism] and worst outcomes has the potential to decrease morbidity and mortality,” they added.
Shalaby K, Kahn A, Silver ES, Kim MJ, Balakumaran K, Kim AS. Outcomes of acute pulmonary embolism in hospitalized patients with cancer. BMC Pulm Med. 2022; 22(1):11. doi:10.1186/s12890-021-01808-9