Pulmonary embolism (PE) is a common cause of death in patients with cancer.1 In recent years, the extensive use of scheduled CT for tumor assessment has led to increasing diagnoses of incidental PE in this population. Thus, the current clinical spectrum of PE may vary from sudden life-threatening events to unsuspected radiologic findings on scheduled CT scans.2,3 In several series of patients with acute symptomatic PE, cancer has been identified as a predictor for adverse outcomes.4,5 Several factors, such as the greater risk of recurrence and bleeding, may influence this poor prognosis compared with similar patients without cancer.6 Similar to the introduction of outpatient therapy for deep venous thrombosis (DVT), the latest evidence-based guidelines from the American College of Chest Physicians7 suggest that early discharge may be appropriate for selected patients with low-risk PE (evidence-based grade 2B). However, this recommendation is based on observational and retrospective studies8-10 and some randomized trials including only symptomatic events11,12 in which patients with cancer were underrepresented.
Several prognostic scales, such as the Pulmonary Embolism Severity Index (PESI),13 the Geneva Prognostic Score (GPS),14 a simplified PESI version,15 and others,16 have been validated to predict short-term PE-related mortality. However, these scales classify almost all patients with cancer as high-risk, limiting their discriminatory power in these patients. This fact has led to the search for specific prognostic scales, such as the POMPE-C17 and the model derived from the Registro Informatizado de la Enfermedad Tromboembólica Venosa (RIETE registry).18 However, these scales have not been validated for incidental PE, and their clinical utility in selecting patients suitable for home treatment has not been prospectively evaluated.
Therefore, it remains of great interest to identify patients with cancer and low-risk PE who could be candidates to receive ambulatory treatment, and to integrate this practice within the continuum of care in the cancer population. The goal of the present study was to describe the feasibility of ambulatory treatment of symptomatic or incidental PE in a prospective cohort of consecutive patients with cancer selected for outpatient management based on a pragmatic set of exclusion criteria. The authors also retrospectively compared the prognostic performance of the PESI, GPS, POMPE-C, and RIETE scales to predict mortality and identify patients who could be safely treated at home.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. These findings were partially reported at the 6th International Conference on Thrombosis and Hemostasis: Issues in Cancer (ICTHIC) in Bergamo, Italy in April 2012 and at the 2012 International Symposium of the Multinational Association of Supportive Care in Cancer (MASCC/ISOO) in New York City in June 2012 (abstract 55).
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