Numerous risk stratification tools exist to predict early complications in patients with acute venous thromboembolism (VTE).1–6 Evidence suggests that these tools can potentially aid both physicians in making difficult patient disposition decisions and policy-makers in establishing hospital treatment guidelines.7,8 However, few tools were specifically designed for use in patients with active cancer.
Patients with cancer who develop an acute VTE are at increased risk for adverse outcomes.9,10 Consequently, many generic (ie, non–cancer-specific) risk stratification tools include cancer as a variable,2,3 but this could unnecessarily lead to classifying low-risk patients as high-risk due to their malignancy status. Because guidelines suggest the use of risk stratification tools to aid in decision-making for home or early discharge treatment,7,8 this misclassification of patients may result in an unneeded extension in hospital length of stay (LOS) and undue economic consequences, given that mean daily hospitalization costs for VTE in the United States have been shown to be upwards of $1,600 USD.11,12
In a retrospective cohort analysis, Ahn et al13 found that the generic Pulmonary Embolism Severity Index (PESI) tool did not accurately predict 30-day mortality in 230 patients with active cancer (C-statistic, 0.565; 95% CI, 0.453–0.677). Such results bring into question the utility of risk stratification tools for patients with pulmonary embolism (PE) and cancer. Thus, we sought to evaluate the performance of 3 cancer-specific (RIETE, POMPE-C, and criteria by Font et al14) and 3 generic (Hestia, PESI, and Geneva prognostic score [GPS]) risk stratification tools for predicting 30-day post-PE mortality in patients with active cancer.
Dr. Coleman has disclosed that he has received grant funding and consultancy fees from Janssen Scientific Affairs, LLC; Bayer Pharma AG; and Boehringer-Ingelheim Pharmaceuticals, Inc. The remaining 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.
See JNCCN.org for supplemental online content.
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