Mortality risk after cancer-related venous thromboembolism has decreased over the last three decades: the HUNT and Tromsø studies
Nikolai H. Eide,
Camilla Langholm,
Fridtjof B. Rinde,
Nick van Es,
Kristian Hveem,
Sigrid K. Brækkan,
John-Bjarne Hansen,
Vânia M. Morelli
Affiliations
Nikolai H. Eide
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø
Camilla Langholm
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø
Fridtjof B. Rinde
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø
Nick van Es
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Pulmonary Hypertension and Thrombosis, Amsterdam
Kristian Hveem
HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; HUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger
Sigrid K. Brækkan
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø
John-Bjarne Hansen
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø
Vânia M. Morelli
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø
Venous thromboembolism (VTE) is a common and serious condition among cancer patients. The diagnostic and therapeutic strategies for cancer and VTE have improved during the last three decades. It remains unclear whether mortality after cancer-related VTE (CRVTE) has decreased in this period. Therefore, we investigated the mortality risk after CRVTE over the last three decades in a population-based cohort. In total, 111,119 participants from Tromsø4-7 (1994-2016) and HUNT2-3 (1995-2008) surveys were followed through 2019, and all firstlifetime cancer and VTE events were recorded. CRVTE patients were compared with participants neither exposed to cancer nor VTE (disease-free-group), and those with cancer. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality using Cox regression with cancer and VTE as time-dependent exposures, and one-year cumulative incidence of mortality after CRVTE. Analyses were performed for three timeperiods (1994-2002, 2003-2011, 2012-2019). The age- and sex-adjusted HRs for mortality after CRVTE versus disease-free-group decreased from 25.3 (95%CI 20.5-31.3) in 1994-2002 to 22.6 (95%CI 19.2-26.6) in 2003-2011, and 16.9 (95%CI 14.3-20.0) in 2012-2019. The HRs for mortality after CRVTE versus cancer-group remained stable (about 3-fold higher) along the three time-periods. Similar estimates were obtained after further adjustments for comorbidities. The one-year cumulative incidence of mortality after CRVTE decreased from 61.8% (95%CI 52.9%-70.8%) in 1994-2002 to 55.6% (95%CI 49.0%-62.4%) in 2003-2011, and 45.5% (95%CI 39.3%-52.1%) in 2012-2019. Our results indicate a decrease in mortality risk after CRVTE over the last three decades, which might be mainly the result of considerable advances in cancer management.
