Childhood cancer survivors face a 25-fold increased risk of venous thromboembolism (VTE) in the first 5 years after diagnosis compared with the general population. According to a study published in the Journal of Clinical Oncology, this increased risk continues throughout their lifespan.
This was the first study to look at the long-term risk of VTE in cancer survivors. The study included 24,355 childhood cancer survivors, and 5051 siblings who participated in the Childhood Cancer Survivor Study (CCSS), a multi-institutional cohort. Participants’ diagnoses were made between 1970 and 1999, had a median age at last follow-up of 28.7 years, and a median follow-up since diagnosis age of 21.3 years.
The incidence of late VTE among survivors and siblings was 1.1 and 0.5 events per 1000 years, respectively, with 2.5 excess events per 100 survivors over 35 years. The cumulative incidence of VTE at 35 years post diagnosis was 4.9% for survivors and 2.4% for siblings. Survivors with the highest risk of late VTE were female survivors who were obese or underweight. Osteosarcoma survivors treated with limb-sparing approaches, survivors exposed to cisplatin, and survivors who developed active cancer were also at higher risk. VTE diagnosis was also associated with an increased mortality risk.
“Providers should be aware of the incidence of VTE among cancer survivors,” wrote the authors, who encouraged the development of interventions, particularly for obese patients, and those treated with cisplatin and limb-sparing approaches.
Madenci AL, Weil BR, Liu Q, et al. Long-term risk of venous thromboembolism in survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2018;36(31):3144-3150.