Risk for VTE Persists Over the Long Term for Survivors of Childhood Cancers

WHAT WAS LEARNED

The researchers hypothesize that the elevated risk of VTE among cancer survivors may be related to late effects of cisplatin, alterations in peripheral vascular anatomy, and homeostasis. They write that these new study findings address a gap in the existing literature on thromboembolic disease. “The data are lacking, and the patient population and the medical providers need the education so as to inform them,” said Dr Weldon.

The VTE rate around the time of cancer diagnosis is known to be elevated initially and then to decrease overtime. However, Dr Weldon and colleagues found a persistently elevated risk of VTE in the decades after childhood cancer diagnosis. The team found there was a 35-year post diagnosis cumulative incidence of 4.9%.

The researchers concluded that childhood cancer survivors have an increased risk for VTE that persists across their lifespan. They found that female survivors, survivors who were obese or underweight, osteosarcoma survivors treated with limb-sparing approaches, survivors treated with cisplatin, and survivors who developed active cancer, may be specific subsets of patients who are at especially high risk.

IMPLICATIONS FOR NURSES

The study showed that VTE was associated with late mortality. The authors contend that these new data should enable healthcare providers to have a more pragmatic discussion with their patients. In some cases, it may be advisable to consider interventions that target obesity. They write that consideration of prophylaxis around transient periods of heightened susceptibility in accordance with existing guidelines should be reinforced, especially for high-risk survivors. In addition, they contend that education should be universal.

“It is not about acute VTE and its morbidities, but rather the long-term risk in cancer patients treated as children. So, oncology nurses would want to educate their pediatric patients as to the increased risk of VTE in their patients, especially those with cisplatin exposure and limb sparing operations amongst others,” Dr Weldon told Oncology Nurse Advisor.

Reference

1. 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):3144-3151.