Prevalence of pulmonary embolism in 127 945 autopsies performed in cancer patients in the United States between 2003 and 2019

2021 ◽  
Vol 19 (6) ◽  
pp. 1591-1593
Author(s):  
Luca Valerio ◽  
Giacomo Turatti ◽  
Frederikus A. Klok ◽  
Stavros V. Konstantinides ◽  
Nils Kucher ◽  
...  
Keyword(s):  
United States ◽  
Pulmonary Embolism ◽  
Cancer Patients ◽  
The United States

Improving VTE prophylaxis in hospitalized oncologic patients: Institutional impact VTE mentored QI project.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 148-148
Author(s):  
Josiah Halm
Keyword(s):  
United States ◽  
Risk Assessment ◽  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Care Delivery ◽  
The United States ◽  
Vte Prophylaxis ◽  
Oncologic Patients ◽  
Order Sets ◽  
Order Set

148 Background: Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism affects hundreds of thousand Americans each year. Pulmonary embolism(PE), is the 3rd leading cause of hospital related death and the most common preventable cause of death in the United States. Cancer is associated with 6-fold increase in the risk of VTE. For those undergoing surgery, the risks of post-operative DVT and fatal PE are 2-3 times greater, respectively, for cancer patients than non-cancer patients. VTE prophylaxis is widely available and effective, but frequently underused. VTE prevention is of particular concern to oncologists. Evidence based oncology-specific guidelines are available from several organizations including American Society of Clinical Oncology (ASCO) to highlight the importance of prophylaxis in oncology patients. An Interdisciplinary team of pharmacists and hospitalists received an educational grant to implement a VTE mentored project in a large Comprehensive Academic Cancer Center in the Southern United States. There was anecdotal evidence and data to suggest adherence to thrombo-prophylaxis was suboptimal, with multiple departments and physicians having their "own" order sets of varying complexities. Performance data on VTE was not routinely being collected and data on hospital-acquired VTE events was not consistently collected and reported. To meet increasing financial, regulatory and the clinical challenge of harmonizing VTE prophylaxis in the institution, a multi-disciplinary team was formed to implement this VTE initiative. Methods: The QI methodology used was the Plan, Do, Study and Act (PDSA). Step 1. Draft a single VTE protocol using best evidence with input from all stakeholders that will be acceptable to most users. Step 2. Analyze the care delivery throughout the hospital Step 3. Set up performance tracking with IT support Step 4. Staggered introduction/education of the VTE protocol across departments/physicians Step 5. Implement and track through cycles of PDSA. Results: The institution went from having about 10 different VTE order sets to a single VTE order set that was a single page and was utilized by medical, surgical and emergency room and ICU physicians. This was embed in all admission, transfer and post op orders. Use of VTE prophylaxis order set went from an aggregate of 40.7 to 76.1%, 3 months after implementation of initiative. 26% percent of patient with no prophylaxis ordered had no contraindications checked. 60.9% and 16% of admitted patients were risk stratified as moderate or high risk respectively. Conclusions: 4 key findings from the implementation project led to improved rates of thrombo-prophylaxis. Prescribers are in the best position to understand all components of the VTE risk as well as contraindications and should be responsible for VTE risk assessment, as hitherto nurses were doing risk assessment and physicians were prescribing prophylaxis. New VTE order set provided a linked menu of appropriate prophylaxis options for each level of risk which the older sets did not do. Embedding VTE order set in admission/transfer and post op orders sets led to increase use. Efforts to raise VTE awareness should be ongoing, routinely monitored and included with other safety indicators such as falls etc and reported back to providers and appropriate medical staff and executive committees.

scholarly journals Lymphoma-Associated Pulmonary Embolism Burden in Hospital Admissions in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3400-3400
Author(s):  
Khalid Shalaby ◽  
Adriana Kahn ◽  
Elizabeth Silver ◽  
Kathir Balakumaran ◽  
Agnes S. Kim
Keyword(s):  
United States ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
The United States ◽  
Inpatient Mortality ◽  
Median Length ◽  
Acute Pe ◽  
Total Charges

Background: Cancer-associated pulmonary embolism (PE) is a common condition that increases morbidity and mortality among cancer patients. Lymphoma has one of the highest rates of venous thromboembolism in cancer patients. The National Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP) includes the largest all-payer inpatient hospital care data in the United States and therefore may represent a significant sample of clinically relevant pulmonary embolism in lymphoma patients. Methods: We utilized the NIS-HCUP database to extract the following data on hospitalizations from 2002 to 2014. We included in our analysis ICD-9 codes for acute PE as a primary or secondary diagnosis of admission and excluded iatrogenic, septic, chronic PE and PE related to obstetrical conditions. We divided our primary population of yielded weighted frequencies i.e. acute PE admissions into two groups: a group with lymphoma as a comorbid condition using Elixhauser comorbidity measures and a group without lymphoma. We identified baseline characteristics of each group including median age on admission, gender and race breakdown as well as common comorbidities' prevalence using Elixhauser comorbidity measures. We ran the analysis for the median length of stay, total charges, mortality scores, readmit scores and inpatient mortality using SAS software, version 9.4 (SAS Institute, Cary, North Carolina). Continuous variables were tested using Wilcoxon two-sample test. Results: We identified a total of 3,293,040 admissions of acute PE in the database from 2002 to 2014, with 98.5% (3,242,571) of the admissions in patients without lymphoma vs. 1.5% (50,469) in patients with lymphoma as a comorbidity. The breakdown of race was comparable across the two groups with the Caucasian race being predominant in lymphoma and non-lymphoma groups at 77.3% vs. 74.2% respectively [Table 1]. Male gender constituted the majority in the lymphoma group at 53.6% in contrast to the non-lymphoma group where female gender was the majority at 53.6%. [Table 2]. While median age on admission was higher in the lymphoma group compared with the non-lymphoma group (68.7 vs. 65 years respectively) , the prevalence of common comorbidities such as hypertension, paralysis, renal failure, heart failure, diabetes mellitus with and without complications were comparable across the two groups except for obesity prevalence which was higher in the non-lymphoma group. [Table 2] Median length of stay was marginally but significantly higher in the lymphoma group at 5.4 days (95% CI 5.33-5.53) vs. 4.96 (95% CI 4.95-4.97) days in the non-lymphoma group (p<0.001); as were the readmission scores with a median readmission score of 30 (95% CI 29.65-30.24) vs. 14 (95% CI 13.99-14.08) for lymphoma and non-lymphoma groups, respectively (p<0.001). We observed that total charges of hospitalization were significantly higher in the lymphoma group with a median of 31,899 US dollars (USD) per hospitalization (95% CI 31,174 - 32,622) compared with 27,784 USD (95% CI 27,704 - 27,864) in the non-lymphoma group. Ultimately, all-cause inpatient mortality was higher in the lymphoma group at 10.4% vs. 7.3% in the non-lymphoma group (Odds ratio 1.46, 95% CI 1.43-1.51, P-value <0.0001). Median mortality score was also significantly higher in the lymphoma group at 13.15 (95% CI 12.6-13.6) vs. 5.53 (95% CI 5.50-5.55) in the non-lymphoma group (p<0.001). Conclusion: Lymphoma was a comorbid diagnosis in 1.5% of patients admitted to the hospital with acute PE between 2002 and 2014 in the NIS-HCUP database. While the median age in the lymphoma group was higher, the prevalence of clinically significant comorbidities was comparable or higher in the non-lymphoma group. Lymphoma was associated with increased all-cause inpatient mortality in patients admitted with acute PE despite the study's limitation of not excluding other cancer patients from the control non-lymphoma group. Patients in the lymphoma group also had a higher risk of readmission in addition to having higher total charges per hospitalization and increased the length of stay. Efforts should continue to better prevent and treat pulmonary embolism in the lymphoma population. Disclosures No relevant conflicts of interest to declare.

Quality Control of Data in a Large-Scale Cancer Register Program

1966 ◽  
Vol 05 (02) ◽  
pp. 67-74 ◽  
Author(s):  
W. I. Lourie ◽  
W. Haenszeland
Keyword(s):  
United States ◽  
Quality Control ◽  
Cancer Patients ◽  
Large Scale ◽  
The United States ◽  
Newly Diagnosed ◽  
Related Data ◽  
Cancer Register ◽  
Independent Review ◽  
End Results

Quality control of data collected in the United States by the Cancer End Results Program utilizing punchcards prepared by participating registries in accordance with a Uniform Punchcard Code is discussed. Existing arrangements decentralize responsibility for editing and related data processing to the local registries with centralization of tabulating and statistical services in the End Results Section, National Cancer Institute. The most recent deck of punchcards represented over 600,000 cancer patients; approximately 50,000 newly diagnosed cases are added annually.Mechanical editing and inspection of punchcards and field audits are the principal tools for quality control. Mechanical editing of the punchcards includes testing for blank entries and detection of in-admissable or inconsistent codes. Highly improbable codes are subjected to special scrutiny. Field audits include the drawing of a 1-10 percent random sample of punchcards submitted by a registry; the charts are .then reabstracted and recoded by a NCI staff member and differences between the punchcard and the results of independent review are noted.

Trends in Frequency of E-cigarette Use Among Cancer Patients and Survivors in the United States, 2014-2018

2021 ◽  
pp. 106913
Author(s):  
Elena O. Dewar ◽  
Edward Christopher Dee ◽  
Melaku A. Arega ◽  
Chul Ahn ◽  
Nina N. Sanford
Keyword(s):  
United States ◽  
Cancer Patients ◽  
The United States ◽  
Cigarette Use

scholarly journals Real-world safety of palbociclib in breast cancer patients in the United States: a new user cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel C. Beachler ◽  
Cynthia de Luise ◽  
Aziza Jamal-Allial ◽  
Ruihua Yin ◽  
Devon H. Taylor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Pulmonary Embolism ◽  
Cohort Study ◽  
Real World ◽  
The United States ◽  
Elevated Risk ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Serious Infections

Abstract Background There is limited real-world safety information on palbociclib for treatment of advanced stage HR+/HER2- breast cancer. Methods We conducted a cohort study of breast cancer patients initiating palbociclib and fulvestrant from February 2015 to September 2017 using the HealthCore Integrated Research Database (HIRD), a longitudinal claims database of commercial health plan members in the United States. The historical comparator cohort comprised patients initiating fulvestrant monotherapy from January 2011 to January 2015. Propensity score matching and Cox regression were used to estimate hazard ratios for various safety events. For acute liver injury (ALI), additional analyses and medical record validation were conducted. Results There were 2445 patients who initiated palbociclib including 566 new users of palbociclib-fulvestrant, and 2316 historical new users of fulvestrant monotherapy. Compared to these historical new users of fulvestrant monotherapy, new users of palbociclib-fulvestrant had a greater than 2-fold elevated risk for neutropenia, leukopenia, thrombocytopenia, stomatitis and mucositis, and ALI. Incidence of anemia and QT prolongation were more weakly associated, and incidences of serious infections and pulmonary embolism were similar between groups after propensity score matching. After adjustment for additional ALI risk factors, the elevated risk of ALI in new users of palbociclib-fulvestrant persisted (e.g. primary ALI algorithm hazard ratio (HR) = 3.0, 95% confidence interval (CI) = 1.1–8.4). Conclusions This real-world study found increased risks of several adverse events identified in clinical trials, including neutropenia, leukopenia, and thrombocytopenia, but no increased risk of serious infections or pulmonary embolism when comparing new users of palbociclib-fulvestrant to fulvestrant monotherapy. We observed an increased risk of ALI, extending clinical trial findings of significant imbalances in grade 3/4 elevations of alanine aminotransferase (ALT).

Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 983-990 ◽  
Author(s):  
Brian Park ◽  
Louis Messina ◽  
Phong Dargon ◽  
Wei Huang ◽  
Rocco Ciocca ◽  
...  
Keyword(s):  
United States ◽  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Resource Utilization ◽  
The United States ◽  
Recent Trends
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