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Original research
Higher incidence of venous thromboembolism associated with increasing lines of treatment in heavily treated ovarian cancer patients
  1. Erika J Lampert1,
  2. Jennifer L Hansen1,
  3. Surabhi Tewari2,
  4. Meng Yao3,
  5. Laura M Chambers4,
  6. Roberto Vargas5 and
  7. Mariam M AlHilli5
    1. 1Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, Ohio, USA
    2. 2Department of Obstetrics and Gynecology, Brigham and Women’s/Mass General Hospital, Boston, Massachusetts, USA
    3. 3Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
    4. 4Department of Gynecologic Oncology, Ohio State University, Columbus, Ohio, USA
    5. 5Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
    1. Correspondence to Dr Erika J Lampert, Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; ejlampert{at}gmail.com

    Abstract

    Objective Ovarian cancer is associated with a high rate of venous thromboembolism. Our objective is to report the incidence of venous thromboembolism in recurrent ovarian cancer, assess the impact on morbidity and mortality, and evaluate predictors of venous thromboembolism.

    Methods A retrospective single institution cohort study was performed. Patients with a diagnosis of recurrent ovarian cancer between 2007 and 2020 and no previous history of venous thromboembolism were identified. Demographic and clinical variables were collected. Univariate and multivariable analyses were performed to identify predictors of venous thromboembolism.

    Results Of the 345 patients included in this study, 77 (22.3%) developed a venous thromboembolism. Most (n=56, 72.7%) were actively receiving treatment at the time of diagnosis of venous thromboembolism, of whom 44 (78.6%) had received three or more lines of treatment. In total, 42 (54.5%) were admitted to hospital on diagnosis and one mortality (1.3%) occurred secondary to venous thromboembolism. An intermediate/high risk Khorana score was not predictive of venous thromboembolism (p=0.24). The risk of venous thromboembolism was significantly higher with increasing lines of chemotherapy (odds ratio 1.14, 95% confidence interval 1.02 to 1.28 per line, p=0.026). There was no significant difference in overall survival (62.9 vs 49.1 median months, p=0.29) between patients with and without venous thromboembolism.

    Conclusions More than 20% of patients with recurrent ovarian cancer developed a venous thromboembolism, and most occurred after three or more lines of treatment. The risk of venous thromboembolism was higher with increasing lines of chemotherapy. While venous thromboembolism did not appear to impact survival in this population, nearly half required hospitalization, emphasizing the morbidity of venous thromboembolism and potential impact on healthcare costs. Further studies are needed to improve risk stratification for venous thromboembolism in this high risk population.

    • Venous Thromboembolism
    • Ovarian Cancer
    • Retrospective Study

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005735

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @ErikaJLampert, @laurajmoulton

      • Presented at The findings of this study were partially presented as an oral presentation at the Society of Gynecologic Oncology Annual Meeting, March 2023.

      • Contributors EJL helped with designing the study, data collection, data analysis, interpretation of data, drafting of the manuscript, and critical revision of the manuscript. JLH helped with drafting the manuscript and critical revision of the manuscript. ST helped with data collection and critical revision of the manuscript. MY helped with designing the study, data analysis, and critical revision of the manuscript. LMC helped with designing the study, data collection, interpretation of data, and critical revision of the manuscript. RJV helped with designing the study, interpretation of data, and critical revision of the manuscript. MAH is the guarantor of this project and helped with designing the study, data analysis, interpretation of data, drafting of the manuscript, and critical revision of the manuscript.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.