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Original research
Venous thromboembolism during neoadjuvant chemotherapy for ovarian cancer
  1. Samuel Oxley1,2,
  2. Sarah Ahmed3,
  3. Kathryn Baxter4,
  4. Dominic Blake3,
  5. Victoria Braden5,
  6. Mark R Brincat2,
  7. Stacey Bryan6,
  8. James Dilley2,
  9. Stephen Dobbs5,
  10. Andrew Durden7,
  11. Nana Gomes8,
  12. Ben Johnston9,10,
  13. Sonali Kaushik11,
  14. Fani Kokka12,
  15. Michelle Lockley13,14,
  16. Jack Lowe-Zinola15,
  17. Ranjit Manchanda1,2,16,
  18. Aiste McCormick9,
  19. Charlotte Nott9,
  20. Gemma Louise Owens17,
  21. Aayushi Pandya13,
  22. Jessica Prince4,
  23. Neil Ryan18,
  24. Nicole Ryan8,
  25. Michail Sideris1,2,
  26. Sameera Tanna6,
  27. Justin Waters12,
  28. Nathan Zamesa11,
  29. Mari Thomas19 and
  30. Adeola Olaitan20
    1. 1Wolfson Institute of Population Health, Queen Mary University of London, London, UK
    2. 2Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
    3. 3Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
    4. 4Manchester University NHS Foundation Trust, Manchester, UK
    5. 5Belfast Health & Social Care Trust, Belfast, UK
    6. 6Imperial College Healthcare NHS Trust, London, UK
    7. 7North Bristol NHS Trust, Bristol, UK
    8. 8The Royal Marsden Hospital NHS Trust, London, UK
    9. 9NHS Greater Glasgow and Clyde, Glasgow, UK
    10. 10University of Glasgow, Glasgow, UK
    11. 11University Hospitals Sussex NHS Foundation Trust, Brighton, UK
    12. 12East Kent Hospitals University NHS Foundation Trust, Margate, UK
    13. 13University College London Hospitals NHS Foundation Trust, London, UK
    14. 14Centre for Cancer Genomics and Computational Biology, Bart's Cancer Institute, Queen Mary University of London, London, UK
    15. 15Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
    16. 16Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
    17. 17Cardiff and Vale University Health Board, Cardiff, UK
    18. 18NHS Lothian, Edinburgh, Edinburgh, UK
    19. 19Department of Haematology, NIHR University College London Hospitals Biomedical Research Centre, London, UK
    20. 20University College London, London, UK
    1. Correspondence to Dr Samuel Oxley, Queen Mary University of London Wolfson Institute of Population Health, London, EC1M 6BQ, UK; s.oxley{at}qmul.ac.uk

    Abstract

    Objective To determine the incidence of venous thromboembolism in patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy in UK gynecological cancer centers. Secondary outcomes included incidence and timing of venous thromboembolism since cancer presentation, impact on cancer treatment, and mortality.

    Methods All UK gynecological cancer centers were invited to participate in this multi-center retrospective audit through the British Gynecological Cancer Society. Data were captured on all patients undergoing neoadjuvant chemotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian cancer within a 12-month period during 2021–2022. Patients on anticoagulation prior to cancer presentation were excluded. Patients who were diagnosed with venous thromboembolism between cancer presentation and commencing neoadjuvant chemotherapy were also excluded from our analysis of venous thromboembolism rates from neoadjuvant chemotherapy.

    Results Fourteen UK gynecological cancer centers returned data on 660 eligible patients. The median age was 67 years (range 34–96). In total, 131/660 (19.8%) patients were diagnosed with venous thromboembolism from cancer presentation until discharge following cytoreductive surgery. Between commencing neoadjuvant chemotherapy and post-operative discharge, 65/594 (10.9%) patients developed venous thromboembolism (median 11.3%, IQR 5.9–11.3); 55/594 (9.3%) during neoadjuvant chemotherapy, 10/594 (1.7%) during post-operative admission. There was no significant difference across centers (p=0.47). Of these 65 patients, 44 (68%) were diagnosed with pulmonary embolism and 30 (46%) with deep-vein thrombosis (nine had both), including in major abdominal/pelvic vessels, with 36 (55%) presenting symptomatically and 29 (45%) diagnosed incidentally on imaging. Venous thromboembolism resulted in mortality (n=3/65, 5%), and delays/changes/cancelation of treatment (n=18/65, 28%).

    Conclusion Across a large, representative sample of UK gynecological cancer centers, one in five patients undergoing neoadjuvant chemotherapy were diagnosed with a potentially preventable venous thromboembolism, including one in nine diagnosed after commencing chemotherapy. This led to adverse clinical consequences for one third, including delay to oncological treatment and mortality. This high venous thromboembolism rate justifies the consideration of thromboprophylaxis in this patient group.

    • Ovarian Cancer
    • Venous Thromboembolism
    • Preoperative Care
    • Carboplatin
    • Paclitaxel

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005742

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • MT and AO are joint senior authors.

      • X @ProfManchanda, @mchsideris

      • Contributors Data acquisition: MRB, AP, GLO, NG, NeR, VB, AD, NiR, KB, JP, NZ, SB, ST, FK, JD, JL-Z, AM, BJ, CN, SA, DB. Analysis: SO, MS. Manuscript initial draft: SO, MS. Revisions and approval: all authors. Guarantors: AO, MT.

      • 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 MT declares research funding from Thrombosis UK and Anthos, has received speaker fees from Bayer, Sanofi and Anthos, served on advisory boards for Ablynx, Sanofi and Bayer, consultancy for Bayer and Anthos, and is the senior author for the British Society of Haematology Guideline - Cancer-associated venous thrombosis in adults (second edition). SO and RM acknowledge funding outside this work from the Rosetrees trust. RM declares research funding from Barts Charity, the Eve Appeal, NHS Innovation Accelerator, British Gynaecological Cancer Society, GSK and Yorkshire Cancer Research outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honoraria for advisory board membership from Astrazeneca, MSD, EGL, GSK. RM is the Topic Advisor for the NICE Guideline [GID-NG10225] -- Ovarian cancer: identifying and managing familial and genetic risk. NeR is supported by a NES/CSO Postdoctoral Clinical Lectureship Scheme – PCL/23/03 from the Chief Scientist Office Scotland. The other authors declare no conflicts of interest.

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