Time-dependent risk and predictors of venous thromboembolism in breast cancer patients: A population-based cohort study

Judith S Brand, Elham Hedayati, Nirmala Bhoo-Pathy, Jonas Bergh, Per Hall, Keith Humphreys, Jonas F Ludvigsson, Kamila Czene

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

BACKGROUND: Venous thromboembolism (VTE) is a serious complication of cancer and its treatment. The current study assessed the risk and clinical predictors of VTE in breast cancer patients by time since diagnosis.

METHODS: This Swedish population-based study included 8338 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region with complete follow-up until 2012. Their incidence of VTE was compared with the incidence among 39,013 age-matched reference individuals from the general population. Cox and flexible parametric models were used to examine associations with patient, tumor, and treatment characteristics, accounting for time-dependent effects.

RESULTS: Over a median follow-up of 7.2 years, 426 breast cancer patients experienced a VTE event (cumulative incidence, 5.1%). The VTE incidence was 3-fold increased (hazard ratio [HR], 3.28; 95% confidence interval [CI], 2.87-3.74) in comparison with the incidence in the general population and was highest 6 months after diagnosis (HR, 8.62; 95% CI, 6.56-11.33) with a sustained increase in risk thereafter (HR at 5 years, 2.19; 95% CI, 1.80-2.67). Independent predictors of VTE included the following: older age, being overweight, preexisting VTE, comorbid disease, tumor size > 40 mm, progesterone receptor (PR)-negative status, more than 4 affected lymph nodes, and receipt of chemo- and endocrine therapy. The impact of chemotherapy was limited to early-onset VTE, whereas comorbid disease and PR-negative status were more strongly associated with late-onset events.

CONCLUSIONS: This study confirms the long-term risk of VTE in breast cancer patients and identifies a comprehensive set of clinical risk predictors. Temporal associations with patient, tumor, and treatment characteristics provide insight into the time-dependent etiology of VTE. Cancer 2017;123:468-475. © 2016 American Cancer Society.

Original languageEnglish
Pages (from-to)468-475
Number of pages8
JournalCancer
Volume123
Issue number3
DOIs
Publication statusPublished - 1 Feb 2017

Keywords

  • Adult
  • Age Factors
  • Aged
  • Breast Neoplasms
  • Cohort Studies
  • Female
  • Humans
  • Middle Aged
  • Proportional Hazards Models
  • Risk Factors
  • Sweden
  • Time Factors
  • Venous Thromboembolism
  • Journal Article

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    Brand, J. S., Hedayati, E., Bhoo-Pathy, N., Bergh, J., Hall, P., Humphreys, K., Ludvigsson, J. F., & Czene, K. (2017). Time-dependent risk and predictors of venous thromboembolism in breast cancer patients: A population-based cohort study. Cancer, 123(3), 468-475. https://doi.org/10.1002/cncr.30364