Incidence and factors associated with venous thromboembolism in women with gynecologic cancer.

INTRODUCTION: Venous thromboembolism (VTE) is a frequent clinical event in patients with gynecologic cancer. However, studies that exclusively address the incidence of VTE according the type of gynecologic cancer are poorly reported. OBJECTIVE: To analyze the incidence of VTE and the associated factors in women with different types of gynecologic cancer. RESULTS: A total of 1.885 women with gynecologic cancer was included. Among them, 40.8% (769) experienced venous thromboembolic events, most of them in the first two years after cancer diagnosis. There was no statistically significant difference in the incidence of VTE according to the type of gynecologic cancer. However, we observed statistically significant difference in the incidence of pulmonary embolism when stratified by type of thromboembolic events. Multiple regression analysis identified the absence of cancer treatment as a factor associated with VTE in patients with gynecologic cancer (OR = 3.14, CI 95% 2.50-3.96), particularly in patients with cervical (OR = 2.48, CI 95% 1.81-3.42), endometrial (OR = 4.18, CI 95% 2.46-7.10), and ovarian (OR = 3.55, CI 95% 2.22-5.68) cancer. For the total study population, especially patients with cervical and endometrial cancer an advanced stage of cancer was found to be associated with the incidence of VTE. CONCLUSION: We observed that 40.8% experienced venous thromboembolic events. These events were associated with the treatment modality and the stage of cancer.

Advanced Clinical Stage at Diagnosis of Breast Cancer Is Associated with Poorer Health-Related Quality of Life: A Cross-Sectional Study.

OBJECTIVE: To describe the clinical stage in women diagnosed with breast cancer and the association between clinical stage and Health-related quality of life (HRQoL). MATERIALS AND METHODS: This was a cross-sectional study involving women diagnosed with breast cancer. HRQoL was assessed with European Organization for Research and Treatment of Cancer 30-Item Quality of Life Questionnaire and the Quality of Life Questionnaire Breast Cancer 23. The principal exposure was clinical stage (

Tromboembolismo venoso: incidência e sobrevida em mulheres com câncer ginecológico / Venous thromboembolism: incidence and survival in women with gynecological cancer

Introdução: O tromboembolismo venoso (TEV) é um evento clínico frequente em pacientes com câncer. A associação entre o câncer ginecológico e a presença de TEV tem sido observada. Entretanto, ainda são escassos estudos que abordem, exclusivamente, incidência e sobrevida das pacientes com neoplasias ginecológicas. Este estudo tem como objetivo analisar a incidência de TEV, os fatores associados e o impacto no prognóstico de mulheres diagnosticadas com neoplasia ginecológica no Hospital do Câncer II/INCA. Metodologia: Trata-se de um estudo de coorte com coleta de dados retrospectiva. Foram incluídas pacientes que tenham realizado exame para a detecção de TEV no período de janeiro de 2008 a julho 2015 e que tinham diagnóstico de neoplasia de colo de útero, endométrio, ovário, vagina e vulva. O desenvolvimento de TEV e a ocorrência de óbito foram considerados os desfechos neste estudo e as características demográficas e clínicas foram consideradas variáveis independentes. Foi realizada análise descritiva das pacientes por meio da média (desvio padrão) para as variáveis contínuas e distribuição de frequência para as categóricas. A análise descritiva foi realizada para a população total e estratificada por topografia e, posteriormente, baseada na presença de TEV. Para avaliação dos fatores associados ao TEV, foi utilizada a regressão logística univariada e múltipla. A análise da sobrevida global foi realizada pelo método de Kaplan-Meier e, para identificar associação entre a presença de TEV e sobrevida global, foi realizado o modelo de regressão múltipla de Cox. Para ambas as avaliações, as variáveis independentes com p<0,20 foram inseridas no modelo de regressão múltipla e ficaram retidas aquelas com p<0,05. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do INCA. Resultados: Foram incluídas 1885 mulheres que realizaram investigação de TEV no período do estudo. Dessas, 769 (40,8%) apresentaram TEV, das quais, 36,0% desenvolveram o evento até seis meses após o diagnóstico de câncer. O tempo mediano de sobrevida foi menor e o risco de morte aumentado nas pacientes que desenvolveram TEV em todas as topografias estudadas. Conclusão: Foi observada alta incidência de TEV entre as mulheres, independentemente da topografia ginecológica, assim como foi observado um impacto negativo no prognóstico das pacientes que desenvolveram evento tromboembólico

Introduction: Venous thromboembolism (VTE) is a frequent clinical event in cancer patients, which has been observed to have association with gynecological cancer. Nevertheless, there are still few studies that exclusively address the incidence and survival in patients with gynecological malignancies. This study aims to analyze the incidence of VTE, the associated factors and the impact on prognosis of women diagnosed with gynecological cancer at Cancer Hospital II/INCA. Methodology: This is a cohort study with retrospective data collection in which were included patients who underwent VTE examination from January 2008 to July 2015 and who had a diagnosis of cervical, endometrial, ovary, vaginal and vulvar cancer. The development of VTE and the occurrence of death were considered the outcomes in this study and demographic and clinical characteristics were considered independent variables. Descriptive analysis of patients was performed through the mean (standard deviation) for continuous variables while the frequency distribution was used for categorical ones. The descriptive analysis was performed for the total population and stratified by topography and, later, based on the presence of VTE. The univariate and multiple logistic regressions were used to evaluate associated factors with VTE. The overall survival analysis was performed by KaplanMeier method and Cox multiple regression model was performed to identify an association between the presence of VTE and global survival. For both evaluations, the independent variables with p <0, 20 were inserted into the multiple regression model and those with p <0.05 were retained in the model. This study was approved by the INCA Research Ethics Committee. Results: We included 1885 women who underwent VTE investigation during the study period. Of these total of women, 769 (40.8%) presented VTE, of which, 36.0% developed the event up to six months after cancer diagnosis. The median survival time was lower and the risk of death increased among the patients who developed VTE in all the topographies studied. Conclusion: There was a high incidence of VTE among women, regardless of the gynecological site, as well as a negative impact on prognosis of patients who developed thromboembolic event.

Mecanismos do tromboembolismo venoso no câncer: uma revisão da literatura / Mechanisms of venous thromboembolism in cancer: aliterature review

Existe uma estreita relação entre o tromboembolismo venoso e o câncer. Pacientes com neoplasias apresentam maior incidência de eventos tromboembólicos em sua evolução clínica. A ocorrência desses eventos é considerada um marcador preditivo negativo nesse grupo de pacientes. Revisamos, então, a ativação dos mecanismos de coagulação neste grupo de pacientes. Trata-se de um processo complexo e multifatorial, relacionado tanto a características tumorais, estadiamento clínico, agressividade da doença e sítios tumorais, dentre outros. Novos biomarcadores vêm sendo pesquisados ao longo dos anos na tentativa de correlacioná-los ao risco trombótico, visando uma intervenção que melhore a evolução clínica desses pacientes oncológicos

There is a strong relationship between venous thromboembolism and cancer. Patients with tumors have a higher incidence of thromboembolic events in their clinical evolution. The occurrence of such events is considered a negative predictive marker in this group of patients. Thus, we aim to review activation of coagulation mechanisms in this group of patients. Activation of coagulation mechanisms in cancer patients is a complex and multifactorial process, related to tumor characteristics, clinical staging, the disease's aggressiveness, tumor sites, and additional factors caused by disease progression. New biomarkers have been under investigation over the years in the attempt to correlate them to the risk of thrombosis, aiming to develop interventions that improve the clinical evolution of these cancer patients

Rivaroxaban Used in the Treatment Patients With Gynecologic Cancer and Venous Thromboembolism: The Experience of Instituto Nacional de Câncer-Rio de Janeiro, Brazil.

INTRODUCTION: Venous thromboembolism (VTE) is a major complication of malignant diseases and is a frequent cause of death in patients with cancer. Managing anticoagulation in these patients is challenging because of the high risk of recurrent VTE and bleeding events. Rivaroxaban is an oral anticoagulant that provides rapid onset of anticoagulation. OBJECTIVE: The aim of this study was to describe the complications of rivaroxaban and potentially associated factors in patients with gynecologic cancer and VTE. METHODS: This was an observational study in women with gynecological cancer who developed VTE and were treated with 15 and 20 mg rivaroxaban at Instituto Nacional de Câncer from July 2014 to July 2015. RESULTS: Forty-one patients were treated with rivaroxaban. Most patients were younger than 60 years and presented cervical cancer; 58.5% of women did not have complications, thus remaining at a dose of 20 mg/d. Because of complications, 12.2% had the dose reduced to 15 mg/d, 12.2% had the drug suspended, 7.3% had progressive worsening of the disease with suspension of anticoagulation, and 9.8% progressed to death because of progression of the disease. CONCLUSIONS: Rivaroxaban has been documented as a low-cost, easily controlled option compared with standard therapy. Most participants in this study had no complications. However, it was not possible to assess associations with statistical significance. Further analytical studies with larger samples are required to evaluate the safety and efficacy of this treatment in patients with gynecologic cancer.