Medical Professional Publications

How Common is Venous Thromoembolism in Adolescent Cancer Patients?

Many adult patients with cancer receive treatment to prevent venous thromboembolism, or obstructive blood clots, but is such preventative treatment important for adolescents and young adults with cancer?  A study from Nationwide Children’s provides data as a first step in understanding the risk of venous thromboembolism in younger patients.   

Venous thromboembolism (VTE) is the second leading cause of death in adult patients with cancer.  Many adult hospitals use risk-adapted VTE prophylaxis strategies regardless of age, with existing guidelines based heavily on studies of patients older than 40.  “The absolute risk of VTE in younger adult patients with cancer remains poorly defined,” said Sarah H. O’Brien, MD, MSc, pediatric hematologist and principal investigator in the Center for Innovation in Pediatric Practice at The Research Institute and study author.  “Adolescents and young adults would benefit from a standardized approach to the prevention of the adverse event.  The collection of data from children’s hospitals across the country is a critical first step to understanding the risks and benefits of VTE prophylaxis in these patients.”

To provide such data, Dr. O’Brien and colleagues from Nationwide Children’s accessed the Pediatric Hospital Information System (PHIS) and gathered information on adolescent and young adult oncology admissions (patients 15 to 24 years of age) from 35 of the largest children’s hospitals in the United States during an eight-year-period.

Their study, which is published in the Journal of Pediatrics, found that VTE is a common complication in the adolescent and young adult oncology population, occurring in 5.3 percent of patients, even in a sample heavily skewed toward the lower end of the adolescent and young adult age range. VTE occurred most frequently in patients greater than 18 years of age and in patients with leukemia.  Lymphoma and sarcoma patients also had a much higher likelihood of VTE than patients with central nervous system or other tumors.  Patients with brain tumors had the lowest risk of thrombosis. They also found that adolescent and young adult oncology admissions represent an increasing number of admissions at U.S. pediatric hospitals.

“This study is the first to provide large-scale characterization of VTE epidemiology in adolescent and young adult oncology patients hospitalized in pediatric hospitals in the United States,” said Dr. O’Brien.  “The PHIS is a powerful data source, but it is important to remember that our work may not reflect the experiences of younger adolescents and young adults cared for at adult cancer centers or community hospitals.”  Dr. O’Brien says utilizing clinical therapeutic trials for cancers that frequently afflict adolescents and young adults as a method for gathering information regarding VTE complications and VTE prophylaxis use would be a good next step in filling knowledge gaps in this field.

O'Brien SH, Klima J, Termuhlen AM, Kelleher KJ. Venous Thromboembolism and Adolescent and Young Adult Oncology Inpatients in US Children's Hospitals, 2001 to 2008. J Pediatr. 2011 Feb 23. [Epub ahead of print]

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