By Lynda Williams, medwireNews Reporter
medwireNews: US study findings indicate that the incidence of pulmonary embolism (PE)-related death in people with cancer rose significantly between 2011 and 2020 despite an overall reduction in age-adjusted cancer diagnoses and cancer-related deaths over the period.
“These findings highlight a concerning increase in PE-related mortality in patients with cancer, indicating a need for further research and preventive interventions to improve outcomes”, say Gregory Piazza (Brigham and Women’s Hospital, Boston, Massachusetts) and co-authors in JAMA Network Open.
The team collated information for 27,280,194 individuals aged 15 years or older (50.9% male) who died in the USA over the study period and were included in the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research system.
The death rate in the general population increased by 35.1% between 2011 and 2020, while the death rate among people with cancer increased by 8.6% over the same period, the researchers report.
Moreover, the rate of cancer-related deaths fell significantly, from 168.8 to 143.8 per 100,000 people, as did the age-adjusted incidence of new cancer cases, from 470.9 to 403.3 per 100,000 people.
However, the rate of PE-related death among people with cancer increased by 44.3%, from 1360 per 100,000 people in 2011 to 1963 per 100,000 people in 2020, with a significant average 2.9% increase per year. And the age-adjusted mortality rate (AAMR) for acute PE among people with cancer increased on average by a significant 2.5% per year.
The researchers report that men had more PE-related mortality than women, but the average annual increase in AAMR over the study was similar, at a significant 2.3% versus 2.7%, respectively. However, further analysis revealed that the AAMRs in men and women plateaued between 2011 and 2015 before increasing significantly and linearly between 2015 and 2020, during which time there were average annual percent changes of 4.4% and 5.2%, respectively.
Patients aged 15–64 years and those aged at least 65 years experienced a significant increase in AAMR over the whole study period, but the average annual increase was significantly greater in the younger group (3.2 vs 2.7%).
The increase in AAMR for cancer-related PE over the whole study period, and the pattern of a plateau followed by a linear increase in AMMR, was also found among non-Hispanic/non-Latinx White individuals and non-Hispanic/non-Latinx Black or African–American people, with significant average annual increases of 2.7% and 2.2%, respectively.
By contrast, Hispanic/Latinx people had a nonsignificant 2.6% average annual increase in their AAMR for cancer-related PE over the study period, including a trend towards the plateau–increase pattern, whereas there was a plateau in AAMR for cancer-related PE over the whole period among non-Hispanic/non-Latinx Asian and Pacific Islander people.
When assessing the increase in AAMR for PE-related deaths by cancer type between 2011 and 2020, the team detected a significant average annual increase in people with malignancies of the lip, oral cavity or pharynx (9.6%) and melanoma (7.7%), as well as among those with multiple tumours or unknown primary cancers (7.2%).
Discussing their findings, Piazza et al say that the “underlying reasons are probably multifactorial”, including updates to diagnostic guidelines for the recognition and diagnosis of PE in 2016 and 2017, increasing use of imaging during cancer care, a trend towards improved long-term survival of cancer patients, and the increasing prevalence of cardiovascular risk factors among young US adults.
“Recognition and confirmation of such patterns may inform further research into thromboprophylaxis and treatment of PE as a complication of cancer and cancer-directed therapy”, they conclude.
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JAMA Netw Open 2025; 8: e2460315