Clinical and management differences in patients with active cancer and pulmonary embolism

BACKGROUND Cancer is one of the major acquired risk factors for pulmonary embolism (PE). Diagnosis of this disease in cancer patients can be difficult due to its paucisymptomatic clinical presentation, and the management can be suboptimal because of the active cancer diagnosis and state of frailty some patients present with. Purpose Identify differences in clinical features or treatment management in patients presenting with PE, with and without the diagnosis of active cancer. Methods Enrolled patients admitted in the cardiology department with the diagnosis of PE during 2013 and 2017. Divided the patients in two groups: patients with active cancer (known or diagnosed within a year of thromboembolic event) and patients without active cancer. Groups were compared at according to sex, symptoms at presentation, physical examination findings, analytical results, typical PE electrocardiographic and echocardiographic abnormalities and lastly, the use of thrombolysis. For statistical analysis, the two groups were compared using Pearson’s Chi-Square test and Mann Whitney’s test, considering p values <0.05 to be statistically significant. Results The study cohort was composed 178 patients, 61.2% of the patients were female. Mean age of 63.3 years. The active cancer group had 40 patients (22.5%), consisting in various types of cancer: lung, gastrointestinal, breast, hematological, among others. Male sex was more prevalent in active cancer group (52.5% vs 34.8%, p=0.04). In terms of symptoms, patients with active cancer presented more frequently with heart failure (30.0% vs 12.4%, p=0.01). There was no difference between groups in other clinical manifestations or physical findings of PE, namely other typical symptoms or high risk features of PE. Regarding complementary diagnostic tests, there was no difference between groups in blood analysis results, electrocardiographic features and echocardiographic findings suggestive of right heart pressure overload and/or dysfunction. Concerning treatment plan, patients from group without active cancer were submitted more often to fibrinolysis (57.0% vs 37.5%, p=0.03). In a subgroup analysis of patients presenting with intermediate-high or high risk PE that were submitted to thrombolysis, patients in the active cancer group received the treatment with a higher delay than non-cancer patients (mean time of 46 hours vs 20 hours, p<0.01). DISCUSSION In the present study, cancer patients presenting with PE were more often male, presented more frequently with heart failure and were more likely to receive conservative treatment, with higher delays in administration of fibrinolytic therapy.