Pulmonary embolism in cancer patients: Clinical insights and outcomes from a community hospital.

Abstract

e23084 Background: Pulmonary embolism (PE) is a leading cause of death in cancer patients, driven by hypercoagulability, immobility, and cancer therapies. Cancer increases the risk of venous thromboembolism (VTE) by up to 7-fold, with certain malignancies, such as gastrointestinal, pancreatic, and lung cancers, carrying the highest risk. PE in cancer patients often presents atypically, with a high rate of incidental diagnoses and significant mortality and bleeding risks. This study evaluates the clinical presentation, characteristics and outcomes of PE in cancer versus non-cancer patients in a community hospital setting. Methods: A single centre retrospective cohort study was conducted on patients diagnosed with PE from 2018 to 2023 at a community hospital in Northern Illinois. Patient demographics, clinical presentation, PE characteristics, and outcomes were compared between cancer and non-cancer groups. Cancer-specific mortality at 30 days and 1 year was analyzed. Statistical analyses included chi-square and t-tests. Results: Among 301 patients, 69 (22.9%) had active cancer, with lung (24%), gastrointestinal (18%), and breast (14%) cancers being the most common. Cancer patients were older (68 vs. 60 years), predominantly female (57% vs. 48%), and more likely to smoke (50.7% vs. 39.2%). Shortness of breath was the main presenting symptom in both groups, but cancer patients were more likely to have incidental PE (14.4% vs. 8.1%, p = 0.18) and syncope (11.5% vs. 6%, p = 0.1), and less likely to report chest pain (5.7% vs. 14.6%, p = 0.08), though none of these differences were statistically significant. Right heart strain (20.2% vs. 32%, p = 0.08) and saddle PE (1% vs. 5%, p = 0.3) were less common in cancer patients. Bleeding complications were significantly higher in cancer patients (15.9% vs. 6.8%, p = 0.02) along with in-hospital mortality (17.3% vs. 7.3%, p = 0.02), though many deaths were associated with advanced cancer or sepsis rather than PE itself. ICU admissions (33% vs. 34.4%) and recurrent VTE (4% vs. 3.8%) were similar. Hospice involvement occurred in 10% of cancer patients, mostly after intubation and prolonged hospital stays. Thirty-day mortality in cancer patients was 14.5%, primarily driven by sepsis secondary to pneumonia and urine infections. No deaths were linked to recurrent PE or bleeding. One-year mortality was 4.3% and included bleeding, recurrent PE, and cancer-related death. Conclusions: Cancer-associated PE increases in-hospital mortality, yet early recognition and treatment can result in stable long-term outcomes, especially in early stages of cancer. Select patients in ICU might benefit from early palliative intervention. Bleeding risk should be proactively managed throughout the hospital stay and during recovery. Close follow up with oncology or primary care post-discharge is essential to monitor and prevent post-hospitalization complications.