Thromboembolic events and mortality rates in colorectal cancer patients on chemotherapy: predictors and outcomes


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Ali Abdulnabi Mohamed1,Ameer Alarayedh2,Mohamed Almuqamam2
1University Hospitals of Leicester NHS Trust,2Mater Dei Hospital

Abstract

Background

Colorectal cancer is amongst the most common cancers worldwide with high morbidity and mortality. Systemic Anti-Cancer Therapy (SACT) is a cornerstone treatment for this disease. Chemotherapy, however, has several side effects and complications. This study aims to establish the rate of thrombotic events and investigate other early predictors of mortality in colorectal cancer patients undergoing chemotherapy.

Method

This cross-sectional retrospective study included all male patients on FOLFOX and FOLFIRI in 2014 in Malta. Data was retrospectively collected from the hospital registry, clinical manager and radiology software programmes. CT scans pre-, mid-cycle and post- chemotherapy were reviewed for evidence of progression and/or incidental pulmonary embolism. Cycle 1, 6 and 12 dates and mortality trends were documented. Parametric and nonparametric test of associations were used for statistical analysis.

Results

During 2014, a total of 104 patients were newly started on either FOLFOX or FOLFIRI, 85% and 15% respectively. The mean age of patients was 65.2 years. There were 7 thrombotic complications (7.8%) from which 3 patients (3%) had incidental pulmonary embolism on CT scans. All thromboembolic events occurred in the first 6 cycles of the chemotherapy. The mortality rate during chemotherapy was 9.6% (N=10) and all patients who passed away had metastatic disease. The repeat mid-cycle CT scans at 3 months showed disease progression in all patients who passed away (χ2 (1) = 19.490, p<0.001) compared to patients with stable disease. The CEA level was also shown to rise in patients with progressive disease.

Conclusion

The rate of thromboembolic events and mortality in patients with colorectal cancer on SACT was high at 7.8% and 9.6% respectively. The mortality rate can be deduced from early imaging scans and CEA levels confirming disease progression. These are useful indicators of avoidable harm and should be taken into account when deciding to proceed with SACT.