Patients with cancer are at substantially increased risk for deep vein thrombosis (DVT) and resulting pulmonary embolism. Together, these two forms of venous thromboembolism constitute the second leading cause of death for patients with known malignancies. The standard of care for DVT is anticoagulation, yet many patients with cancer and DVT are unable to receive anticoagulation because of the bleeding risk that it poses. In a study recently published in JAMA Internal Medicine, a team of investigators under the leadership of Rahul A. Sheth, MD, reported that for patients with cancer and DVT who are unable to receive anticoagulation, inferior vena cava (IVC) filter placement reduces the risk of pulmonary embolism. In this interview with i3 Health, Dr. Sheth discusses his study findings and shares his advice for physicians as they care for patients with cancer and DVT.
In what ways is DVT treatment more challenging in patients with cancer compared to patients without cancer?
Rahul A. Sheth, MD: Cancer adds to the complexity of treating patients with DVT in several ways. Cancer itself increases a patient's propensity for developing DVT. At the same time, though, many cancer patients are at increased risk for bleeding, rendering the gold standard therapy of anticoagulation unsafe.
What prompted you to investigate the association between IVC filter placement and pulmonary embolism risk in patients with cancer and DVT?
Dr. Sheth: IVC filters are commonly considered the best treatment option for patients with DVT who cannot receive anticoagulation. However, the data on their efficacy are surprisingly limited given the frequency with which these devices are used. This is particularly true for the population of patients with cancer. We wanted to see if we could address some of the important knowledge gaps using a "big data" approach across a large cohort of patients with cancer.
Can you comment on the significance of your findings?
Dr. Sheth: In our study of almost 90,000 patients, we found that IVC filters were effective in reducing the rate of pulmonary embolism across the spectrum of cancer types. We also saw that IVC filters did not increase the rate of DVT, an association that has been suggested by prior studies. We did not, however, see an improvement in the survival of patients who received IVC filters. This is likely due to the fact that IVC filters tended to be placed in cancer patients with worse overall health.
What advice can you share with physicians as they seek to provide the best care to patients with cancer and DVT?
Dr. Sheth: IVC filters can be effective tools in preventing the development of pulmonary embolism for cancer patients with DVT. As always, careful patient selection is critical to ensuring the best outcomes.
About Dr. Sheth
Rahul A. Sheth, MD, is an Assistant Professor of Interventional Radiology at The University of Texas Medical School and The University of Texas MD Anderson Cancer Center in Houston, Texas. His research, which focuses on treatments involving interventional radiology for patients with cancer and hematological conditions, has been published extensively. He has been the recipient of multiple honors, most recently including the President's Recognition for Faculty Excellence in Research at MD Anderson. His research is funded by several foundations, including the Society for Interventional Radiology, the Radiological Society of North America, and the National Institutes of Health.
For More Information
Balabhadra S, Kuban JD, Lee S, et al (2020). Association of inferior vena cava filter placement with rates of pulmonary embolism in patients with cancer and acute lower extremity deep venous thrombosis. JAMA Netw Open, 3(7):e2011079. DOI:10.1001/jamanetworkopen.2020.11079
Interview edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.