1485PD - Outpatient management of cancer-related pulmonary embolism: a propensity score-matched analysis of 803 patients from the EPIPHANY study

Date 29 September 2014
Event ESMO 2014
Session Supportive and palliative care
Topics Supportive Care
Presenter Alberto Carmona-Bayonas
Citation Annals of Oncology (2014) 25 (suppl_4): iv517-iv541. 10.1093/annonc/mdu356
Authors A. Carmona-Bayonas1, M. Biosca2, C. Font Puig3, L. Faez4, M.D.P. Solís Hernández4, P. Jimenez Fonseca5, M. Antonio Rebollo6, I. De La Haba6, E. Castanon Alvarez7, C. Beato8, A. Ramchandani9, M.A. Vicente Conesa10, O. Madridano11, R. Otero12
  • 1Medical Oncology - Haematology, Hospital Universitario Morales Meseguer, 30008 - Murcia/ES
  • 2Medical Oncology, Hospital Vall D´Hebrón, Barcelona/ES
  • 3Medical Oncology - Haematology, Hospital Clínic, Barcelona/ES
  • 4Medical Oncology, Hospital Universitario Central de Asturias, 33006 - Oviedo/ES
  • 5Servicio De Oncologia Medica, Hospital Universitario Central de Asturias, ES-33006 - Oviedo/ES
  • 6Medical Oncology, ICO- Duran i Reynals, Barcelona/ES
  • 7Oncology Department, Clinica Universitaria de Navarra, 31008 - Pamplona/ES
  • 8Medical Oncology, Hospital Nisa Sevilla-Aljarafe, Sevilla/ES
  • 9Medical Oncology, Hospital de Las Palmas, Las Palmas/ES
  • 10Haematology And Clinical Oncology, Hospital Universitario Morales Meseguer, Murcia/ES
  • 11Internal Medicine, Hospital Universitario Infanta Sofía, Madrid/ES
  • 12Pneumology, Hsopital Universitario Virgen del Rocío, Sevilla/ES

Abstract

Aim

Outpatient management of ‘low-risk’ pulmonary embolism (PE) is suggested in clinical guidelines (Evidence 2B) although the definition of ‘low-risk’ varies according to different authors. We aimed here to assess whether home versus hospital management were equivalent to treat ‘low-risk’ cancer-related PE.

Methods

EPIPHANY is an observational, multicenter study to assess prognostic factors and patterns of care on cancer-related PE. The definition of low risk used in this study comprised: systolic blood pressure ? 100 mmHg, arterial oxygen saturation≥90%, respiratory rate ?30 breaths/min, pulse ?110 beats/min, no sudden or progressive dyspnea and absence of a clinically relevant hemorrhage. We used propensity score matching to compare the efficacy and safety of outpatient versus inpatient therapy.

Results

We included 803 consecutive patients, 390 (48%) of whom were classified as low risk. Ambulatory management was used in 201 (51%) of them, whereas 189 (49%) were treated in hospital. Unadjusted rates of acute complications, 30- and 90- mortality were significantly lower in outpatients (Table 1). However, incidental detection, previous ambulatory status, absence of symptoms and oxygen saturation ≥96% were significantly more frequent in patients treated at home. After adjusting for imbalances, absolute difference estimates for 30- and 90 days mortality were: -0.6% (95% CI, -3.7 to+2.5%) and -2.7% (95% CI, -9.4% to +3.9%), respectively. Rates of venous rethrombosis and major bleeding events were also similar. Table 1.

Outpatients (95% CI) Inpatients (95% CI)
Short-term complications 2.5% (1- 5.7%) 6.3% (3.7- 10.7%)
30 days mortality 1.4% (0.5- 4.2%) 8.5% (5.2- 13.3%)
90 days mortality 7.4% (4.5- 11.9%) 20.1% (15- 26.3%)
30 days major bleeding 1.8% (0.7- 4.5%) 1.8% (0.7- 4.6%)
Venous retrombosis 5.9% (3.4- 9.8%) 6.7% (4.1- 11%)

Conclusions

Outpatient management of low-risk cancer-related PE appears to be safe and effective. A randomized trial is needed to confirm these data and assess outcomes in specific subgroups.

Disclosure

All authors have declared no conflicts of interest.