ABSTRACT
Treating a patient with cancer is a challenging clinical problem entailing a multidisciplinary approach, whether the intention is to cure or to palliate. Life expectancy may be improved in certain patients by aggressive intervention, but if a limited life span is expected, preserving quality of life becomes paramount. In both scenarios, the occurrence of venous thromboembolism (VTE) is an important clinical consideration. The association of VTE with malignant disease was fi rst described in 1865 (1) by Trousseau lecturing about thrombophlebitis migrans; since then, a two-way relationship between VTE and cancer has been clearly established. Thromboembolic events may be the fi rst clinical manifestation of undiagnosed malignancy (2-4); two large studies in the Danish and Swedish population showed an increased incidence of cancer of respectively 1.3-and 3.2-fold in patients with idiopathic VTE when compared to the native population (5,6). Patients with an established diagnosis of malignant disease are at high risk of developing VTE, with a wide range of clinical manifestations, ranging from asymptomatic deep vein thrombosis (DVT) at one extreme to fatal pulmonary embolism (PE) at the other. It is estimated that up to 60% of thromboembolic deaths occur at an otherwise favorable time in the history of the cancer (7). Cancer patients are often debilitated either by malignant cachexia or as
a result of treatment toxicity, may be bed-bound for signifi cant periods of time, and often require central venous access to dispense treatment or nutrients. These factors contribute to the increased risk of VTE and may be compounded by the hypercoagulable state associated with tumor activity, which has been described in patients with a variety of solid tumors (8).
