What Impact Does Venous Thromboembolism and Bleeding Have on Cancer Patients’ Quality of Life?

• Published in: Value in health 2018-04, Vol.21 (4), p.449-455
• Main Authors: Lloyd, Andrew J., Dewilde, Sarah, Noble, Simon, Reimer, Elisabeth, Lee, Agnes Y.Y.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Bleeding; Blood clots; Cancer; cancer-associated thrombosis; Clinical variables; Cost analysis; Cost of Illness; Data processing; EQ-5D; Female; Health status; Hemorrhage; Hemorrhage - chemically induced; Hemorrhage - psychology; Hemostasis; High risk; Humans; low-molecular-weight heparin; Male; Metastases; Metastasis; Middle Aged; Neoplasms - complications; Neoplasms - diagnosis; Newly diagnosed; Oncology; Patients; Quality of Life; Questionnaires; Recurrence; Recurrent; Risk Factors; Specification; Surveys and Questionnaires; Thromboembolism; Time Factors; Treatment Outcome; venous thromboembolism; Venous Thromboembolism - diagnosis; Venous Thromboembolism - drug therapy; Venous Thromboembolism - etiology; Venous Thromboembolism - psychology; Venous thrombosis
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.09.015

Venous thromboembolism (VTE) is common in cancer patients and its treatment is associated with a high risk of recurrent VTE (rVTE) and bleeding. To analyze data from the Comparison of Acute Treatments in Cancer Hemostasis (CATCH) trial to describe the impact of rVTE and bleeding events on health-related quality of life. The three-level EuroQol five-dimensional questionnaire (EQ-5D) data were collected monthly for up to 7 months in patients starting anticoagulation for newly diagnosed VTE. Analyses were designed to describe the impact of rVTE and bleeding on EQ-5D scores while controlling for effects of covariates such as background and clinical variables and longitudinal changes. A repeated-measures model with specification of the variance-covariance matrix to characterize the intrapatient correlation was used to estimate the utility values. The impact of an rVTE or a bleeding event was assumed to be reflected in the utility value when it occurred within 2 weeks from a planned data collection point. Data were available from 883 patients. A total of 76 rVTE and 159 bleeding events occurred during follow-up. rVTE had a significant impact on EQ-5D scores, with a decrement of −0.075 on the basis of our reference case (male, no metastasis, Eastern Cooperative Oncology Group score = 1, Western European), but different patients might have different decrements. Bleeding events had a smaller (nonstatistically significant) impact on EQ-5D scores. This data set study has quantified the decline in EQ-5D scores associated with experiencing rVTE or bleeding events in cancer patients. These results indicate the net gain in quality of life and impact on cost-effectiveness of secondary VTE prevention.