Performance status and long-term clinical outcomes in pulmonary embolism patients with cancer. An analysis of Hokusai VTE Cancer study

Pulmonary embolism is an acute cardiovascular disease that results from the entrapment of a blood clot, usually originating from deep veins in the lower extremities, in the arterial pulmonary circulation. This condition is estimated to affect 29 to 78 per 100,000 population every year, for a total of about 430,000 annual cases in Europe and up to 600,000 cases in the United States (Heit 2016, Raskob 2014, Rahimtoola 2005). Patients at particularly high risk of pulmonary embolism include patients with cancer, those who experience periods of prolonged immobility (such as patients recovering from surgery, especially after orthopaedic interventions), or pregnant women (Heit 2016). While pulmonary embolism can be fatal and still contributes to approximately 40,000 deaths per year both in the United States and in the World Health Organization European Region, its mortality rate has been reported to be decreasing over the last few years (Barco 2019, Barco 2020). This epidemiologicla shift is progressively increasing the need of high-quality evidence to guide clinical management of survivors of pulmonary embolism. These patients often complain of long-lasting and potentially severe symptoms or disability that may jeopardize their functional status, working ability, and health-related quality of life. Accordingly, they receive long-term clinical monitoring and may require additional testing for comorbidities or rare long-term complications, physical rehabilitation to prevent cardiopulmonary deconditioning, and frequent adjustment of medical (typically anticoagulant) treatment.
The precise nature, temporal course and clinical significance of these long-term sequelae have not been fully characterized, especially in selected populations that pose complex management issues, such as patients with cancer-associated pulmonary embolism. In particular, there is scarce information on the clinical value of performance and quality of life assessment both at baseline and over follow-up. Knowing the prognostic implications of baseline performance status and quality of life scores at baseline would help clinicians to identify at an early stage patients at a high risk of clinical complications and over-average healthcare resource utilization, whereas knowing the typical patterns of performance status over time for specific patient categories of clinical interest would make it possible to identify those patients that are deviating from the expected path and take timely measures to adjust management and prevent clinical and overall deterioration.