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Background The natural history of unsuspected pulmonary embolism (PE) in patients with cancer has not been thoroughly studied. Methods We used the RIETE Registry data to compare the clinical characteristics, treatment strategies and outcome in cancer patients with unsuspected PE and in those presenting with symptomatic, acute PE. Results Up to December 2011, 78 cancer patients with unsuspected PE and 1,994 with symptomatic PE had been enrolled. Patients with unsuspected PE more likely had colorectal cancer than those with symptomatic PE (28% vs. 13%), and less likely had prostate (3.8% vs. 10%) or hematologic (1.3% vs. 6.4%) cancer, or prior venous thromboembolism (3.8% vs. 12%). While the patients were receiving anticoagulant therapy, the incidence of PE recurrences (0% vs. 1.9%) or major bleeding (2.6% vs. 4.8%) were similar. After completion of anticoagulation, recurrent PE developed in 2.6% vs. 1.4% of patients, and major bleeding in 0% vs. 0.4%, respectively. Conclusions Our findings suggest that the clinical characteristics and outcome in cancer patients with unsuspected PE are quite similar to those in patients with symptomatic PE.

The influence of the site of cancer on outcome in cancer women with venous thromboembolism (VTE) is poorly understood. Reliable information on its influence might facilitate better use of prevention strategies. We assessed the 30-day outcome in all women with active cancer in the RIETE Registry, trying to identify if differences exist according to the tumor site. Up to May 2010, 2474 women with cancer and acute VTE had been enrolled. The most common sites were the breast (26%), colon (13%), uterus (9.3%), and haematologic (8.6%) cancers. During the 30-day study period, 329 (13%) patients died. Of them, 71 (2.9%) died of pulmonary embolism (PE), 22 (0.9%) died of bleeding. Fatal PE was more common in women with breast, colorectal, lung or pancreatic cancer (59% of the fatal PEs). Fatal bleeding was more frequent in women with colorectal, haematologic, ovarian cancer or carcinoma of unknown origin (55% of fatal bleedings).

While some genetic factors may explain the development of cancer, its main causes are related to environmental exposure to carcinogenic agents as well as to the effect of determined lifestyles and habits. Several epidemiological studies have shown a consistent relation between obesity and cancer. In non smokers, obesity is the most relevant risk factor in the development of malignant tumors. There is a clear association between obesity and endometrial cancer, breast cancer in postmenopausal women, pancreatic, esophageal and colon cancer. Sexual steroids, insulin like growth factor axis and adipokines are the three main models to explain the biological basis for the obesity-cancer relationship. However, these models do not explain all the biological mechanisms that link obesity to cancer. There are other factors in play such as chronic inflammation, hypoxia and oxidative stress. Obesity may hamper the screening, diagnosis and treatment of some tumors, increasing mortality rates. Obesity prevention and management, therefore, may be the most important modifiable factor in reducing both incidence and mortality in cancer. New studies are required to quantify the effect of intentional weight reduction on the incidence and relapse of cancer. Considering the efficacy of bariatric surgery for weight reduction, it is an attractive model to study this link.

While some genetic factors may explain the development of cancer, its main causes are related to environmental exposure to carcinogenic agents as well as to the effect of determined lifestyles and habits. Several epidemiological studies have shown a consistent relation between obesity and cancer. In non smokers, obesity is the most relevant risk factor in the development of malignant tumors. There is a clear association between obesity and endometrial cancer, breast cancer in postmenopausal women, pancreatic, esophageal and colon cancer. Sexual steroids, insulin like growth factor axis and adipokines are the three main models to explain the biological basis for the obesity-cancer relationship. However, these models do not explain all the biological mechanisms that link obesity to cancer. There are other factors in play such as chronic inflammation, hypoxia and oxidative stress. Obesity may hamper the screening, diagnosis and treatment of some tumors, increasing mortality rates. Obesity prevention and management, therefore, may be the most important modifiable factor in reducing both incidence and mortality in cancer. New studies are required to quantify the effect of intentional weight reduction on the incidence and relapse of cancer. Considering the efficacy of bariatric surgery for weight reduction, it is an attractive model to study this link.

While some genetic factors may explain the development of cancer, its main causes are related to environmental exposure to carcinogenic agents as well as to the effect of determined lifestyles and habits. Several epidemiological studies have shown a consistent relation between obesity and cancer. In non smokers, obesity is the most relevant risk factor in the development of malignant tumors. There is a clear association between obesity and endometrial cancer, breast cancer in postmenopausal women, pancreatic, esophageal and colon cancer. Sexual steroids, insulin like growth factor axis and adipokines are the three main models to explain the biological basis for the obesity-cancer relationship. However, these models do not explain all the biological mechanisms that link obesity to cancer. There are other factors in play such as chronic inflammation, hypoxia and oxidative stress. Obesity may hamper the screening, diagnosis and treatment of some tumors, increasing mortality rates. Obesity prevention and management, therefore, may be the most important modifiable factor in reducing both incidence and mortality in cancer. New studies are required to quantify the effect of intentional weight reduction on the incidence and relapse of cancer. Considering the efficacy of bariatric surgery for weight reduction, it is an attractive model to study this link.

[Background] Physicians need a specific risk-stratification tool to facilitate safe and cost-effective approaches to the management of patients with cancer and acute pulmonary embolism (PE). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and cancer by using measures readily obtained at the time of PE diagnosis., [Methods] Investigators randomly allocated 1,556 consecutive patients with cancer and acute PE from the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica to derivation (67%) and internal validation (33%) samples. The external validation cohort for this study consisted of 261 patients with cancer and acute PE. Investigators compared 30-day all-cause mortality and nonfatal adverse medical outcomes across the derivation and two validation samples., [Results] In the derivation sample, multivariable analyses produced the risk score, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%–8.2%) compared with 29.9% (95% CI, 25.4%–34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%–25.0%) in the high-risk group., [Conclusions] The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE., We are grateful to Sanofi Spain for supporting this registry with an unrestricted educational grant. We are also grateful to Bayer Pharma AG for supporting this registry. Bayer Pharma AG's support was limited to the part of RIETE outside Spain, which accounts for 15.53% of the total patients included in the RIETE Registry.

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision. This Registry is supported by unrestricted educational grants from Sanofi Spain and Bayer Pharma AG. The funding source had no role in the design, protocol development, or conduct of the study; data collection, management, or analysis; interpretation, preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The RIETE Registry was supported with an unrestricted educational grant from Sanofi Spain and Bayer Pharma AG. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 20.05% of the total patients included in the RIETE Registry. The authors have nothing to disclose. The authors have declared that no competing interests exist.