Assessment of clinical and functional outcome in patients with cancer and acute ischemic stroke

The treatment of cancer-associated stroke is determined based on stroke etiology; however, the optimal treatment and therapeutic benefits remain unclear. We aimed to evaluate the clinical and functional outcomes of patients with cancer and acute ischemic stroke, especially focusing on patients with cryptogenic stroke. We retrospectively reviewed consecutive cancer patients diagnosed with acute ischemic stroke at our institution between January 2018 and December 2019. Stroke subtype, cancer treatment after stroke, modified Rankin Scale (mRS) scores before and at ischemic stroke, 3 months after ischemic stroke or last follow-up, and discharge destination were evaluated. We analyzed 48 cancer patients with acute ischemic stroke, including 24 with cryptogenic stroke and 24 with known stroke mechanisms. The median survival time of the patients was 62 days. Thirty-one patients (64.6%) discontinued cancer treatment after stroke. Forty patients (83.3%) and 37 (77.1%) were in poor functional states (defined as mRS score ≥ 3) at stroke onset and 3 months after stroke or last follow-up. Twenty-two patients (91.7%) with cryptogenic stroke discontinued cancer treatment after stroke, whereas 15 patients (62.5%) with known stroke mechanisms continued cancer treatment (p = 0.0004). Home or rehabilitation hospital discharge destinations were less frequently seen in patients with cryptogenic stroke (n = 7, 29.2%) than those with known stroke mechanisms (n = 15, 62.5%, p = 0.021). Stroke has a significant negative impact on patients’ functional states and cancer treatment strategy, leading to short survival times, especially in patients with cryptogenic stroke.