This predetermined companion report from the multicenter, randomized ONCO PE trial in Japan evaluated the 3-month clinical outcomes of home treatment versus in-hospital treatment for active cancer patients with low-risk pulmonary embolism (PE). The parent trial investigated the optimal duration of rivaroxaban treatment in cancer-associated PE patients with a simplified Pulmonary Embolism Severity Index (sPESI) score of 1. Among 178 study patients, 66 (37%) were assigned to home treatment and 112 (63%) to in-hospital treatment. The primary endpoint was a composite of PE-related death, recurrent venous thromboembolism (VTE), and major bleeding. At 3 months, this composite endpoint occurred in 3 patients (4.6% [95% CI: 0.0-9.6%]) in the home treatment group and in 2 patients (1.8% [95% CI: 0.0-4.3%]) in the in-hospital treatment group. A detailed analysis of the home treatment group revealed no cases of PE-related death or recurrent VTE. However, major bleeding occurred in 3 patients (4.6% [95% CI: 0.0-9.6%]), and 2 of these patients (3.0% [95% CI: 0.0-7.2%]) required hospitalization due to the bleeding events. The report concludes that active cancer patients with PE and an sPESI score of 1 could be potential candidates for home treatment.
If you have active cancer and develop a blood clot in your lung, the standard approach has been hospital treatment. But new research asks: could some of these patients be safely treated at home? The question matters because hospital stays are disruptive, especially when you're already managing cancer.
A study in Japan looked at 178 patients with active cancer and a specific low-risk score for their lung clot. Doctors divided them into two groups: 66 were treated at home, and 112 were treated in the hospital. All patients were on the same blood thinner medication.
The researchers tracked them for three months, looking for serious problems like death from the clot, another clot forming, or major bleeding. In the home treatment group, 3 patients (4.6%) had a major bleeding event. Two of those needed to be hospitalized for it. There were no deaths from clots or new clots in the home group. In the hospital group, 2 patients (1.8%) had one of the serious problems tracked.
The study concludes that for active cancer patients with this specific low-risk clot, home treatment could be a potential option. The findings suggest the safety outcomes between home and hospital care were comparable in this group.
What this means for you: Some active cancer patients with low-risk lung clots may be candidates for safe home treatment.
View Original Abstract ↓
BACKGROUND: Patients with appropriately selected low-risk pulmonary embolism (PE) can be treated at home, although it has been controversial whether applies to patients with cancer, who are considered not to be at low risk.Methods and Results: The current predetermined companion report from the ONCO PE trial evaluated the 3-month clinical outcomes of patients with home treatment and those with in-hospital treatment. The ONCO PE trial was a multicenter, randomized clinical trial among 32 institutions in Japan investigating the optimal duration of rivaroxaban treatment in cancer-associated PE patients with a score of 1 using the simplified version of the Pulmonary Embolism Severity Index (sPESI). Among 178 study patients, there were 66 (37%) in the home treatment group and 112 (63%) in the in-hospital treatment group. The primary endpoint of a composite of PE-related death, recurrent venous thromboembolism (VTE) and major bleeding occurred in 3 patients (4.6% [0.0-9.6%]) in the home treatment group and in 2 patients (1.8% [0.0-4.3%]) in the in-hospital treatment group. In the home treatment group, there were no cases of PE-related death or recurrent VTE, but major bleeding occurred in 3 patients (4.6% [0.0-9.6%]), and 2 patients (3.0% [0.0-7.2%]) required hospitalization due to bleeding events.
CONCLUSIONS: Active cancer patients with PE of sPESI score=1 could be potential candidates for home treatment.