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. 2025 Feb 3;8(2):e2460315.
doi: 10.1001/jamanetworkopen.2024.60315.

Pulmonary Embolism-Related Mortality in Patients With Cancer

Marco Zuin  1   2 , Anju Nohria  3 , Stanislav Henkin  4 , Darsiya Krishnathasan  5 , Alyssa Sato  5 , Gregory Piazza  5   6
Affiliations

Pulmonary Embolism-Related Mortality in Patients With Cancer

Marco Zuin et al. JAMA Netw Open. .

Abstract

Importance: Acute pulmonary embolism (PE) is a major cause of morbidity and mortality in patients with cancer in the US and worldwide.

Objectives: To assess the trends in PE-related mortality from 2011 to 2020 among US patients with cancer across age, sex, ethnic and racial groups, urbanicity, and regionality.

Design, setting, and participants: This cohort study used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system to determine national trends in age-adjusted mortality rates (AAMRs) due to acute PE among US patients with cancer aged 15 years or older from January 2011 to December 2020. Concomitant trends in cancer mortality and incidence that may have contributed to PE-related mortality were obtained from US Cancer Statistics. Data were analyzed from September to November 2024.

Exposure: PE-related mortality.

Main outcomes and measures: The primary outcome was PE-related deaths among individuals with cancer. AAMRs and cancer incidence were assessed using joinpoint regression modeling, expressed as an average annual percentage change (AAPC) with relative 95% CIs.

Results: From 2011 to 2020, a total of 27 280 194 individuals aged 15 years or older (13 897 519 male [50.9%]; 13 382 675 female [49.1%]) died in the US. The AAMR for PE-related mortality in patients with cancer increased during this time period (AAPC, 2.5%; 95% CI, 1.4% to 3.6%; P = .001), without differences between sexes (P for parallelism = .38). The AAMR increased among those aged 15 to 64 years (AAPC, 3.2%; 95% CI, 1.9% to 4.6%; P = .001), non-Hispanic and non-Latinx White individuals (AAPC, 2.7%; 95% CI, 1.52% to 3.94%; P = .001), non-Hispanic and non-Latinx Black or African American individuals (AAPC, 2.2%; 95% CI, 0.7% to 3.7%; P = .001), Hispanic and Latinx individuals (AAPC, 2.6%; 95% CI, 0.7% to 4.5%; P = .006), and among individuals residing in the Southern US (AAPC, 3.7%; 95% CI, 1.3% to 6.2%; P = .003). During the same period, age-adjusted cancer incidence and cancer-related mortality decreased while the absolute number of new cancer diagnoses and cancer-related deaths increased.

Conclusions and relevance: This cohort study found that despite decreases in cancer-related mortality rates, age-adjusted PE-related mortality in US patients with cancer increased over the last decade; concerning trends included rising PE-related mortality in younger individuals aged 15 to 64 years, particular ethnic and racial groups, and the Southern region of the US. Recognition of such patterns may inform further research into thromboprophylaxis and treatment of PE as a complication of cancer and cancer-directed therapy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nohria reported receiving personal fees from Altathera Pharmaceuticals, AstraZeneca, Regeneron Pharmaceuticals, and Takeda Oncology and grants from Bristol Myers Squibb outside the submitted work. Dr Piazza reported receiving grants from Bristol Myers Squibb, Pfizer, Janssen, Alexion, Bayer, Amgen, Boston Scientific, Esperion, and the National Institutes of Health and serving on advisory panels for Boston Scientific, Amgen, BCRI, Pulmonary Embolism Response Consortium, North American Science Associates, Bristol Myers Squibb, Janssen, and Regeneron outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Pulmonary Embolism–Related Mortality Rates Among US Patients With Cancer From 2011 to 2020, Stratified by Sex
Figure 2.
Figure 2.. Changes in Absolute Numbers and Age-Adjusted Cancer-Related Mortality and New Cancer Diagnoses in the US, 2011-2020
The COVID-19 pandemic disrupted health services, leading to delays and reductions in cancer screening, diagnosis, and reporting of data to cancer registries contributing to the decline in new cancer cases. To avoid misleading interpretations, the 2020 data point is not connected in the incidence line chart.
See this image and copyright information in PMC

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