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. 2025 Aug 14;33(9):786.
doi: 10.1007/s00520-025-09840-9.

Triangulating data to define patient pathways, diagnostic and treatment patterns, and outcomes in cancer patients with deep vein thrombosis in Germany: a mixed-methods real-world data study

Vanessa Colonna #  1 , Rupert Bauersachs #  2 , Roman Gerlach  3 , Roland Jucknewitz  4 , Christoph Kalka  5   6 , Robert Klamroth  7 , Ulrich Mansmann  1 , Jutta Schimmelpfennig  8 , Mandy Schulz  9 , Martin Tauscher  3 , Helmut Ostermann #  10 , Karin Berger #  11
Affiliations

Triangulating data to define patient pathways, diagnostic and treatment patterns, and outcomes in cancer patients with deep vein thrombosis in Germany: a mixed-methods real-world data study

Vanessa Colonna et al. Support Care Cancer. .

Abstract

Purpose: Cancer incidence is rising in Germany, increasing the burden of cancer-associated deep vein thrombosis (DVT). To improve prevention, diagnosis, and treatment, robust regional data on patient numbers, cancer types, healthcare access, and outcomes are essential but currently scarce. This study addresses these gaps using a multi-source approach.

Methods: A mixed-methods analysis was conducted using claims data (2016-2018) from the Bavarian Association of Statutory Health Insurance Physicians and AOK Bayern.

Inclusion criteria: age > 18 years, active cancer diagnosis (ICD-10-GM C00-C99), and incident thrombosis (ICD-10-GM I80-I82). A supplementary patient survey captured care access and travel times.

Results: Among 677,327 Bavarian cancer patients, 38,393 (6%) developed thrombosis (mean age 69.6; 56% female). DVT occurred most frequently in skin cancers (30%), breast (16%), and digestive organs (16%). Complications were documented in 8610 patients, including pulmonary embolism (9%) and chronic venous disease (23%). Hospitalization occurred in 34% of cases (men, 29%; women, 39%). Mortality averaged 9% for cancer patients and rose to 23% when thrombosis was present. Rural patients reported average travel times of 53 min (range, 15-250) to specialized centers.

Conclusion: Cancer-associated thrombosis presents a significant clinical burden, especially in common tumor types. High rates of complications and mortality, combined with limited access to specialized care-particularly in rural areas-underline the urgent need for targeted prevention, better care coordination, and education strategies based on real-world evidence.

Keywords: Cancer incidence; Mixed-methods analysis; Thrombosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was based on health insurance data, analyzed by the Central Research Institute for Ambulatory Health Care in Germany and AOK-Bayern – „Die Gesundheitskasse “. Therefore, no ethical review and no informed consent were needed according to German law. Survey data were collected through a fully anonymized questionnaire that did not gather any personally identifiable information. Participation was entirely voluntary, and respondents were informed about the purpose of the study and their right to withdraw at any time. As the study involved no risk to participants and collected no sensitive or personal data, formal written informed consent was not required. Competing interests: K. Berger, R. Jucknewitz, U. Mansmann, V. Colonna, Mandy Schulz, M. Tauscher, R. Gerlach, J. Schimmelpfennig, and H. Ostermann have no relevant financial or nonfinancial interests to disclose. Rupert Bauersachs: Personal fees from Bayer, Bristol Myers Squibb, LEO Pharma, Pfizer, and VIATRIS. Research support from the CPC University of Colorado, FADOI, Italy. Robert Klamroth: Honoraria for consultation and lectures from Bayer, Biomarin, Biotest, Chugai, CSL Behring, Grifols, Novo Nordisk, Octapharma, Pfizer, Roche, Sanofi, Sobi, Takeda, and Viatris. Christoph Kalka: Personal fees from Bayer.

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