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Deep vein thrombosis (DVT) in advanced cancer patients with lower extremity edema referred for assessment

Edmonton Palliative Care Program, Edmonton, Alberta, Canada

Doreen Oneschuk, MD

Tertiary Palliative Care Unit, Grey Nuns Hospital, Edmonton, Alberta, Canada

John Hanson, MSc

Department of Epidemiology, Cross Cancer Institute, Edmonton, Alberta, Canada

Lower extremity edema is a common complication in advanced cancer patients, and deep vein thrombosis (DVT) is one among many causes. Clinical signs and symptoms are known to be unreliable, and radiographic investigations are often required in diagnosing DVT. A retrospective chart review was conducted on 46 advanced cancer patients with lower extremity edema. Researchers analyzed 52 venous duplex scans to determine the radiographic incidence of DVT, the reliability of other clinical signs and symptoms in diagnosing DVT, apart from leg edema, and to assess other potential causes of lower extremity edema and their correlation to DVT. Twenty-three (44 percent) of 52 scans were positive for DVT. The most common presentation of edema in the patients with positive scans was bilateral asymmetric edema (11/23, 48 percent). There was limited documentation of other clinical signs and symptoms suggesting DVT. Other variables such as serum albumin (p = 0.46) and creatinine (p = 0.11) were not statistically different in patients who had positive and negative scans. Of other potential causes of lower extremity edema, such as previous surgery, radiotherapy, tumor, or lymph node compression, a number of patients had a coexisting DVT with bilateral asymmetric edema as the most common presentation. The results of this study suggest that advanced cancer patients with bilateral asymmetric lower extremity edema of potentially multifactorial origin have a high incidence of DVT.

Key Words: edema • deep vein thrombosis • cancer

American Journal of Hospice and Palliative Medicine®, Vol. 22, No. 2, 145-149 (2005)
DOI: 10.1177/104990910502200213


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