Severity of illness, outcomes, and resource use in elderly cancer patientswith deep venous thrombosis

Low-molecular-weight heparins provide new options for outpatient management of deep venous thrombosis. Because elderly patients: with cancer are at in creased risk of developing deep venous thrombosis, outpatient therapy for t reatment of deep venous thrombosis may be important in this population. We compared the severity of illness, outcomes, and cost of deep venous thrombo sis in elderly patients with cancer to those seen in younger patients with cancer. We examined all 766 episodes of deep venous thrombosis treated at t he University of Texas M.D. Anderson Cancer Center between January 1, 1994 and December 31, 1996. Severity of illness level and predicted risks of mor tality and readmission were obtained from a commercially available disease staging system (Inforum System). Observed outcomes and cost were based on d ata collected fi um the 766 episodes of deep venous thrombosis at our insti tution. One hundred nineteen (16%) episodes of deep venous thrombosis occur red in patients 70 years of age or older. The severity of illness scale (1- 5, least-most severe) were identical (3.7) in the 3 groups studied (< 70 ye ars, 70-79, years and greater than or equal to 80 years). The predicted ris k of death during hospitalization (6%, 9%, 8%, respectively, by group. P = 0.12) and readmission in 30 days (5%, 4%, 3%, respectively, P = 0.04) were similar among the groups. The observed death rates during hospitalization w ere 5%, 6%, and 6%, respectively (P = 0.91), and the rates of hospitalizati on for deep venous thrombosis recurrence were 22%, 16%, and 28%, respective ly (P = 0.27). The similarities in outcomes and resource use between elderl y and younger patients suggest that elderly patients with cancer are not at greater risk of serious clinical outcomes or a prolonged clinical course. There is significant potential for outpatient management of these patients.