Screening for cancer in patients with unprovoked venous thromboembolism: protocol for a systematic review and individual patient data meta-analysis
van Es N (1), Le Gal G (2,3), Otten HM (4), Robin P (5), Piccioli A (6), Lécumberri R (7), Jara-Palomares L (8), Religa P (9,10), Rieu V (11), Rondina MT (12), Beckers MM (13), Prandoni P (6), Salaun PY (5), Nisio MD (1,14), Bossuyt PM (15), Büller HR (1), Carrier M (2).
(1) Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
(2) Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.
(3) Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.
(4) Department of Internal Medicine, Slotervaartziekenhuis, Amsterdam, The Netherlands.
(5) Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.
(6) Departments of Cardiovascular Sciences and Medicine, University Hospital of Padua, Padua, Italy.
(7) Hematology Service, Clinica Universidad de Navarra, Pamplona, Spain.
(8) Medical Surgical Unit of Respiratory Diseases. Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Sevilla, Spain.
(9) Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
(10) Department of Medicine, Warsaw Medical University, Warsaw, Poland.
(11) Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France.
(12) Division of General Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
(13) Department of Hematology, University Hospital Leuven, Leuven, Belgium.
(14) Dipartimento di Medicina e Scienze dell Invecchiamento, Università 'Gabriele d'Annunzio', Chieti-Pescara, Italy.
(15) Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
Occult cancer is present in 4%-9% of patients with unprovoked venous thromboembolism (VTE). Screening for cancer may be considered in these patients, with the aim to diagnose cancers in an early, potentially curable stage. Information is needed about the risk of occult cancer, overall and in specific subgroups, additional risk factors and on the performance of different screening strategies.
METHODS AND ANALYSIS:
MEDLINE, Embase and CENTRAL databases were searched from November 2007 to January 2016 for prospective studies that had evaluated protocol-mandated screening for cancer in patients with unprovoked VTE and with at least 12 months' follow-up.
Two reviewers independently assessed articles for eligibility. Ten eligible studies were identified and individual patient data were obtained from each of them. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool .
Generalised linear mixed-effects models was used to calculate estimates in a one-stage meta-analytic approach, overall and in a number of subgroups, including patients undergoing limited screening only, elderly patients, patients with previous VTE, smokers and patients using oestrogens.
ETHICS AND DISSEMINATION:
Ethical approval is not required for this systematic review and individual patient data meta-analysis. Findings have been submitted for publication in peer-reviewed journals and presentations at national and international conferences to provide clinicians and other decision-makers with valid and precise risk estimates of occult cancer, overall and in specific clinical subgroups, with risk factors for occult cancer, with estimates of the diagnostic performance of limited screening and with an exploration of the benefit of extensive screening strategies.
CITATION BMJ Open. 2017 Jun 10;7(6):e015562. doi: 10.1136/bmjopen-2016-015562.