Short-term outcomes for stroke reperfusion similar in patients with, without cancer
Among patients with cancer who experienced a stroke, reperfusion therapy conferred similar short-term outcomes as in patients with stroke and nonactive cancer or no history of cancer, researchers reported.
However, patients with active cancer experienced poorer long-term survival after IV thrombolysis or endovascular treatment, according to data published in Stroke.
“It is not easy to determine the treatment protocol when an acute ischemic stroke occurs in patients with active cancer,” Joonsang Yoo, MD, of the department of neurology at Yongin Severance Hospital, South Korea, and colleagues wrote. “Guidelines on management of patients with stroke do not provide clear treatment protocols for these patients. In particular, while treating patients with metastasis, physicians may be reluctant in administering reperfusion therapy, due to their short life expectancy. The rate of reperfusion treatment in patients with ischemic stroke and cancer is compatible with noncancer patients. However, even after successful reperfusion, there may be a fear of hemorrhage.”
For this study of the association between cancer and the outcomes of reperfusion therapy in patients with stroke, researchers included 1,338 patients who underwent IV thrombolysis and endovascular therapy, of whom 4.6% had active cancer, 5.8% had nonactive cancer and 89.5% had no history of cancer. Outcomes of interest included 24-hour NIH Stroke Scale score, adverse events, 3-month modified Rankin Scale (mRS) score, and 6-month survival and related factors.
Researchers observed that at, 24 hours, NIHSS score was slightly higher among patients with active cancer but was not statistically significant (P = .082), and absolute change in the NIHSS score was similar among the three patient groups (P = .844).
The active cancer group had worse 3-month mRS score compared with the other two groups after reperfusion therapy (active cancer vs. nonactive cancer, P = .002; active cancer vs. no history of cancer, P < .001).
Moreover, those with nonactive cancer had similar outcomes to patients without a history of cancer (P > .999), according to the study.
Among patients with active cancer, 36.4% had an independent functional outcome and 45.5% were able to walk independently at 3 months. After excluding 23 deceased patients, 78.1% of the remaining population had an mRS score of 0 to 3.
In a Kaplan-Meier estimate, at 6 months, patients without a history of cancer had similar survival compared with those with nonactive cancer (P = .08); however, patients with active cancer experienced poor survival (P < .001).
According to the study, active cancer was independently associated with poor 6-month survival after reperfusion therapy (HR = 3.973; 95% CI, 2.528-6.245).
Additionally, Charlson comorbidity index (HR = 1.304; 95% CI, 1.147-1.483) and initial stroke severity (HR for each 1-point NIHSS increase = 1.118; 95% CI, 1.085-1.152) were also associated with poorer survival.
“Rather than giving up these patients in advance with self-fulfilling prophecies, carefully attempting reperfusion treatment may give them time to receive more advanced cancer treatment,” the researchers wrote. “Considering many stroke patients with active cancer died due to not stroke itself but cancer-related origin, buying time may mean giving them a chance to get new cancer therapeutics.”