We agree with Lopez Gomez et al that venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatment. It is quite possible that improved diagnostic technologies may account in part for the increased frequency. In our analysis, the proportion of patients who underwent a computed tomography scan of the chest and also carried a diagnosis of pulmonary embolism increased significantly, from 1.7% in 1995 to 7.2% in 2003 (P <.0001 for trend).1 However, clinicians should be just as cautious of unsuspected VTE events because respiratory and extremity symptoms are often overlooked.2 Newer chemotherapy regimens and antiangiogenic agents such as thalidomide and lenalidomide may also be contributory. Although VTE can often be the initial presenting feature of malignancy, the need for extensive diagnostic screening is controversial. We are heartened to see an increased awareness of the problem of VTE among cancer providers, but much work needs to be done to ensure that cancer patients receive appropriate prophylaxis and treatment for VTE. The recently formulated American Society of Clinical Oncology Guidelines will hopefully further this objective.3
Alok A. Khorana MD*, Charles W. Francis MD*, Gary H. Lyman MD, * James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, New York, Department of Medicine, Duke University Medical Center, Duke Comprehensive Cancer Center, Durham, North Carolina.