Initiating or Resuming Cancer Treatment After Ischemic Stroke and Clinical Outcomes.
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BACKGROUND AND OBJECTIVES: Patients with acute ischemic stroke (AIS) and active cancer (AC) are at high risk of mortality and stroke recurrence. While cancer characteristics are key prognostic factors, the impact of initiating or resuming active cancer treatment (ACT) after AIS remains unclear. This study aimed to estimate the proportion of patients initiating or resuming ACT after AIS and evaluate their clinical characteristics and outcomes. METHODS: Using 2003-2021 data from the Acute STroke Registry and Analysis of Lausanne, we retrospectively analyzed patients with AC who initiated or resumed ACT within 3 months of index AIS vs those who did not. Exclusion criteria included patients with no or inactive cancer, insufficient data on ACT, and posthospitalization cancer diagnoses and those who died or entered palliative care before decisions on ACT. Outcomes included the modified Rankin Scale (mRS) score, mortality, and cerebrovascular recurrences at 3 and 12 months. Analyses comprised multivariable regressions, adjusting for prognostic variables, and propensity score matching (PSM). RESULTS: Among 6,686 patients with AIS, 260 had AC and met eligibility criteria, with 117 (45%) initiating or resuming ACT. The median age was 73 years (interquartile range 16-5); 101 (39%) were women. Chemotherapy was the most prescribed ACT. Lower stroke severity was associated with initiating or resuming ACT (adjusted odds ratio [aOR] 0.93, 95% CI 0.88-0.98). Initiating or resuming ACT was associated with reduced mortality at 3 months before (adjusted hazard ratio [aHR] 0.39, 95% CI 0.28-0.56) and after (aHR 0.33, 95% CI 0.13-0.80) PSM and at 12 months before PSM (aHR 0.81, 95% CI 0.67-0.98). Mortality at 12 months after PSM (aHR 0.73, 95% CI 0.45-1.20), mRS scores at 3 months (aOR 0.96, 95% CI 0.58-1.59) and 12 months (aOR 0.66, 95% CI 0.36-1.19), and cerebrovascular recurrence risk at 3 months (subdistribution hazard ratio [sHR] 0.69, 95% CI 0.28-1.69) and 12 months (sHR 0.71, 95% CI 0.28-1.78) remained similar across groups before and after PSM. DISCUSSION: In a nearly 2-decade stroke registry, almost half of the patients with AC initiated or resumed ACT within 3 months after AIS, with reduced medium-term and potentially long-term mortality but no differences in functional outcomes or cerebrovascular recurrence risk.