Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of low-risk cancer-associated PE.

In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups: 47 patients with active cancer treated at home (group 1), 691 patients without active cancer treated at home (group 2), and 33 patients with active cancer hospitalized only because of cancer (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization.

Among the patients treated at home, the rate of the composite was 4.3% (2/47) in group 1 and 1.0% (7/691) in group 2 (p=0.11). In group 1 and 3, rates of main outcome were 4.3% and 3.0% (1/33) respectively (p=1.00). In multivariable analysis, among patients treated at home, active cancer was associated with an increased risk of the composite (OR 7.95; 95%CI [1.48-42.82]). For patients with active cancer, home treatment was not independently associated with the primary outcome at 30-day (OR 1.19, IC 95% [0.15-9.74]).

Among patients treated at home, active cancer was a risk factor of complications, but among patients with active cancer, home treatment was not associated with adverse evolution. These data suggest that home treatment of low-risk PE patients with active cancer is feasible and does not worsen their prognosis.