Use of Aspirin postdiagnosis improves survival for colon cancer patients

E. Bastiaannet; K. Sampieri; O. M. Dekkers; A. J.M. De Craen; M. P.P. Van Herk-Sukel; V. Lemmens; C. B.M. Van Den Broek; J. W. Coebergh; R. M.C. Herings; C. J.H. Van De Velde; R. Fodde; G. J. Liefers

doi:10.1038/bjc.2012.101

Use of Aspirin postdiagnosis improves survival for colon cancer patients

E. Bastiaannet, K. Sampieri, O. M. Dekkers, A. J.M. De Craen, M. P.P. Van Herk-Sukel, V. Lemmens, C. B.M. Van Den Broek, J. W. Coebergh, R. M.C. Herings, C. J.H. Van De Velde, R. Fodde, G. J. Liefers^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The preventive role of non-steroid anti-inflammatory drugs (NSAIDs) and aspirin, in particular, on colorectal cancer is well established. More recently, it has been suggested that aspirin may also have a therapeutic role. Aim of the present observational population-based study was to assess the therapeutic effect on overall survival of aspirin/NSAIDs as adjuvant treatment used after the diagnosis of colorectal cancer patients. Methods: Data concerning prescriptions were obtained from PHARMO record linkage systems and all patients diagnosed with colorectal cancer (1998-2007) were selected from the Eindhoven Cancer Registry (population-based cancer registry). Aspirin/NSAID use was classified as none, prediagnosis and postdiagnosis and only postdiagnosis. Patients were defined as non-user of aspirin/NSAIDs from the date of diagnosis of the colorectal cancer to the date of first use of aspirin or NSAIDs and user from first use to the end of follow-up. Poisson regression was performed with user status as time-varying exposure.Results:In total, 1176 (26%) patients were non-users, 2086 (47%) were prediagnosis and postdiagnosis users and 1219 (27%) were only postdiagnosis users (total n=4481). Compared with non-users, a survival gain was observed for aspirin users; the adjusted rate ratio (RR) was 0.77 (95% confidence interval (CI) 0.63-0.95; P=0.015). Stratified for colon and rectal, the survival gain was only present in colon cancer (adjusted RR 0.65 (95%CI 0.50-0.84; P=0.001)). For frequent users survival gain was larger (adjusted RR 0.61 (95%CI 0.46-0.81; P=0.001). In rectal cancer, aspirin use was not associated with survival (adjusted RR 1.10 (95%CI 0.79-1.54; P=0.6). The NSAIDs use was associated with decreased survival (adjusted RR 1.93 (95%CI 1.70-2.20; P<0.001). Conclusion: Aspirin use initiated or continued after diagnosis of colon cancer is associated with a lower risk of overall mortality. These findings strongly support initiation of a placebo-controlled trial that investigates the role of aspirin as adjuvant treatment in colon cancer patients.

Original language	English
Pages (from-to)	1564-1570
Number of pages	7
Journal	British Journal of Cancer
Volume	106
Issue number	9
DOIs	https://doi.org/10.1038/bjc.2012.101
Publication status	Published - 24 Apr 2012
Externally published	Yes

Keywords

aspirin
Colorectal cancer
NSAIDs
population based
survival

Access to Document

10.1038/bjc.2012.101

Cite this

Bastiaannet, E., Sampieri, K., Dekkers, O. M., De Craen, A. J. M., Van Herk-Sukel, M. P. P., Lemmens, V., Van Den Broek, C. B. M., Coebergh, J. W., Herings, R. M. C., Van De Velde, C. J. H., Fodde, R., & Liefers, G. J. (2012). Use of Aspirin postdiagnosis improves survival for colon cancer patients. British Journal of Cancer, 106(9), 1564-1570. https://doi.org/10.1038/bjc.2012.101

@article{8432ca7fe30743f896592b33b1967574,

title = "Use of Aspirin postdiagnosis improves survival for colon cancer patients",

abstract = "Background: The preventive role of non-steroid anti-inflammatory drugs (NSAIDs) and aspirin, in particular, on colorectal cancer is well established. More recently, it has been suggested that aspirin may also have a therapeutic role. Aim of the present observational population-based study was to assess the therapeutic effect on overall survival of aspirin/NSAIDs as adjuvant treatment used after the diagnosis of colorectal cancer patients. Methods: Data concerning prescriptions were obtained from PHARMO record linkage systems and all patients diagnosed with colorectal cancer (1998-2007) were selected from the Eindhoven Cancer Registry (population-based cancer registry). Aspirin/NSAID use was classified as none, prediagnosis and postdiagnosis and only postdiagnosis. Patients were defined as non-user of aspirin/NSAIDs from the date of diagnosis of the colorectal cancer to the date of first use of aspirin or NSAIDs and user from first use to the end of follow-up. Poisson regression was performed with user status as time-varying exposure.Results:In total, 1176 (26%) patients were non-users, 2086 (47%) were prediagnosis and postdiagnosis users and 1219 (27%) were only postdiagnosis users (total n=4481). Compared with non-users, a survival gain was observed for aspirin users; the adjusted rate ratio (RR) was 0.77 (95% confidence interval (CI) 0.63-0.95; P=0.015). Stratified for colon and rectal, the survival gain was only present in colon cancer (adjusted RR 0.65 (95%CI 0.50-0.84; P=0.001)). For frequent users survival gain was larger (adjusted RR 0.61 (95%CI 0.46-0.81; P=0.001). In rectal cancer, aspirin use was not associated with survival (adjusted RR 1.10 (95%CI 0.79-1.54; P=0.6). The NSAIDs use was associated with decreased survival (adjusted RR 1.93 (95%CI 1.70-2.20; P<0.001). Conclusion: Aspirin use initiated or continued after diagnosis of colon cancer is associated with a lower risk of overall mortality. These findings strongly support initiation of a placebo-controlled trial that investigates the role of aspirin as adjuvant treatment in colon cancer patients.",

keywords = "aspirin, Colorectal cancer, NSAIDs, population based, survival",

author = "E. Bastiaannet and K. Sampieri and Dekkers, {O. M.} and {De Craen}, {A. J.M.} and {Van Herk-Sukel}, {M. P.P.} and V. Lemmens and {Van Den Broek}, {C. B.M.} and Coebergh, {J. W.} and Herings, {R. M.C.} and {Van De Velde}, {C. J.H.} and R. Fodde and Liefers, {G. J.}",

year = "2012",

month = apr,

day = "24",

doi = "10.1038/bjc.2012.101",

language = "English",

volume = "106",

pages = "1564--1570",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Nature Publishing Group",

number = "9",

}

TY - JOUR

T1 - Use of Aspirin postdiagnosis improves survival for colon cancer patients

AU - Bastiaannet, E.

AU - Sampieri, K.

AU - Dekkers, O. M.

AU - De Craen, A. J.M.

AU - Van Herk-Sukel, M. P.P.

AU - Lemmens, V.

AU - Van Den Broek, C. B.M.

AU - Coebergh, J. W.

AU - Herings, R. M.C.

AU - Van De Velde, C. J.H.

AU - Fodde, R.

AU - Liefers, G. J.

PY - 2012/4/24

Y1 - 2012/4/24

N2 - Background: The preventive role of non-steroid anti-inflammatory drugs (NSAIDs) and aspirin, in particular, on colorectal cancer is well established. More recently, it has been suggested that aspirin may also have a therapeutic role. Aim of the present observational population-based study was to assess the therapeutic effect on overall survival of aspirin/NSAIDs as adjuvant treatment used after the diagnosis of colorectal cancer patients. Methods: Data concerning prescriptions were obtained from PHARMO record linkage systems and all patients diagnosed with colorectal cancer (1998-2007) were selected from the Eindhoven Cancer Registry (population-based cancer registry). Aspirin/NSAID use was classified as none, prediagnosis and postdiagnosis and only postdiagnosis. Patients were defined as non-user of aspirin/NSAIDs from the date of diagnosis of the colorectal cancer to the date of first use of aspirin or NSAIDs and user from first use to the end of follow-up. Poisson regression was performed with user status as time-varying exposure.Results:In total, 1176 (26%) patients were non-users, 2086 (47%) were prediagnosis and postdiagnosis users and 1219 (27%) were only postdiagnosis users (total n=4481). Compared with non-users, a survival gain was observed for aspirin users; the adjusted rate ratio (RR) was 0.77 (95% confidence interval (CI) 0.63-0.95; P=0.015). Stratified for colon and rectal, the survival gain was only present in colon cancer (adjusted RR 0.65 (95%CI 0.50-0.84; P=0.001)). For frequent users survival gain was larger (adjusted RR 0.61 (95%CI 0.46-0.81; P=0.001). In rectal cancer, aspirin use was not associated with survival (adjusted RR 1.10 (95%CI 0.79-1.54; P=0.6). The NSAIDs use was associated with decreased survival (adjusted RR 1.93 (95%CI 1.70-2.20; P<0.001). Conclusion: Aspirin use initiated or continued after diagnosis of colon cancer is associated with a lower risk of overall mortality. These findings strongly support initiation of a placebo-controlled trial that investigates the role of aspirin as adjuvant treatment in colon cancer patients.

AB - Background: The preventive role of non-steroid anti-inflammatory drugs (NSAIDs) and aspirin, in particular, on colorectal cancer is well established. More recently, it has been suggested that aspirin may also have a therapeutic role. Aim of the present observational population-based study was to assess the therapeutic effect on overall survival of aspirin/NSAIDs as adjuvant treatment used after the diagnosis of colorectal cancer patients. Methods: Data concerning prescriptions were obtained from PHARMO record linkage systems and all patients diagnosed with colorectal cancer (1998-2007) were selected from the Eindhoven Cancer Registry (population-based cancer registry). Aspirin/NSAID use was classified as none, prediagnosis and postdiagnosis and only postdiagnosis. Patients were defined as non-user of aspirin/NSAIDs from the date of diagnosis of the colorectal cancer to the date of first use of aspirin or NSAIDs and user from first use to the end of follow-up. Poisson regression was performed with user status as time-varying exposure.Results:In total, 1176 (26%) patients were non-users, 2086 (47%) were prediagnosis and postdiagnosis users and 1219 (27%) were only postdiagnosis users (total n=4481). Compared with non-users, a survival gain was observed for aspirin users; the adjusted rate ratio (RR) was 0.77 (95% confidence interval (CI) 0.63-0.95; P=0.015). Stratified for colon and rectal, the survival gain was only present in colon cancer (adjusted RR 0.65 (95%CI 0.50-0.84; P=0.001)). For frequent users survival gain was larger (adjusted RR 0.61 (95%CI 0.46-0.81; P=0.001). In rectal cancer, aspirin use was not associated with survival (adjusted RR 1.10 (95%CI 0.79-1.54; P=0.6). The NSAIDs use was associated with decreased survival (adjusted RR 1.93 (95%CI 1.70-2.20; P<0.001). Conclusion: Aspirin use initiated or continued after diagnosis of colon cancer is associated with a lower risk of overall mortality. These findings strongly support initiation of a placebo-controlled trial that investigates the role of aspirin as adjuvant treatment in colon cancer patients.

KW - aspirin

KW - Colorectal cancer

KW - NSAIDs

KW - population based

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=84860250352&partnerID=8YFLogxK

U2 - 10.1038/bjc.2012.101

DO - 10.1038/bjc.2012.101

M3 - Article

C2 - 22454078

AN - SCOPUS:84860250352

SN - 0007-0920

VL - 106

SP - 1564

EP - 1570

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 9

ER -

Use of Aspirin postdiagnosis improves survival for colon cancer patients

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this