Abstract
BackgroundCancer patients have a highly increased risk of psychiatric disorders following diagnosis, compared with cancer-free individuals. Inflammation is involved in the development of both cancer and psychiatric disorders. The role of non-steroidal anti-inflammatory drugs (NSAIDs) in the subsequent risk of psychiatric disorders after cancer diagnosis is however unknown.MethodsWe performed a cohort study of all patients diagnosed with a first primary malignancy between July 2006 and December 2013 in Sweden. Cox proportional hazards models were used to assess the association of NSAID use during the year before cancer diagnosis with the risk of depression, anxiety, and stress-related disorders during the first year after cancer diagnosis.ResultsAmong 316,904 patients identified, 5613 patients received a diagnosis of depression, anxiety, or stress-related disorders during the year after cancer diagnosis. Compared with no use of NSAIDs, the use of aspirin alone was associated with a lower rate of depression, anxiety, and stress-related disorders (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.81 to 0.97), whereas the use of non-aspirin NSAIDs alone was associated with a higher rate (HR, 1.24; 95% CI, 1.15 to 1.32), after adjustment for sociodemographic factors, comorbidity, indications for NSAID use, and cancer characteristics. The association of aspirin with reduced rate of depression, anxiety, and stress-related disorders was strongest for current use (HR, 0.84; 95% CI, 0.75 to 0.93), low-dose use (HR, 0.88; 95% CI, 0.80 to 0.98), long-term use (HR, 0.84; 95% CI, 0.76 to 0.94), and among patients with cardiovascular disease (HR, 0.81; 95% CI, 0.68 to 0.95) or breast cancer (HR, 0.74; 95% CI, 0.56 to 0.98).ConclusionPre-diagnostic use of aspirin was associated with a decreased risk of depression, anxiety, and stress-related disorders during the first year following cancer diagnosis.
Highlights
Cancer patients have a highly increased risk of psychiatric disorders following diagnosis, compared with cancer-free individuals
As aspirin is the most frequently used non-steroidal anti-inflammatory drugs (NSAIDs), and our animal study suggested its protective role in cognitive wellbeing in a mouse model of breast cancer [28], we studied aspirin and categorized the use of aspirin according to recency of use, daily dose, and duration of use
Among the 316,904 patients included in the analysis, the median age at cancer diagnosis was 68 years and 53.4% were male. 58,761 (18.5%) of these patients used aspirin alone and 49,059 (15.4%) used non-aspirin NSAIDs alone during the year before cancer diagnosis (Fig. 1)
Summary
Cancer patients have a highly increased risk of psychiatric disorders following diagnosis, compared with cancer-free individuals. We reported a highly increased risk of common psychiatric disorders, including depression, anxiety, and stress-related disorders, namely posttraumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, among cancer patients, especially during the first year after cancer diagnosis [5]. Underlying reasons for such increased risk may include a severe stress response after receiving cancer diagnosis [6,7,8] and psychiatric symptoms caused by cancer treatment [9, 10], pain [11], and inflammation [12, 13]. The link between inflammation and psychiatric disorders has been less explored among patients with cancer, chronic inflammatory disorders have been reported to be risk factors for depression and anxiety among cancer patients [21]
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