Abstract
A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p < 0.001). In multivariable analyses, willingness to prescribe (600 mg) was higher among GPs ≥50 years (OR 1.46, 95% CI 1.03-2.07), more experienced GPs (OR 1.50, 95% CI 1.10-2.04), GPs who were aware of the cancer preventive effects of aspirin (OR 1.58, 95% CI 1.20-2.09), and those who reported seeing a Lynch Syndrome patient in practice (OR 1.44, 95% CI 1.01-2.05, p = 0.045). GPs report limited awareness of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, prescribing guidance and strategies to educate GPs should be developed.
Highlights
In the UK, colorectal cancer (CRC) affects over 41,000 people annually and more than 16,000 people die of the disease every year [1]
As 600 mg was the dose proven to reduce the risk of CRC associated with Lynch Syndrome in the CaPP2 trial [5], we investigated the general practitioner (GP) characteristics associated with willingness to prescribe at this level
There was a statistically significant decline in willingness to prescribe aspirin for Lynch Syndrome carriers across the three doses being tested, with only twothirds indicating they would prescribe at the 600 mg dose
Summary
In the UK, colorectal cancer (CRC) affects over 41,000 people annually and more than 16,000 people die of the disease every year [1]. There is ongoing interest in the use of aspirin to prevent cancer among carriers of Lynch Syndrome. The Colorectal Adenoma/Carcinoma Prevention Programme’s second trial (CaPP2) is the only randomised controlled trial to compare aspirin (600 mg) against placebo among Lynch Syndrome carriers (n = 861) [5]. To identify the optimal dose for Lynch Syndrome carriers, the CaPP3 trial was developed. CaPP3 is a non-inferiority trial comparing doses of 100 mg, 300 mg and 600 mg among 2000 Lynch Syndrome carriers in the UK. Participants will take their allocated dose for 2 years, at which point the study will become open-label at the same dose.
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